|
US PREGNANCY > 14 WEEKS
|
Facility
|
OP
|
$563.15
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
2301053
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$125.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$168.94
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$407.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.92
|
|
|
US PREGNANCY COMPLETE W/DETAIL
|
Facility
|
IP
|
$905.70
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
2301054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.85
|
|
|
US PREGNANCY COMPLETE W/DETAIL
|
Facility
|
OP
|
$905.70
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
2301054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,023.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$394.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,023.24
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.71
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.83
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$407.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.00
|
|
|
US PREGNT UTERUS LIMITED
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
94061504A
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.76 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.00
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$177.55
|
|
|
US PREGNT UTERUS LIMITED
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
94061504A
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
|
|
US PREGN UTERUS COMPL
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
2101114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
|
|
US PREGN UTERUS COMPL
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
2101114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$125.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.00
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$407.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$177.55
|
|
|
US PREGN UTERUS FOLLOW UP/REPE
|
Facility
|
OP
|
$542.45
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
2101118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.74
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$407.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.37
|
|
|
US PREGN UTERUS FOLLOW UP/REPE
|
Facility
|
IP
|
$542.45
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
2101118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.37 |
| Max. Negotiated Rate |
$81.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.37
|
|
|
US PRE OP WIRE LOCALIZATION BX
|
Facility
|
OP
|
$996.25
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
2100240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$7,082.74 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,082.74
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$298.88
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,311.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.01
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.40
|
|
|
US PRE OP WIRE LOCALIZATION BX
|
Facility
|
IP
|
$996.25
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
2100240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.44 |
| Max. Negotiated Rate |
$149.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.44
|
|
|
US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
2301055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$156.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.00
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$177.55
|
|
|
US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
2301055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
|
|
US PROSTATE VOLUME
|
Facility
|
IP
|
$563.15
|
|
|
Service Code
|
HCPCS 76873
|
| Hospital Charge Code |
2301056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.47 |
| Max. Negotiated Rate |
$84.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.47
|
|
|
US PROSTATE VOLUME
|
Facility
|
OP
|
$563.15
|
|
|
Service Code
|
HCPCS 76873
|
| Hospital Charge Code |
2301056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$168.94
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.92
|
|
|
US PROSTATIC SEED IMPLANT (OR)
|
Facility
|
OP
|
$752.50
|
|
|
Service Code
|
HCPCS 76965
|
| Hospital Charge Code |
2100352
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$285.95
|
| Rate for Payer: Aetna Medicare Advantage |
$225.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$332.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.89
|
| Rate for Payer: Cigna Commercial |
$376.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.75
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.94
|
|
|
US PROSTATIC SEED IMPLANT (OR)
|
Facility
|
IP
|
$752.50
|
|
|
Service Code
|
HCPCS 76965
|
| Hospital Charge Code |
2100352
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$112.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.88
|
|
|
US-PSEUDOANEURYSM INJ
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
2308001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,690.13
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.40
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.06
|
|
|
US-PSEUDOANEURYSM INJ
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
2308001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$136.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.20
|
|
|
US PUNC/ASP CYST BREAST
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
2100547
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
US PUNC/ASP CYST BREAST
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
2100547
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,036.77
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$124.33
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.98
|
|
|
US PUNC/ASP CYST BRST EA ADDL
|
Facility
|
OP
|
$9,757.55
|
|
|
Service Code
|
HCPCS 19001
|
| Hospital Charge Code |
2100545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$235.16 |
| Max. Negotiated Rate |
$4,878.77 |
| Rate for Payer: Aetna Commercial |
$3,707.87
|
| Rate for Payer: Aetna Medicare Advantage |
$2,927.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,488.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,488.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,488.18
|
| Rate for Payer: Cigna Commercial |
$4,878.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,927.26
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,463.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$235.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$258.58
|
|
|
US PUNC/ASP CYST BRST EA ADDL
|
Facility
|
IP
|
$9,757.55
|
|
|
Service Code
|
HCPCS 19001
|
| Hospital Charge Code |
2100545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,463.63 |
| Max. Negotiated Rate |
$1,463.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,463.63
|
|
|
US RENAL DIAGNOSTIC COMPL
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
2100113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$127.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.00
|
| Rate for Payer: Oxford Commercial |
$1,746.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,517.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.47
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$407.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$177.55
|
|
|
US RENAL DIAGNOSTIC COMPL
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
2100113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
|
