|
STRESS TAB W/FE
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60634440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.90
|
| Rate for Payer: Oxford Commercial |
$0.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
STRESS TEST
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
74115009
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
STRESS TEST
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
94053035
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
STRESS TEST
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
94053035
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$592.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,300.00
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$291.50
|
|
|
STRESS TEST
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
36540004
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
STRESS TEST
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
74115009
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$592.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,300.00
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$291.50
|
|
|
STRESS TEST
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
74116009
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
STRESS TEST
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
74116009
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$592.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,300.00
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$291.50
|
|
|
STRESS TEST
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
74117009
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
STRESS TEST
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
74117009
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$592.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,300.00
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$291.50
|
|
|
STRESS TEST
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
36540004
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$592.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,300.00
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$291.50
|
|
|
STRESS TEST
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
5300058
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$592.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,300.00
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$291.50
|
|
|
STRESS TEST
|
Facility
|
OP
|
$3,249.40
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
36540019
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$78.31 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$592.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$974.82
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.11
|
|
|
STRESS TEST
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
5300058
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
STRESS TEST
|
Facility
|
IP
|
$3,249.40
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
36540019
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$487.41 |
| Max. Negotiated Rate |
$487.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.41
|
|
|
STRESS TEST WITH S & I
|
Facility
|
IP
|
$2,169.60
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
74117008
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$325.44 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.44
|
|
|
STRESS TEST WITH S & I
|
Facility
|
IP
|
$2,169.60
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
74115008
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$325.44 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.44
|
|
|
STRESS TEST WITH S & I
|
Facility
|
IP
|
$2,169.60
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
74116008
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$325.44 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.44
|
|
|
STRESS TEST WITH S & I
|
Facility
|
OP
|
$2,169.60
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
74115008
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$824.45
|
| Rate for Payer: Aetna Medicare Advantage |
$650.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$553.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$553.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$664.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$553.25
|
| Rate for Payer: Cigna Commercial |
$1,084.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$650.88
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.49
|
|
|
STRESS TEST WITH S & I
|
Facility
|
OP
|
$2,169.60
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
94053030
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$824.45
|
| Rate for Payer: Aetna Medicare Advantage |
$650.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$553.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$553.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$664.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$553.25
|
| Rate for Payer: Cigna Commercial |
$1,084.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$650.88
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.49
|
|
|
STRESS TEST WITH S & I
|
Facility
|
OP
|
$2,169.60
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
74117008
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$824.45
|
| Rate for Payer: Aetna Medicare Advantage |
$650.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$553.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$553.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$664.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$553.25
|
| Rate for Payer: Cigna Commercial |
$1,084.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$650.88
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.49
|
|
|
STRESS TEST WITH S & I
|
Facility
|
IP
|
$2,169.60
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
94053030
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$325.44 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.44
|
|
|
STRESS TEST WITH S & I
|
Facility
|
OP
|
$2,169.60
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
5300055
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$824.45
|
| Rate for Payer: Aetna Medicare Advantage |
$650.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$553.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$553.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$664.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$553.25
|
| Rate for Payer: Cigna Commercial |
$1,084.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$650.88
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.49
|
|
|
STRESS TEST WITH S & I
|
Facility
|
IP
|
$2,169.60
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
5300055
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$325.44 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.44
|
|
|
STRESS TEST WITH S & I
|
Facility
|
OP
|
$2,169.60
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
74116008
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$4,924.00 |
| Rate for Payer: Aetna Commercial |
$824.45
|
| Rate for Payer: Aetna Medicare Advantage |
$650.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$553.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$553.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$664.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$553.25
|
| Rate for Payer: Cigna Commercial |
$1,084.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$650.88
|
| Rate for Payer: Oxford Commercial |
$2,807.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$325.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,924.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.49
|
|
