|
XR UE RT INFANT MIN 2VW
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 73092RT
|
| Hospital Charge Code |
2002195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR UGI AIR CONT W BARIUM W SB
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
HCPCS 74249
|
| Hospital Charge Code |
2011125
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$586.72
|
| Rate for Payer: Aetna Medicare Advantage |
$463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$393.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$393.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$393.72
|
| Rate for Payer: Cigna Commercial |
$772.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$463.20
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$37.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.92
|
|
|
XR UGI AIR CONT W BARIUM W SB
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
HCPCS 74249
|
| Hospital Charge Code |
2011125
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$231.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.60
|
|
|
XR UNLISTED PROCEDURE
|
Facility
|
OP
|
$258.70
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
2011408
|
|
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) 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 UNLISTED PROCEDURE
|
Facility
|
IP
|
$258.70
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
2011408
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.80
|
|
|
XR UPPER GI
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
2011410
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.15 |
| Max. Negotiated Rate |
$78.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.15
|
|
|
XR UPPER GI
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
2011410
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.56 |
| 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 |
$92.70
|
| 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 |
$156.30
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.56
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$407.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.81
|
|
|
XR UPPER GI W/AIR CNTRST & KUB
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 74241
|
| Hospital Charge Code |
2011412
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$197.98
|
| Rate for Payer: Aetna Medicare Advantage |
$156.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.85
|
| Rate for Payer: Cigna Commercial |
$260.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.30
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.56
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$407.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.81
|
|
|
XR UPPER GI W/AIR CNTRST & KUB
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 74241
|
| Hospital Charge Code |
2011412
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.15 |
| Max. Negotiated Rate |
$78.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.15
|
|
|
XR UPPER GI W/ AIR CONTRAST
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
2011411
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.56 |
| 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 |
$99.65
|
| 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 |
$156.30
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.56
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.81
|
|
|
XR UPPER GI W/ AIR CONTRAST
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
2011411
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.15 |
| Max. Negotiated Rate |
$78.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.15
|
|
|
XR UPPER GI W SCOUT DBLE CONTR
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
404174246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR UPPER GI W SCOUT DBLE CONTR
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
404174246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.65 |
| 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 |
$99.65
|
| 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 UPPER XTRMTY INFANT BILTRAL
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 7309250
|
| Hospital Charge Code |
2011409
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.91 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,938.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| 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: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR UPPER XTRMTY INFANT BILTRAL
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 7309250
|
| Hospital Charge Code |
2011409
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR URETHROCYSTOGRAPHY
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74455
|
| Hospital Charge Code |
2000784
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$1,975.00 |
| 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 |
$54.21
|
| 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 |
$198.43
|
| 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 |
$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 |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR URETHROCYSTOGRAPHY
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74455
|
| Hospital Charge Code |
2000784
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR URETHROCYSTOGRAPHY RETROGR
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
2004919
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR URETHROCYSTOGRAPHY RETROGR
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
2004919
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$1,975.00 |
| 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 |
$54.21
|
| 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 |
$198.43
|
| 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 |
$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 |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.15
|
|
|
XR UROGRAPHY ANTEGRADE PYELO
|
Facility
|
OP
|
$906.25
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
2002335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$1,127.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,496.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,496.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$414.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,496.11
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: Cigna Medicare Advantage |
$290.13
|
| Rate for Payer: Clover Medicare Advantage |
$393.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.41
|
| Rate for Payer: Humana Medicare Advantage |
$426.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$414.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.88
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.02
|
|
|
XR UROGRAPHY ANTEGRADE PYELO
|
Facility
|
IP
|
$906.25
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
2002335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.94 |
| Max. Negotiated Rate |
$135.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.94
|
|
|
XR UROGRAPHY-ANTEGRAD RAD SUP
|
Facility
|
IP
|
$906.25
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
5600011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.94 |
| Max. Negotiated Rate |
$135.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.94
|
|
|
XR UROGRAPHY-ANTEGRAD RAD SUP
|
Facility
|
OP
|
$906.25
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
5600011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$1,127.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,496.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,496.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$414.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,496.11
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: Cigna Medicare Advantage |
$290.13
|
| Rate for Payer: Clover Medicare Advantage |
$393.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.41
|
| Rate for Payer: Humana Medicare Advantage |
$426.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$414.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.88
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.02
|
|
|
XR UROGRAPHY-ANTEGRAD RAD SUP
|
Facility
|
IP
|
$906.25
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
7411679
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.94 |
| Max. Negotiated Rate |
$135.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.94
|
|
|
XR UROGRAPHY-ANTEGRAD RAD SUP
|
Facility
|
OP
|
$906.25
|
|
|
Service Code
|
HCPCS 74425
|
| Hospital Charge Code |
7411679
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$1,127.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,496.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,496.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$414.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,496.11
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: Cigna Medicare Advantage |
$290.13
|
| Rate for Payer: Clover Medicare Advantage |
$393.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.41
|
| Rate for Payer: Humana Medicare Advantage |
$426.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$414.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.88
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.02
|
|