|
IR-BIOPSY KIDNEY-LT
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 50200LT
|
| Hospital Charge Code |
321050200L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY KIDNEY-LT
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 50200LT
|
| Hospital Charge Code |
2101202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY KIDNEY-LT
|
Facility
|
IP
|
$7,071.40
|
|
|
Service Code
|
HCPCS 50200LT
|
| Hospital Charge Code |
7412040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,060.71 |
| Max. Negotiated Rate |
$1,060.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,060.71
|
|
|
IR-BIOPSY KIDNEY-LT
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
HCPCS 50200LT
|
| Hospital Charge Code |
7411956
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.14 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$443.40
|
| Rate for Payer: Aetna Medicare Advantage |
$443.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.89
|
| 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 |
$376.89
|
| Rate for Payer: Cigna Commercial |
$739.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$192.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.70
|
|
|
IR-BIOPSY KIDNEY-LT
|
Facility
|
OP
|
$7,071.40
|
|
|
Service Code
|
HCPCS 50200LT
|
| Hospital Charge Code |
7412040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$919.28 |
| Max. Negotiated Rate |
$3,535.70 |
| Rate for Payer: Aetna Commercial |
$2,121.42
|
| Rate for Payer: Aetna Medicare Advantage |
$2,121.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,803.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,803.21
|
| 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 |
$1,803.21
|
| Rate for Payer: Cigna Commercial |
$3,535.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$919.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,060.71
|
|
|
IR-BIOPSY KIDNEY-RT
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
HCPCS 50200RT
|
| Hospital Charge Code |
7411957
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.70 |
| Max. Negotiated Rate |
$221.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.70
|
|
|
IR-BIOPSY KIDNEY-RT
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 50200RT
|
| Hospital Charge Code |
2691545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,047.12 |
| Max. Negotiated Rate |
$4,027.40 |
| Rate for Payer: Aetna Commercial |
$2,416.44
|
| Rate for Payer: Aetna Medicare Advantage |
$2,416.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,053.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,053.97
|
| 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 |
$2,053.97
|
| Rate for Payer: Cigna Commercial |
$4,027.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,047.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY KIDNEY-RT
|
Facility
|
OP
|
$7,071.40
|
|
|
Service Code
|
HCPCS 50200RT
|
| Hospital Charge Code |
7412041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$919.28 |
| Max. Negotiated Rate |
$3,535.70 |
| Rate for Payer: Aetna Commercial |
$2,121.42
|
| Rate for Payer: Aetna Medicare Advantage |
$2,121.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,803.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,803.21
|
| 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 |
$1,803.21
|
| Rate for Payer: Cigna Commercial |
$3,535.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$919.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,060.71
|
|
|
IR-BIOPSY KIDNEY-RT
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 50200RT
|
| Hospital Charge Code |
2101203
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY KIDNEY-RT
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 50200RT
|
| Hospital Charge Code |
2691545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY KIDNEY-RT
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 50200RT
|
| Hospital Charge Code |
2101203
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,047.12 |
| Max. Negotiated Rate |
$4,027.40 |
| Rate for Payer: Aetna Commercial |
$2,416.44
|
| Rate for Payer: Aetna Medicare Advantage |
$2,416.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,053.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,053.97
|
| 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 |
$2,053.97
|
| Rate for Payer: Cigna Commercial |
$4,027.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,047.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY KIDNEY-RT
|
Facility
|
IP
|
$7,071.40
|
|
|
Service Code
|
HCPCS 50200RT
|
| Hospital Charge Code |
7412041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,060.71 |
| Max. Negotiated Rate |
$1,060.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,060.71
|
|
|
IR-BIOPSY KIDNEY-RT
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 50200RT
|
| Hospital Charge Code |
321050200R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY KIDNEY-RT
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 50200RT
|
| Hospital Charge Code |
321050200R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,047.12 |
| Max. Negotiated Rate |
$4,027.40 |
| Rate for Payer: Aetna Commercial |
$2,416.44
|
| Rate for Payer: Aetna Medicare Advantage |
$2,416.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,053.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,053.97
|
| 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 |
$2,053.97
|
| Rate for Payer: Cigna Commercial |
$4,027.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,047.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY KIDNEY-RT
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
HCPCS 50200RT
|
| Hospital Charge Code |
7411957
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.14 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$443.40
|
| Rate for Payer: Aetna Medicare Advantage |
$443.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.89
|
| 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 |
$376.89
|
| Rate for Payer: Cigna Commercial |
$739.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$192.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.70
|
|
|
IR-BIOPSY LUNG
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
2680125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY LUNG
|
Facility
|
OP
|
$4,709.90
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
7411377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$612.29 |
| Max. Negotiated Rate |
$2,354.95 |
| Rate for Payer: Aetna Commercial |
$1,412.97
|
| Rate for Payer: Aetna Medicare Advantage |
$1,412.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,201.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,201.02
|
| 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 |
$1,201.02
|
| Rate for Payer: Cigna Commercial |
$2,354.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$612.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$706.49
|
|
|
IR-BIOPSY LUNG
|
Facility
|
IP
|
$4,709.90
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
7411377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$706.49 |
| Max. Negotiated Rate |
$706.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$706.49
|
|
|
IR-BIOPSY LUNG
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
321032405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,047.12 |
| Max. Negotiated Rate |
$4,027.40 |
| Rate for Payer: Aetna Commercial |
$2,416.44
|
| Rate for Payer: Aetna Medicare Advantage |
$2,416.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,053.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,053.97
|
| 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 |
$2,053.97
|
| Rate for Payer: Cigna Commercial |
$4,027.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,047.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY LUNG
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
2680125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,047.12 |
| Max. Negotiated Rate |
$4,027.40 |
| Rate for Payer: Aetna Commercial |
$2,416.44
|
| Rate for Payer: Aetna Medicare Advantage |
$2,416.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,053.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,053.97
|
| 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 |
$2,053.97
|
| Rate for Payer: Cigna Commercial |
$4,027.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,047.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY LUNG
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
321032405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY LUNG-BI
|
Facility
|
IP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 3240550
|
| Hospital Charge Code |
2690370
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,208.22 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY LUNG-BI
|
Facility
|
OP
|
$8,054.80
|
|
|
Service Code
|
HCPCS 3240550
|
| Hospital Charge Code |
2690370
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,047.12 |
| Max. Negotiated Rate |
$4,027.40 |
| Rate for Payer: Aetna Commercial |
$2,416.44
|
| Rate for Payer: Aetna Medicare Advantage |
$2,416.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,053.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,053.97
|
| 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 |
$2,053.97
|
| Rate for Payer: Cigna Commercial |
$4,027.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,047.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,208.22
|
|
|
IR-BIOPSY LUNG-BI
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
HCPCS 3240550
|
| Hospital Charge Code |
7411781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.14 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$443.40
|
| Rate for Payer: Aetna Medicare Advantage |
$443.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.89
|
| 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 |
$376.89
|
| Rate for Payer: Cigna Commercial |
$739.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$192.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.70
|
|
|
IR-BIOPSY LUNG-BI
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
HCPCS 3240550
|
| Hospital Charge Code |
7411781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.70 |
| Max. Negotiated Rate |
$221.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.70
|
|