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Service Code HCPCS 87904
Hospital Charge Code 401387904F
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904D
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904I
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904E
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Service Code HCPCS 87904
Hospital Charge Code 401387904H
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904I
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Service Code HCPCS 87904
Hospital Charge Code 401387904B
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904J
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904H
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Service Code HCPCS 87904
Hospital Charge Code 401387904B
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Service Code HCPCS 87904
Hospital Charge Code 401387904D
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Service Code HCPCS 87904
Hospital Charge Code 401387904G
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Service Code HCPCS 87904
Hospital Charge Code 401387904A
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Service Code HCPCS 87904
Hospital Charge Code 401387904C
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Service Code HCPCS 87904
Hospital Charge Code 401387904J
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Service Code HCPCS 87904
Hospital Charge Code 401387904C
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904G
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904A
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904K
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Service Code HCPCS 87904
Hospital Charge Code 401387904K
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904E
Hospital Revenue Code 306
Min. Negotiated Rate $25.95
Max. Negotiated Rate $25.95
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Service Code HCPCS 87904
Hospital Charge Code 401387904F
Hospital Revenue Code 306
Min. Negotiated Rate $13.04
Max. Negotiated Rate $114.00
Rate for Payer: Cigna Commercial $26.07
Rate for Payer: Cigna Medicare Advantage $13.04
Rate for Payer: Aetna Commercial $84.47
Rate for Payer: Aetna Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $95.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage $26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health $27.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $95.52
Rate for Payer: Clover Medicare Advantage $24.77
Rate for Payer: EmblemHealth Commercial $78.21
Rate for Payer: Humana Medicare Advantage $26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $22.49
Rate for Payer: Oxford Commercial $101.00
Rate for Payer: Qualcare PPO/HMO/WC $25.95
Rate for Payer: UnitedHealthcare Commercial $114.00
Rate for Payer: UnitedHealthcare Medicare Advantage $26.07
Rate for Payer: Wellcare Ambetter Commercial-Exchange $27.63
Rate for Payer: Wellcare Medicare Advantage $26.07
Hospital Charge Code 60627476
Hospital Revenue Code 252
Min. Negotiated Rate $1.09
Max. Negotiated Rate $1.09
Rate for Payer: Qualcare PPO/HMO/WC $1.09
Hospital Charge Code 60627476
Hospital Revenue Code 252
Min. Negotiated Rate $0.94
Max. Negotiated Rate $3.62
Rate for Payer: Aetna Commercial $2.17
Rate for Payer: Aetna Medicare Advantage $2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $1.85
Rate for Payer: Cigna Commercial $3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $0.94
Rate for Payer: Oxford Commercial $3.62
Rate for Payer: Qualcare PPO/HMO/WC $1.09
Rate for Payer: UnitedHealthcare Commercial $3.62
Hospital Charge Code 60629102
Hospital Revenue Code 250
Min. Negotiated Rate $1.25
Max. Negotiated Rate $4.83
Rate for Payer: Aetna Commercial $2.90
Rate for Payer: Aetna Medicare Advantage $2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity $2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care $2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO $2.46
Rate for Payer: Cigna Commercial $4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC $1.25
Rate for Payer: Oxford Commercial $4.83
Rate for Payer: Qualcare PPO/HMO/WC $1.45
Rate for Payer: UnitedHealthcare Commercial $4.83