|
XR SINUS 2 VIEW
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
2002178
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR SINUS 2 VIEW
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
2002178
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.72 |
| 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 |
$38.72
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$216.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR SINUS >=3VIEWS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
2000388
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR SINUS >=3VIEWS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
2000388
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.24 |
| 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 |
$53.24
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$216.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR SKULL 2 VIEWS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
2002467
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR SKULL 2 VIEWS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
2002467
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.45 |
| 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 |
$36.45
|
| 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 SKULL 4 VIEWS
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
2000396
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR SKULL 4 VIEWS
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
2000396
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.24 |
| 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 |
$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 |
$1,530.00
|
| 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 |
$407.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR SKULL PORTABLE, LIMITED STU
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
2003002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.45 |
| 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 |
$36.45
|
| 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 SKULL PORTABLE, LIMITED STU
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
2003002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR SMALL BOWEL SERIES
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
2000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR SMALL BOWEL SERIES
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
2000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$752.19
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| 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 |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR SM BOWEL-ENTEROCLYSIS TUBE
|
Facility
|
IP
|
$1,631.25
|
|
|
Service Code
|
HCPCS 74251
|
| Hospital Charge Code |
2002392
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.69 |
| Max. Negotiated Rate |
$244.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.69
|
|
|
XR SM BOWEL-ENTEROCLYSIS TUBE
|
Facility
|
OP
|
$1,631.25
|
|
|
Service Code
|
HCPCS 74251
|
| Hospital Charge Code |
2002392
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$87.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$752.19
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$489.38
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$244.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.23
|
|
|
XR SPEECH THERAPY SWALLOW
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
2002756
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.60 |
| Max. Negotiated Rate |
$90.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.60
|
|
|
XR SPEECH THERAPY SWALLOW
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
2002756
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$566.79
|
| Rate for Payer: Aetna Medicare Advantage |
$675.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$208.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$78.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$752.19
|
| Rate for Payer: Cigna Commercial |
$417.70
|
| Rate for Payer: Cigna Medicare Advantage |
$145.87
|
| Rate for Payer: Clover Medicare Advantage |
$197.96
|
| Rate for Payer: EmblemHealth Commercial |
$625.14
|
| Rate for Payer: Humana Medicare Advantage |
$214.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$208.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.20
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.56
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.01
|
|
|
XR SPINE 1 VIEW
|
Facility
|
OP
|
$430.45
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
2002350
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.37 |
| 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 |
$23.60
|
| 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 |
$129.13
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$216.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.41
|
|
|
XR SPINE 1 VIEW
|
Facility
|
IP
|
$430.45
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
2002350
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.57 |
| Max. Negotiated Rate |
$64.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.57
|
|
|
XR SPINE 1 VIEW CERVICAL
|
Facility
|
OP
|
$258.70
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
2011385
|
|
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 |
$23.60
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$216.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.86
|
|
|
XR SPINE 1 VIEW CERVICAL
|
Facility
|
IP
|
$258.70
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
2011385
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.80
|
|
|
XR SPINE 1 VIEW LUMBAR
|
Facility
|
IP
|
$258.70
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
2011386
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.80
|
|
|
XR SPINE 1 VIEW LUMBAR
|
Facility
|
OP
|
$258.70
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
2011386
|
|
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 |
$23.60
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$216.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.86
|
|
|
XR SPINE 1 VIEW THORACIC
|
Facility
|
OP
|
$258.70
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
2011387
|
|
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 |
$23.60
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$216.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.86
|
|
|
XR SPINE 1 VIEW THORACIC
|
Facility
|
IP
|
$258.70
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
2011387
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.80
|
|
|
XR SPINE CRVCAL W/FLXT& OR/EXT
|
Facility
|
OP
|
$440.25
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
2011389
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.61 |
| 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 |
$61.10
|
| 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 |
$132.07
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.61
|
| 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 |
$11.67
|
|
