|
NEEDLELOC MAMMO GUIDE ADD LES
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 19282LT
|
| Hospital Charge Code |
94064011L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.33
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| 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 |
$105.68
|
| Rate for Payer: Cigna Commercial |
$207.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19287RT
|
| Hospital Charge Code |
94064021R
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19287LT
|
| Hospital Charge Code |
94064021L
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 1928750
|
| Hospital Charge Code |
94064021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,755.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$4,050.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,755.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,989.00
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19287RT
|
| Hospital Charge Code |
94064021R
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,755.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$4,050.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,755.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,989.00
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19287LT
|
| Hospital Charge Code |
94064021L
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,755.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$4,050.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,755.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,989.00
|
|
|
NEEDLE LOC MRI GUIDE 1STLESION
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 1928750
|
| Hospital Charge Code |
94064021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
IP
|
$983.40
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023L
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.51
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
OP
|
$983.40
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023R
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$57.57 |
| Max. Negotiated Rate |
$3,989.00 |
| Rate for Payer: Aetna Commercial |
$295.02
|
| Rate for Payer: Aetna Medicare Advantage |
$295.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$250.77
|
| Rate for Payer: Cigna Commercial |
$57.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.84
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,989.00
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$57.57 |
| Max. Negotiated Rate |
$4,050.00 |
| Rate for Payer: Aetna Commercial |
$4,050.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$57.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,755.00
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,989.00
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
OP
|
$983.40
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023L
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$57.57 |
| Max. Negotiated Rate |
$3,989.00 |
| Rate for Payer: Aetna Commercial |
$295.02
|
| Rate for Payer: Aetna Medicare Advantage |
$295.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$250.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$250.77
|
| Rate for Payer: Cigna Commercial |
$57.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.84
|
| Rate for Payer: Oxford Commercial |
$3,513.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,989.00
|
|
|
NEEDLE LOC MRI GUIDE ADDLESION
|
Facility
|
IP
|
$983.40
|
|
|
Service Code
|
HCPCS 19288
|
| Hospital Charge Code |
94064023R
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.51
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
IP
|
$1,597.20
|
|
|
Service Code
|
HCPCS 19283RT
|
| Hospital Charge Code |
94064013R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.58 |
| Max. Negotiated Rate |
$239.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.58
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
OP
|
$1,597.20
|
|
|
Service Code
|
HCPCS 19283LT
|
| Hospital Charge Code |
94064013L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.64 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$479.16
|
| Rate for Payer: Aetna Medicare Advantage |
$479.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$407.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$407.29
|
| 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 |
$407.29
|
| Rate for Payer: Cigna Commercial |
$798.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.58
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
IP
|
$3,194.40
|
|
|
Service Code
|
HCPCS 1928350
|
| Hospital Charge Code |
94064013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$479.16 |
| Max. Negotiated Rate |
$479.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$479.16
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
OP
|
$3,194.40
|
|
|
Service Code
|
HCPCS 1928350
|
| Hospital Charge Code |
94064013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$415.27 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$958.32
|
| Rate for Payer: Aetna Medicare Advantage |
$958.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$814.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$814.57
|
| 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 |
$814.57
|
| Rate for Payer: Cigna Commercial |
$1,597.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$415.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$479.16
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
IP
|
$1,597.20
|
|
|
Service Code
|
HCPCS 19283LT
|
| Hospital Charge Code |
94064013L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.58 |
| Max. Negotiated Rate |
$239.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.58
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
OP
|
$1,597.20
|
|
|
Service Code
|
HCPCS 19283RT
|
| Hospital Charge Code |
94064013R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.64 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$479.16
|
| Rate for Payer: Aetna Medicare Advantage |
$479.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$407.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$407.29
|
| 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 |
$407.29
|
| Rate for Payer: Cigna Commercial |
$798.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.58
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
IP
|
$1,597.20
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
87502811
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.58 |
| Max. Negotiated Rate |
$239.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.58
|
|
|
NEEDLE LOC STEREO GUIDE 1ST LE
|
Facility
|
OP
|
$1,597.20
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
87502811
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.64 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$479.16
|
| Rate for Payer: Aetna Medicare Advantage |
$479.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$407.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$407.29
|
| 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 |
$407.29
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.64
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$239.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
NEEDLE LOC STEREO GUIDE ADD LE
|
Facility
|
IP
|
$1,184.85
|
|
|
Service Code
|
HCPCS 19284
|
| Hospital Charge Code |
94064015R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.73 |
| Max. Negotiated Rate |
$177.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.73
|
|
|
NEEDLE LOC STEREO GUIDE ADD LE
|
Facility
|
OP
|
$2,369.70
|
|
|
Service Code
|
HCPCS 19284
|
| Hospital Charge Code |
94064015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.69 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$710.91
|
| Rate for Payer: Aetna Medicare Advantage |
$710.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$604.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$604.27
|
| 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 |
$604.27
|
| Rate for Payer: Cigna Commercial |
$45.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$308.06
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$355.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
NEEDLE LOC STEREO GUIDE ADD LE
|
Facility
|
IP
|
$1,184.85
|
|
|
Service Code
|
HCPCS 19284
|
| Hospital Charge Code |
87502812
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.73 |
| Max. Negotiated Rate |
$177.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.73
|
|
|
NEEDLE LOC STEREO GUIDE ADD LE
|
Facility
|
OP
|
$1,184.85
|
|
|
Service Code
|
HCPCS 19284LT
|
| Hospital Charge Code |
94064015L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.03 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$355.45
|
| Rate for Payer: Aetna Medicare Advantage |
$355.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$302.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$302.14
|
| 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 |
$302.14
|
| Rate for Payer: Cigna Commercial |
$592.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$154.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.73
|
|
