|
CT DRAINAGE TRAY
|
Facility
|
IP
|
$720.00
|
|
| Hospital Charge Code |
270669755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
CT DRAINAGE TRAY
|
Facility
|
OP
|
$650.00
|
|
| Hospital Charge Code |
270669755N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$195.00
|
| Rate for Payer: Aetna Medicare Advantage |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$165.75
|
| Rate for Payer: Cigna Commercial |
$325.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
|
|
CT DRAINAGE TRAY
|
Facility
|
OP
|
$720.00
|
|
| Hospital Charge Code |
270669755R
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Medicare Advantage |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$183.60
|
| Rate for Payer: Cigna Commercial |
$360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.60
|
| Rate for Payer: Oxford Commercial |
$360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$360.00
|
|
|
CT ELBOW W/ CONTAST LEFT
|
Facility
|
OP
|
$1,776.85
|
|
|
Service Code
|
HCPCS 73201LT
|
| Hospital Charge Code |
2205459
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$230.99 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$533.05
|
| Rate for Payer: Aetna Medicare Advantage |
$533.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$453.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$453.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$453.10
|
| Rate for Payer: Cigna Commercial |
$888.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.99
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
CT ELBOW W/ CONTAST LEFT
|
Facility
|
IP
|
$1,776.85
|
|
|
Service Code
|
HCPCS 73201LT
|
| Hospital Charge Code |
2205459
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$266.53 |
| Max. Negotiated Rate |
$266.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.53
|
|
|
CT ELBOW W/ CONTRAST BILATERAL
|
Facility
|
OP
|
$1,521.90
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
2205458
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$197.85 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$456.57
|
| Rate for Payer: Aetna Medicare Advantage |
$456.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$388.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$388.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$388.08
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$197.85
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$228.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
CT ELBOW W/ CONTRAST BILATERAL
|
Facility
|
IP
|
$1,521.90
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
2205458
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$228.28 |
| Max. Negotiated Rate |
$228.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$228.28
|
|
|
CT ELBOW W/ CONTRAST RIGHT
|
Facility
|
OP
|
$1,776.85
|
|
|
Service Code
|
HCPCS 73201RT
|
| Hospital Charge Code |
2205460
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$230.99 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$533.05
|
| Rate for Payer: Aetna Medicare Advantage |
$533.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$453.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$453.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$453.10
|
| Rate for Payer: Cigna Commercial |
$888.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.99
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
CT ELBOW W/ CONTRAST RIGHT
|
Facility
|
IP
|
$1,776.85
|
|
|
Service Code
|
HCPCS 73201RT
|
| Hospital Charge Code |
2205460
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$266.53 |
| Max. Negotiated Rate |
$266.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.53
|
|
|
CT ELBOW W/O CONTRAST LEFT
|
Facility
|
IP
|
$1,120.75
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
2205462
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$168.11 |
| Max. Negotiated Rate |
$168.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.11
|
|
|
CT ELBOW W/O CONTRAST LEFT
|
Facility
|
OP
|
$1,120.75
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
2205462
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$336.23
|
| Rate for Payer: Aetna Medicare Advantage |
$336.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.79
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.70
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
CT ELBOW W/O CONTRAST RIGHT
|
Facility
|
IP
|
$1,120.75
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
2205463
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$168.11 |
| Max. Negotiated Rate |
$168.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.11
|
|
|
CT ELBOW W/O CONTRAST RIGHT
|
Facility
|
OP
|
$1,120.75
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
2205463
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$336.23
|
| Rate for Payer: Aetna Medicare Advantage |
$336.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.79
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.70
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
CT ELBOW W/O CONTRST BILATERAL
|
Facility
|
IP
|
$1,120.75
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
2205461
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$168.11 |
| Max. Negotiated Rate |
$168.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.11
|
|
|
CT ELBOW W/O CONTRST BILATERAL
|
Facility
|
OP
|
$1,120.75
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
2205461
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$336.23
|
| Rate for Payer: Aetna Medicare Advantage |
$336.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$233.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.79
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.70
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
CT ELBOW W&W/O CNTRST BILATERL
|
Facility
|
IP
|
$4,260.90
|
|
|
Service Code
|
HCPCS 7320250
|
| Hospital Charge Code |
2205455
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$639.13 |
| Max. Negotiated Rate |
$639.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$639.13
|
|
|
CT ELBOW W&W/O CNTRST BILATERL
|
Facility
|
OP
|
$4,260.90
|
|
|
Service Code
|
HCPCS 7320250
|
| Hospital Charge Code |
2205455
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$553.92 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$1,278.27
|
| Rate for Payer: Aetna Medicare Advantage |
$1,278.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,086.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,086.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,086.53
|
| Rate for Payer: Cigna Commercial |
$2,130.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$553.92
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$639.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
CT ELBOW W&W/O CONTRAST LEFT
|
Facility
|
IP
|
$2,130.45
|
|
|
Service Code
|
HCPCS 73202LT
|
| Hospital Charge Code |
2205456
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$319.57 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.57
|
|
|
CT ELBOW W&W/O CONTRAST LEFT
|
Facility
|
OP
|
$2,130.45
|
|
|
Service Code
|
HCPCS 73202LT
|
| Hospital Charge Code |
2205456
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$276.96 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$639.13
|
| Rate for Payer: Aetna Medicare Advantage |
$639.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$543.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$543.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$543.26
|
| Rate for Payer: Cigna Commercial |
$1,065.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$276.96
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
CT ELBOW W&W/O CONTRAST RIGHT
|
Facility
|
IP
|
$2,130.45
|
|
|
Service Code
|
HCPCS 73202RT
|
| Hospital Charge Code |
2205457
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$319.57 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.57
|
|
|
CT ELBOW W&W/O CONTRAST RIGHT
|
Facility
|
OP
|
$2,130.45
|
|
|
Service Code
|
HCPCS 73202RT
|
| Hospital Charge Code |
2205457
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$276.96 |
| Max. Negotiated Rate |
$2,773.00 |
| Rate for Payer: Aetna Commercial |
$639.13
|
| Rate for Payer: Aetna Medicare Advantage |
$639.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$543.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$543.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$543.26
|
| Rate for Payer: Cigna Commercial |
$1,065.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$276.96
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,773.00
|
|
|
C-TELOPEPTIDE, SERUM
|
Facility
|
OP
|
$92.85
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
3038129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$60.52
|
| Rate for Payer: Aetna Medicare Advantage |
$18.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.44
|
| Rate for Payer: Cigna Commercial |
$18.68
|
| Rate for Payer: Cigna Medicare Advantage |
$9.34
|
| Rate for Payer: Clover Medicare Advantage |
$17.75
|
| Rate for Payer: EmblemHealth Commercial |
$56.04
|
| Rate for Payer: Humana Medicare Advantage |
$19.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.07
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.68
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$19.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.68
|
|
|
C-TELOPEPTIDE, SERUM
|
Facility
|
IP
|
$92.85
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
3038129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$13.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.93
|
|
|
CT ENDOCRINE SURGERY PROCEDURE
|
Facility
|
OP
|
$21,205.25
|
|
|
Service Code
|
HCPCS 60699
|
| Hospital Charge Code |
2205492
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$14,396.79 |
| Rate for Payer: Aetna Commercial |
$6,361.57
|
| Rate for Payer: Aetna Medicare Advantage |
$6,361.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,407.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,407.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,407.34
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,756.68
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,180.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,851.00
|
|
|
CT ENDOCRINE SURGERY PROCEDURE
|
Facility
|
IP
|
$21,205.25
|
|
|
Service Code
|
HCPCS 60699
|
| Hospital Charge Code |
2205492
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,180.79 |
| Max. Negotiated Rate |
$3,180.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,180.79
|
|