|
XR REP OF PREV CATH UN FLUORO
|
Facility
|
OP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
5100580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.34 |
| Max. Negotiated Rate |
$6,750.64 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,750.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,750.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| 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 |
$6,750.64
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,921.26
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$154.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$169.71
|
|
|
XR REPOS GI FEED TUBE DUODENUM
|
Facility
|
OP
|
$3,929.65
|
|
|
Service Code
|
HCPCS 43761
|
| Hospital Charge Code |
2004893
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.70 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$807.38
|
| Rate for Payer: Aetna Medicare Advantage |
$961.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,071.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$296.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,071.47
|
| Rate for Payer: Cigna Commercial |
$594.98
|
| Rate for Payer: Cigna Medicare Advantage |
$296.83
|
| Rate for Payer: Clover Medicare Advantage |
$281.99
|
| Rate for Payer: EmblemHealth Commercial |
$890.49
|
| Rate for Payer: Humana Medicare Advantage |
$305.73
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$296.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,178.89
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$94.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$104.14
|
|
|
XR REPOS GI FEED TUBE DUODENUM
|
Facility
|
IP
|
$3,929.65
|
|
|
Service Code
|
HCPCS 43761
|
| Hospital Charge Code |
2004893
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$589.45 |
| Max. Negotiated Rate |
$589.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$589.45
|
|
|
XR REPOSITION VENOUS CATHETER
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
2011255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
XR REPOSITION VENOUS CATHETER
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 36597
|
| Hospital Charge Code |
2011255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.60 |
| Max. Negotiated Rate |
$6,750.64 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,750.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,750.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| 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 |
$6,750.64
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,800.00
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$144.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$159.00
|
|
|
XR REP VENOUS BLOCK OPEN VENUS
|
Facility
|
IP
|
$7,917.57
|
|
|
Service Code
|
HCPCS 35460
|
| Hospital Charge Code |
5100607
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,187.64 |
| Max. Negotiated Rate |
$1,187.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.64
|
|
|
XR REP VENOUS BLOCK OPEN VENUS
|
Facility
|
OP
|
$7,917.57
|
|
|
Service Code
|
HCPCS 35460
|
| Hospital Charge Code |
5100607
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$190.81 |
| Max. Negotiated Rate |
$3,958.78 |
| Rate for Payer: Aetna Commercial |
$3,008.68
|
| Rate for Payer: Aetna Medicare Advantage |
$2,375.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,018.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,018.98
|
| 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 |
$2,018.98
|
| Rate for Payer: Cigna Commercial |
$3,958.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,375.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$190.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$209.82
|
|
|
XR RIBS 2 VIEWS LEFT
|
Facility
|
IP
|
$258.70
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
2011376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.80
|
|
|
XR RIBS 2 VIEWS LEFT
|
Facility
|
OP
|
$258.70
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
2011376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$281.22
|
| Rate for Payer: Aetna Medicare Advantage |
$334.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$103.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$373.21
|
| Rate for Payer: Cigna Commercial |
$207.24
|
| Rate for Payer: Cigna Medicare Advantage |
$72.37
|
| Rate for Payer: Clover Medicare Advantage |
$98.22
|
| Rate for Payer: EmblemHealth Commercial |
$310.17
|
| Rate for Payer: Humana Medicare Advantage |
$106.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$103.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.61
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.86
|
|
|
XR RIBS 2 VIEWS RIGHT
|
Facility
|
OP
|
$258.70
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
2011377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$281.22
|
| Rate for Payer: Aetna Medicare Advantage |
$334.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$103.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$373.21
|
| Rate for Payer: Cigna Commercial |
$207.24
|
| Rate for Payer: Cigna Medicare Advantage |
$72.37
|
| Rate for Payer: Clover Medicare Advantage |
$98.22
|
| Rate for Payer: EmblemHealth Commercial |
$310.17
|
| Rate for Payer: Humana Medicare Advantage |
$106.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$103.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.61
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.86
|
|
|
XR RIBS 2 VIEWS RIGHT
|
Facility
|
IP
|
$258.70
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
2011377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.80
|
|
|
XR RIBS BI
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 71110
|
| Hospital Charge Code |
2000578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.72 |
| Max. Negotiated Rate |
$1,975.00 |
| 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 |
$38.72
|
| 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 |
$86.94
|
| 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 |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR RIBS BI
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 71110
|
| Hospital Charge Code |
2000578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR RIBS BI INCL AP
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
2011100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.76 |
| Max. Negotiated Rate |
$1,975.00 |
| 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 |
$86.94
|
| 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 |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR RIBS BI INCL AP
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
2011100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR RIBS LEFT & PA CHEST
|
Facility
|
IP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
2011142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$990.18 |
| Max. Negotiated Rate |
$990.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
|
|
XR RIBS LEFT & PA CHEST
|
Facility
|
OP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
2011142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$1,980.36 |
| 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 |
$53.24
|
| 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 |
$86.94
|
| 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 |
$1,980.36
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$159.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$174.93
|
|
|
XR RIBS RIGHT & PA CHEST
|
Facility
|
IP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
2011145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$990.18 |
| Max. Negotiated Rate |
$990.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
|
|
XR RIBS RIGHT & PA CHEST
|
Facility
|
OP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
2011145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$1,980.36 |
| 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 |
$53.24
|
| 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 |
$86.94
|
| 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 |
$1,980.36
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$159.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$174.93
|
|
|
XR RIBS UNI
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
2000560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$281.22
|
| Rate for Payer: Aetna Medicare Advantage |
$334.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$373.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$103.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$373.21
|
| Rate for Payer: Cigna Commercial |
$207.24
|
| Rate for Payer: Cigna Medicare Advantage |
$72.37
|
| Rate for Payer: Clover Medicare Advantage |
$98.22
|
| Rate for Payer: EmblemHealth Commercial |
$310.17
|
| Rate for Payer: Humana Medicare Advantage |
$106.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$103.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR RIBS UNI
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
2000560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR SACROILIAC JOINTS 1-2 VIEWS
|
Facility
|
IP
|
$258.70
|
|
|
Service Code
|
HCPCS 72200
|
| Hospital Charge Code |
2011378
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.80
|
|
|
XR SACROILIAC JOINTS 1-2 VIEWS
|
Facility
|
OP
|
$258.70
|
|
|
Service Code
|
HCPCS 72200
|
| Hospital Charge Code |
2011378
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$1,975.00 |
| 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 |
$38.72
|
| 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 |
$86.94
|
| 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 |
$77.61
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.23
|
| 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 |
$6.86
|
|
|
XR SACROILLIAC JOINTS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
2000990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.72 |
| Max. Negotiated Rate |
$1,975.00 |
| 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 |
$38.72
|
| 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 |
$86.94
|
| 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 |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| 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 |
$316.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR SACROILLIAC JOINTS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
2000990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
