|
NEEDLE LOC STEREO GUIDE ADD LE
|
Facility
|
OP
|
$1,184.85
|
|
|
Service Code
|
HCPCS 19284
|
| Hospital Charge Code |
94064015R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.69 |
| 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 |
$45.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$154.03
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.73
|
| 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
|
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 US GD ADD LES BIL
|
Facility
|
OP
|
$4,642.30
|
|
|
Service Code
|
HCPCS 1928650
|
| Hospital Charge Code |
94064019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$603.50 |
| Max. Negotiated Rate |
$2,321.15 |
| Rate for Payer: Aetna Commercial |
$1,392.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,392.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,183.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,183.79
|
| 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 |
$1,183.79
|
| Rate for Payer: Cigna Commercial |
$2,321.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$603.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$696.35
|
|
|
NEEDLE LOC US GD ADD LES BIL
|
Facility
|
IP
|
$4,642.30
|
|
|
Service Code
|
HCPCS 1928650
|
| Hospital Charge Code |
94064019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$696.35 |
| Max. Negotiated Rate |
$696.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$696.35
|
|
|
NEEDLE LOC US GUIDE 1ST LES BI
|
Facility
|
IP
|
$5,497.10
|
|
|
Service Code
|
HCPCS 1928550
|
| Hospital Charge Code |
94064017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$824.57 |
| Max. Negotiated Rate |
$824.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$824.57
|
|
|
NEEDLE LOC US GUIDE 1ST LES BI
|
Facility
|
OP
|
$5,497.10
|
|
|
Service Code
|
HCPCS 1928550
|
| Hospital Charge Code |
94064017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$714.62 |
| Max. Negotiated Rate |
$2,748.55 |
| Rate for Payer: Aetna Commercial |
$1,649.13
|
| Rate for Payer: Aetna Medicare Advantage |
$1,649.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,401.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,401.76
|
| 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 |
$1,401.76
|
| Rate for Payer: Cigna Commercial |
$2,748.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$714.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$824.57
|
|
|
NEEDLE LOC US GUIDE 1ST LESION
|
Facility
|
OP
|
$2,748.55
|
|
|
Service Code
|
HCPCS 19285RT
|
| Hospital Charge Code |
94064017R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.31 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$824.57
|
| Rate for Payer: Aetna Medicare Advantage |
$824.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$700.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$700.88
|
| 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 |
$700.88
|
| Rate for Payer: Cigna Commercial |
$1,374.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$357.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.28
|
|
|
NEEDLE LOC US GUIDE 1ST LESION
|
Facility
|
OP
|
$2,748.55
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
87502813
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.31 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$824.57
|
| Rate for Payer: Aetna Medicare Advantage |
$824.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$700.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$700.88
|
| 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 |
$700.88
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$357.31
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
NEEDLE LOC US GUIDE 1ST LESION
|
Facility
|
IP
|
$2,748.55
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
87502813
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$412.28 |
| Max. Negotiated Rate |
$412.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.28
|
|
|
NEEDLE LOC US GUIDE 1ST LESION
|
Facility
|
IP
|
$2,748.55
|
|
|
Service Code
|
HCPCS 19285RT
|
| Hospital Charge Code |
94064017R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$412.28 |
| Max. Negotiated Rate |
$412.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.28
|
|
|
NEEDLE LOC US GUIDE 1ST LESION
|
Facility
|
IP
|
$2,748.55
|
|
|
Service Code
|
HCPCS 19285LT
|
| Hospital Charge Code |
94064017L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$412.28 |
| Max. Negotiated Rate |
$412.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.28
|
|
|
NEEDLE LOC US GUIDE 1ST LESION
|
Facility
|
OP
|
$2,748.55
|
|
|
Service Code
|
HCPCS 19285LT
|
| Hospital Charge Code |
94064017L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.31 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$824.57
|
| Rate for Payer: Aetna Medicare Advantage |
$824.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$700.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$700.88
|
| 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 |
$700.88
|
| Rate for Payer: Cigna Commercial |
$1,374.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$357.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.28
|
|
|
NEEDLE LOC US GUIDE ADDLESION
|
Facility
|
IP
|
$2,321.15
|
|
|
Service Code
|
HCPCS 19286LT
|
| Hospital Charge Code |
94064019L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.17 |
| Max. Negotiated Rate |
$348.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.17
|
|
|
NEEDLE LOC US GUIDE ADDLESION
|
Facility
|
OP
|
$2,321.15
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
87502814
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$696.35
|
| Rate for Payer: Aetna Medicare Advantage |
$696.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$591.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$591.89
|
| 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 |
$591.89
|
| Rate for Payer: Cigna Commercial |
$38.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$301.75
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
NEEDLE LOC US GUIDE ADDLESION
|
Facility
|
OP
|
$2,321.15
|
|
|
Service Code
|
HCPCS 19286LT
|
| Hospital Charge Code |
94064019L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$301.75 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$696.35
|
| Rate for Payer: Aetna Medicare Advantage |
$696.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$591.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$591.89
|
| 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 |
$591.89
|
| Rate for Payer: Cigna Commercial |
$1,160.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$301.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.17
|
|
|
NEEDLE LOC US GUIDE ADDLESION
|
Facility
|
OP
|
$2,321.15
|
|
|
Service Code
|
HCPCS 19286RT
|
| Hospital Charge Code |
94064019R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$301.75 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$696.35
|
| Rate for Payer: Aetna Medicare Advantage |
$696.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$591.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$591.89
|
| 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 |
$591.89
|
| Rate for Payer: Cigna Commercial |
$1,160.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$301.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.17
|
|
|
NEEDLE LOC US GUIDE ADDLESION
|
Facility
|
IP
|
$2,321.15
|
|
|
Service Code
|
HCPCS 19286
|
| Hospital Charge Code |
87502814
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.17 |
| Max. Negotiated Rate |
$348.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.17
|
|
|
NEEDLE LOC US GUIDE ADDLESION
|
Facility
|
IP
|
$2,321.15
|
|
|
Service Code
|
HCPCS 19286RT
|
| Hospital Charge Code |
94064019R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.17 |
| Max. Negotiated Rate |
$348.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.17
|
|
|
NEEDLE LVT VERRES 5IN 120305
|
Facility
|
OP
|
$603.75
|
|
| Hospital Charge Code |
270608439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.49 |
| Max. Negotiated Rate |
$301.88 |
| Rate for Payer: Aetna Commercial |
$181.12
|
| Rate for Payer: Aetna Medicare Advantage |
$181.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.96
|
| Rate for Payer: Cigna Commercial |
$301.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$78.49
|
| Rate for Payer: Oxford Commercial |
$301.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$301.88
|
|
|
NEEDLE LVT VERRES 5IN 120305
|
Facility
|
IP
|
$603.75
|
|
| Hospital Charge Code |
270608439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.56 |
| Max. Negotiated Rate |
$90.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.56
|
|
|
NEEDLE MAYO 1/2 #5 CIRC
|
Facility
|
OP
|
$15.12
|
|
| Hospital Charge Code |
270669513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$7.56 |
| Rate for Payer: Aetna Commercial |
$4.54
|
| Rate for Payer: Aetna Medicare Advantage |
$4.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.86
|
| Rate for Payer: Cigna Commercial |
$7.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.97
|
| Rate for Payer: Oxford Commercial |
$7.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.56
|
|
|
NEEDLE MAYO 1/2 #5 CIRC
|
Facility
|
IP
|
$15.12
|
|
| Hospital Charge Code |
270669513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.27
|
|
|
NEEDLE MAYO 1/2 CIRC CATGUT #4
|
Facility
|
OP
|
$23.60
|
|
| Hospital Charge Code |
270663269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$11.80 |
| Rate for Payer: Aetna Commercial |
$7.08
|
| Rate for Payer: Aetna Medicare Advantage |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.02
|
| Rate for Payer: Cigna Commercial |
$11.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.07
|
| Rate for Payer: Oxford Commercial |
$11.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.80
|
|
