|
ECHO BMTRC MP FP SZ 10
|
Facility
|
OP
|
$30,810.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$15,405.00 |
| Rate for Payer: Aetna Commercial |
$11,707.80
|
| Rate for Payer: Aetna Medicare Advantage |
$9,243.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,856.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,856.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,162.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,856.55
|
| Rate for Payer: Cigna Commercial |
$15,405.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,456.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,621.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$973.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$875.00
|
|
|
ECHO BMTRC MP FP SZ 10
|
Facility
|
IP
|
$30,810.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,621.50 |
| Max. Negotiated Rate |
$7,456.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,162.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,456.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,621.50
|
|
|
ECHO BUNDLE
|
Facility
|
IP
|
$8,497.67
|
|
| Hospital Charge Code |
EXP5300
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,274.65 |
| Max. Negotiated Rate |
$1,274.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,274.65
|
|
|
ECHO BUNDLE
|
Facility
|
OP
|
$8,497.67
|
|
| Hospital Charge Code |
EXP5300
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$4,248.84 |
| Rate for Payer: Aetna Commercial |
$3,229.11
|
| Rate for Payer: Aetna Medicare Advantage |
$2,549.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,166.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,166.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,166.91
|
| Rate for Payer: Cigna Commercial |
$4,248.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,209.39
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,274.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$268.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$241.33
|
|
|
ECHOCARDIOGRAM/CARDDOPPLER/COL
|
Facility
|
IP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
36540002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$885.00 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$885.00
|
|
|
ECHOCARDIOGRAM/CARDDOPPLER/COL
|
Facility
|
OP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
36540002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$167.56 |
| Max. Negotiated Rate |
$2,354.83 |
| Rate for Payer: Aetna Commercial |
$1,765.72
|
| Rate for Payer: Aetna Medicare Advantage |
$2,103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$649.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$651.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,354.83
|
| Rate for Payer: Cigna Commercial |
$1,301.24
|
| Rate for Payer: Cigna Medicare Advantage |
$649.16
|
| Rate for Payer: Clover Medicare Advantage |
$616.70
|
| Rate for Payer: EmblemHealth Commercial |
$1,947.48
|
| Rate for Payer: Humana Medicare Advantage |
$668.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$649.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,534.00
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$885.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$186.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$167.56
|
|
|
ECHO COMP W/ M MODE/C FLOW/DOP
|
Facility
|
OP
|
$7,938.54
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
74117025
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$225.45 |
| Max. Negotiated Rate |
$2,354.83 |
| Rate for Payer: Aetna Commercial |
$1,765.72
|
| Rate for Payer: Aetna Medicare Advantage |
$2,103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$649.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$651.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,354.83
|
| Rate for Payer: Cigna Commercial |
$1,301.24
|
| Rate for Payer: Cigna Medicare Advantage |
$649.16
|
| Rate for Payer: Clover Medicare Advantage |
$616.70
|
| Rate for Payer: EmblemHealth Commercial |
$1,947.48
|
| Rate for Payer: Humana Medicare Advantage |
$668.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$649.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,064.02
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,190.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$250.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$225.45
|
|
|
ECHO COMP W/ M MODE/C FLOW/DOP
|
Facility
|
IP
|
$7,938.54
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
74117025
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,190.78 |
| Max. Negotiated Rate |
$1,190.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,190.78
|
|
|
ECHO COMP W/ M MODE/C FLOW/DOP
|
Facility
|
OP
|
$7,938.54
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
94053105
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$225.45 |
| Max. Negotiated Rate |
$2,354.83 |
| Rate for Payer: Aetna Commercial |
$1,765.72
|
| Rate for Payer: Aetna Medicare Advantage |
$2,103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$649.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$651.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,354.83
|
| Rate for Payer: Cigna Commercial |
$1,301.24
|
| Rate for Payer: Cigna Medicare Advantage |
$649.16
|
| Rate for Payer: Clover Medicare Advantage |
$616.70
|
| Rate for Payer: EmblemHealth Commercial |
$1,947.48
|
| Rate for Payer: Humana Medicare Advantage |
$668.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$649.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,064.02
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,190.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$250.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$225.45
|
|
|
ECHO COMP W/ M MODE/C FLOW/DOP
|
Facility
|
IP
|
$7,938.54
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
94053105
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,190.78 |
| Max. Negotiated Rate |
$1,190.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,190.78
|
|
|
ECHO COMP W/ M MODE/C FLOW/DOP
|
Facility
|
IP
|
$7,938.54
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
74115025
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,190.78 |
| Max. Negotiated Rate |
$1,190.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,190.78
|
|
|
ECHO COMP W/ M MODE/C FLOW/DOP
|
Facility
|
OP
|
$7,938.54
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
74115025
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$225.45 |
| Max. Negotiated Rate |
$2,354.83 |
| Rate for Payer: Aetna Commercial |
$1,765.72
|
| Rate for Payer: Aetna Medicare Advantage |
$2,103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$649.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$651.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,354.83
|
| Rate for Payer: Cigna Commercial |
$1,301.24
|
| Rate for Payer: Cigna Medicare Advantage |
$649.16
|
| Rate for Payer: Clover Medicare Advantage |
$616.70
|
| Rate for Payer: EmblemHealth Commercial |
$1,947.48
|
| Rate for Payer: Humana Medicare Advantage |
$668.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$649.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,064.02
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,190.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$250.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$225.45
|
|
|
ECHO COMP W/ M MODE/C FLOW/DOP
|
Facility
|
IP
|
$3,596.60
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
5300080
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$539.49 |
| Max. Negotiated Rate |
$539.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$539.49
|
|
|
ECHO COMP W/ M MODE/C FLOW/DOP
|
Facility
|
OP
|
$3,596.60
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
5300080
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$102.14 |
| Max. Negotiated Rate |
$2,354.83 |
| Rate for Payer: Aetna Commercial |
$1,765.72
|
| Rate for Payer: Aetna Medicare Advantage |
$2,103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$649.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$651.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,354.83
|
| Rate for Payer: Cigna Commercial |
$1,301.24
|
| Rate for Payer: Cigna Medicare Advantage |
$649.16
|
| Rate for Payer: Clover Medicare Advantage |
$616.70
|
| Rate for Payer: EmblemHealth Commercial |
$1,947.48
|
| Rate for Payer: Humana Medicare Advantage |
$668.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$649.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$935.12
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$539.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$113.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$102.14
|
|
|
ECHO COMP W/ M MODE/C FLOW/DOP
|
Facility
|
IP
|
$7,938.54
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
74116025
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,190.78 |
| Max. Negotiated Rate |
$1,190.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,190.78
|
|
|
ECHO COMP W/ M MODE/C FLOW/DOP
|
Facility
|
OP
|
$7,938.54
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
74116025
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$225.45 |
| Max. Negotiated Rate |
$2,354.83 |
| Rate for Payer: Aetna Commercial |
$1,765.72
|
| Rate for Payer: Aetna Medicare Advantage |
$2,103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,354.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$649.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$651.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,354.83
|
| Rate for Payer: Cigna Commercial |
$1,301.24
|
| Rate for Payer: Cigna Medicare Advantage |
$649.16
|
| Rate for Payer: Clover Medicare Advantage |
$616.70
|
| Rate for Payer: EmblemHealth Commercial |
$1,947.48
|
| Rate for Payer: Humana Medicare Advantage |
$668.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$649.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,064.02
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,190.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$250.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$225.45
|
|
|
ECHO DOPPLER COLOR FLOW
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
HCPCS 93325
|
| Hospital Charge Code |
5300132
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$242.25
|
|
|
ECHO DOPPLER COLOR FLOW
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
HCPCS 93325
|
| Hospital Charge Code |
5300132
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$45.87 |
| Max. Negotiated Rate |
$2,338.00 |
| Rate for Payer: Aetna Commercial |
$613.70
|
| Rate for Payer: Aetna Medicare Advantage |
$484.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$411.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$411.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$217.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$411.82
|
| Rate for Payer: Cigna Commercial |
$807.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$419.90
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$242.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.87
|
|
|
ECHO DOPPLER COMPLETE
|
Facility
|
IP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 93320
|
| Hospital Charge Code |
5300108
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$223.65 |
| Max. Negotiated Rate |
$223.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.65
|
|
|
ECHO DOPPLER COMPLETE
|
Facility
|
OP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 93320
|
| Hospital Charge Code |
5300108
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$2,338.00 |
| Rate for Payer: Aetna Commercial |
$566.58
|
| Rate for Payer: Aetna Medicare Advantage |
$447.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$266.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.20
|
| Rate for Payer: Cigna Commercial |
$745.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$387.66
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.34
|
|
|
ECHO DOPPLER LIMITED/FOLLOW UP
|
Facility
|
OP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
5300086
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$2,950.00 |
| Rate for Payer: Aetna Commercial |
$2,242.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,770.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,504.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,504.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$2,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,534.00
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$885.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$186.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$167.56
|
|
|
ECHO DOPPLER LIMITED/FOLLOW UP
|
Facility
|
IP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
5300086
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$885.00 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$885.00
|
|
|
ECHO GUIDE FOR BIOPSY
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
421076942
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$3,350.00 |
| Rate for Payer: Aetna Commercial |
$2,546.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,010.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,708.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,708.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,708.50
|
| Rate for Payer: Cigna Commercial |
$3,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,742.00
|
| Rate for Payer: Oxford Commercial |
$2,697.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,904.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$211.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
ECHO GUIDE FOR BIOPSY
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
421076942
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,005.00
|
|
|
ECHO POR FMRL FPP NC 13X145MM
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| 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) NJ Health |
$2,700.00
|
| 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 |
$3,267.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
