|
INTERP CERV MYELOGRAM
|
Facility
|
OP
|
$2,963.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
84506070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$1,866.82 |
| Rate for Payer: Aetna Commercial |
$888.90
|
| Rate for Payer: Aetna Medicare Advantage |
$888.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.57
|
| Rate for Payer: Cigna Commercial |
$1,866.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$385.19
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
INTERP LUMBAR MYELOGRAM
|
Facility
|
IP
|
$2,963.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
84506080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.45 |
| Max. Negotiated Rate |
$444.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.45
|
|
|
INTERP LUMBAR MYELOGRAM
|
Facility
|
OP
|
$2,963.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
84506080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$1,866.82 |
| Rate for Payer: Aetna Commercial |
$888.90
|
| Rate for Payer: Aetna Medicare Advantage |
$888.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.57
|
| Rate for Payer: Cigna Commercial |
$1,866.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$385.19
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
INTERP PSYCH RESULTS MD FAM AS
|
Facility
|
IP
|
$401.70
|
|
|
Service Code
|
HCPCS 90877
|
| Hospital Charge Code |
94810240
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$60.26 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.26
|
|
|
INTERP PSYCH RESULTS MD FAM AS
|
Facility
|
OP
|
$401.70
|
|
|
Service Code
|
HCPCS 90877
|
| Hospital Charge Code |
94810240
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$1,994.00 |
| Rate for Payer: Aetna Commercial |
$120.51
|
| Rate for Payer: Aetna Medicare Advantage |
$120.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.43
|
| Rate for Payer: Cigna Commercial |
$200.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.22
|
| Rate for Payer: Oxford Commercial |
$1,757.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,994.00
|
|
|
INTERPRETATION AND REPORT
|
Facility
|
IP
|
$1,181.00
|
|
|
Service Code
|
HCPCS 83912
|
| Hospital Charge Code |
300935C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$177.15 |
| Max. Negotiated Rate |
$177.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.15
|
|
|
INTERPRETATION AND REPORT
|
Facility
|
OP
|
$1,181.00
|
|
|
Service Code
|
HCPCS 83912
|
| Hospital Charge Code |
300935C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$590.50 |
| Rate for Payer: Aetna Commercial |
$354.30
|
| Rate for Payer: Aetna Medicare Advantage |
$354.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$301.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$301.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$301.15
|
| Rate for Payer: Cigna Commercial |
$590.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.53
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
INTERPRETATION AND REPORT
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
3009069F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
|
|
INTERPRETATION AND REPORT
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
3009345C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
|
|
INTERPRETATION AND REPORT
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
3009345C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.30
|
| Rate for Payer: Cigna Commercial |
$55.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.43
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
INTERPRETATION AND REPORT
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
3009069F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.30
|
| Rate for Payer: Cigna Commercial |
$55.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.43
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
INTERPRETATION OF OUTSIDE SLID
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
38474079
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.45 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$204.00
|
| Rate for Payer: Aetna Medicare Advantage |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$173.40
|
| Rate for Payer: Cigna Commercial |
$88.94
|
| Rate for Payer: Cigna Medicare Advantage |
$36.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
INTERPRETATION OF OUTSIDE SLID
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
38474079
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
|
|
INTERPSTIN ARTHROPL IC/ICM JNT
|
Facility
|
IP
|
$16,063.45
|
|
|
Service Code
|
HCPCS 25447
|
| Hospital Charge Code |
16000395
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,409.52 |
| Max. Negotiated Rate |
$2,409.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,409.52
|
|
|
INTERPSTIN ARTHROPL IC/ICM JNT
|
Facility
|
OP
|
$16,063.45
|
|
|
Service Code
|
HCPCS 25447
|
| Hospital Charge Code |
16000395
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$8,580.00 |
| Rate for Payer: Aetna Commercial |
$4,819.03
|
| Rate for Payer: Aetna Medicare Advantage |
$4,819.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,096.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,096.18
|
| 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 |
$4,096.18
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,088.25
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,409.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,580.00
|
|
|
INTERP THORACIC MYELOGRAM
|
Facility
|
OP
|
$2,963.00
|
|
|
Service Code
|
HCPCS 72255
|
| Hospital Charge Code |
84506075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$1,866.82 |
| Rate for Payer: Aetna Better Health Medicaid |
$1,595.10
|
| Rate for Payer: Aetna Commercial |
$888.90
|
| Rate for Payer: Aetna Medicare Advantage |
$888.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$755.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$755.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$755.57
|
| Rate for Payer: Cigna Commercial |
$1,866.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$385.19
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,627.00
|
|
|
INTERP THORACIC MYELOGRAM
|
Facility
|
IP
|
$2,963.00
|
|
|
Service Code
|
HCPCS 72255
|
| Hospital Charge Code |
84506075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.45 |
| Max. Negotiated Rate |
$444.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.45
|
|
|
INTERPULSE HANDPIECE W/HI FLOW
|
Facility
|
OP
|
$197.98
|
|
| Hospital Charge Code |
270668406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$98.99 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Aetna Medicare Advantage |
$59.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.48
|
| Rate for Payer: Cigna Commercial |
$98.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.74
|
| Rate for Payer: Oxford Commercial |
$98.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.99
|
|
|
INTERPULSE HANDPIECE W/HI FLOW
|
Facility
|
IP
|
$197.98
|
|
| Hospital Charge Code |
270668406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
IP
|
$301.65
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
94053090
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$45.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.25
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
IP
|
$301.65
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
5300165
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$45.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.25
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
OP
|
$301.65
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
5300165
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$1,793.00 |
| Rate for Payer: Aetna Commercial |
$90.50
|
| Rate for Payer: Aetna Medicare Advantage |
$90.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.92
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.21
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,793.00
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
IP
|
$214.68
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
74117022
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.20
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
OP
|
$214.68
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
74116022
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$1,793.00 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare Advantage |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.74
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.91
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,793.00
|
|
|
INTERROG DEVICE EVAL PER VISIT
|
Facility
|
OP
|
$301.65
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
94053090
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$1,793.00 |
| Rate for Payer: Aetna Commercial |
$90.50
|
| Rate for Payer: Aetna Medicare Advantage |
$90.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.92
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.21
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,793.00
|
|
