|
ARTERY X-RAYS ABDOMEN
|
Facility
|
OP
|
$25,628.45
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
2004877
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$235.16 |
| Max. Negotiated Rate |
$23,980.53 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,980.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,980.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,980.53
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,663.40
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,844.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$809.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$727.85
|
|
|
ARTERY X-RAYS ABDOMEN
|
Facility
|
IP
|
$25,628.45
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
2004877
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,844.27 |
| Max. Negotiated Rate |
$3,844.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,844.27
|
|
|
ARTERY X-RAYS ABDOMEN
|
Facility
|
IP
|
$25,628.45
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
321075726
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,844.27 |
| Max. Negotiated Rate |
$3,844.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,844.27
|
|
|
ARTERY X-RAYS CHEST
|
Facility
|
IP
|
$14,613.44
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
366875756
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,192.02 |
| Max. Negotiated Rate |
$2,192.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.02
|
|
|
ARTERY X-RAYS CHEST
|
Facility
|
OP
|
$14,613.44
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
366875756
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$114.76 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,799.49
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,192.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$461.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$415.02
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
IP
|
$34,050.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
366875741
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,107.50 |
| Max. Negotiated Rate |
$5,107.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,107.50
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
OP
|
$34,050.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
411075741
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,853.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,107.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,075.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$967.02
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
OP
|
$34,050.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
366875741
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,853.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,107.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,075.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$967.02
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
IP
|
$34,050.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
411075741
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,107.50 |
| Max. Negotiated Rate |
$5,107.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,107.50
|
|
|
ARTERY X-RAYS LUNGS
|
Facility
|
IP
|
$12,461.85
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
411075743
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,869.28 |
| Max. Negotiated Rate |
$1,869.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,869.28
|
|
|
ARTERY X-RAYS LUNGS
|
Facility
|
IP
|
$12,461.85
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
366875743
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,869.28 |
| Max. Negotiated Rate |
$1,869.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,869.28
|
|
|
ARTERY X-RAYS LUNGS
|
Facility
|
OP
|
$12,461.85
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
366875743
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$288.73 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,240.08
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,869.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$393.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$353.92
|
|
|
ARTERY X-RAYS LUNGS
|
Facility
|
OP
|
$12,461.85
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
411075743
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$288.73 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,240.08
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,869.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$393.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$353.92
|
|
|
ARTERY X-RAYS PELVIS
|
Facility
|
IP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
411075736
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,750.69 |
| Max. Negotiated Rate |
$3,750.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
|
|
ARTERY X-RAYS PELVIS
|
Facility
|
OP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
411075736
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.48 |
| Max. Negotiated Rate |
$23,980.53 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,980.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,980.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$249.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,980.53
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,501.20
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$790.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$710.13
|
|
|
ARTERY X-RAYS SPINE
|
Facility
|
OP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75705
|
| Hospital Charge Code |
411075705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.87 |
| Max. Negotiated Rate |
$23,980.53 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,980.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,980.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$293.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,980.53
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,501.20
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$790.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$710.13
|
|
|
ARTERY X-RAYS SPINE
|
Facility
|
OP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75705
|
| Hospital Charge Code |
366875705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.87 |
| Max. Negotiated Rate |
$23,980.53 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,980.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,980.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$293.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,980.53
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,501.20
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$790.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$710.13
|
|
|
ARTERY X-RAYS SPINE
|
Facility
|
IP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75705
|
| Hospital Charge Code |
366875705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,750.69 |
| Max. Negotiated Rate |
$3,750.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
|
|
ARTERY X-RAYS SPINE
|
Facility
|
IP
|
$25,004.60
|
|
|
Service Code
|
HCPCS 75705
|
| Hospital Charge Code |
411075705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,750.69 |
| Max. Negotiated Rate |
$3,750.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.69
|
|
|
ARTHD CMBN 1INTRSPC LUMBAR
|
Facility
|
OP
|
$108,286.15
|
|
|
Service Code
|
HCPCS 22633
|
| Hospital Charge Code |
1600000292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,075.33 |
| Max. Negotiated Rate |
$116,935.87 |
| Rate for Payer: Aetna Commercial |
$87,681.76
|
| Rate for Payer: Aetna Medicare Advantage |
$104,444.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$116,935.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$116,935.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$32,235.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$116,935.87
|
| Rate for Payer: Cigna Commercial |
$64,616.81
|
| Rate for Payer: Cigna Medicare Advantage |
$32,235.94
|
| Rate for Payer: Clover Medicare Advantage |
$30,624.14
|
| Rate for Payer: EmblemHealth Commercial |
$96,707.82
|
| Rate for Payer: Humana Medicare Advantage |
$33,203.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$32,235.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28,154.40
|
| Rate for Payer: Oxford Commercial |
$15,591.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16,242.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$17,348.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3,421.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$32,235.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$32,235.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3,075.33
|
|
|
ARTHD CMBN 1INTRSPC LUMBAR
|
Facility
|
IP
|
$108,286.15
|
|
|
Service Code
|
HCPCS 22633
|
| Hospital Charge Code |
1600000292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,242.92 |
| Max. Negotiated Rate |
$16,242.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16,242.92
|
|
|
ARTHOFLEX 40x70 mm
|
Facility
|
OP
|
$10,200.00
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
270657242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$2,468.40 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,040.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,468.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,530.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$322.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$289.68
|
|
|
ARTHOFLEX 40x70 mm
|
Facility
|
IP
|
$10,200.00
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
270657242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$2,468.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,040.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,468.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,530.00
|
|
|
ARTHOFLEX DECELLULARIZED DERMS
|
Facility
|
IP
|
$19,445.00
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
270679770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,916.75 |
| Max. Negotiated Rate |
$4,705.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,889.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,705.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,916.75
|
|
|
ARTHOFLEX DECELLULARIZED DERMS
|
Facility
|
OP
|
$19,445.00
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
270679770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$4,705.69 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,889.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,705.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,916.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$614.46
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$552.24
|
|
