|
MRI LUMBAR SPINE
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
94061079
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$544.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,028.29
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$817.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
|
MRI LUMBAR SPINE
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
94061079
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI LUMBAR SPINE W/WO CON
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
94061087
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$1,127.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$414.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$897.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,503.49
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: Cigna Medicare Advantage |
$414.47
|
| Rate for Payer: Clover Medicare Advantage |
$393.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.41
|
| Rate for Payer: Humana Medicare Advantage |
$426.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$414.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,543.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
|
MRI LUMBAR SPINE W/WO CON
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
94061087
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI LUMBAR SP W/GAD INJ
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
94061081
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$1,127.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$414.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,503.49
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: Cigna Medicare Advantage |
$414.47
|
| Rate for Payer: Clover Medicare Advantage |
$393.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.41
|
| Rate for Payer: Humana Medicare Advantage |
$426.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$414.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
|
MRI LUMBAR SP W/GAD INJ
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
94061081
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI LUMBAR W CONT
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
2400174
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI LUMBAR W CONT
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
2400174
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$1,127.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$414.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,503.49
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: Cigna Medicare Advantage |
$414.47
|
| Rate for Payer: Clover Medicare Advantage |
$393.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.41
|
| Rate for Payer: Humana Medicare Advantage |
$426.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$414.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
|
MRI MRCP
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
2400608
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$544.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,028.29
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
|
MRI MRCP
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
2400608
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI NECK W & WITHOUT CON
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
94061025
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI NECK W & WITHOUT CON
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
94061025
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$1,127.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$414.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$807.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,503.49
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: Cigna Medicare Advantage |
$414.47
|
| Rate for Payer: Clover Medicare Advantage |
$393.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.41
|
| Rate for Payer: Humana Medicare Advantage |
$426.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$414.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
|
MRI NON STERILE TREPHINE 21.5
|
Facility
|
OP
|
$2,350.00
|
|
| Hospital Charge Code |
270690415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$1,175.00 |
| Rate for Payer: Aetna Commercial |
$893.00
|
| Rate for Payer: Aetna Medicare Advantage |
$705.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$599.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$599.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$599.25
|
| Rate for Payer: Cigna Commercial |
$1,175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$611.00
|
| Rate for Payer: Oxford Commercial |
$470.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$352.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$470.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$66.74
|
|
|
MRI NON STERILE TREPHINE 21.5
|
Facility
|
IP
|
$2,350.00
|
|
| Hospital Charge Code |
270690415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$352.50
|
|
|
MRI ONE BRST-GL
|
Facility
|
IP
|
$3,597.20
|
|
|
Service Code
|
HCPCS 77058
|
| Hospital Charge Code |
85000170
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$539.58 |
| Max. Negotiated Rate |
$539.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$539.58
|
|
|
MRI ONE BRST-GL
|
Facility
|
OP
|
$3,597.20
|
|
|
Service Code
|
HCPCS 77058
|
| Hospital Charge Code |
85000170
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$102.16 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$1,366.94
|
| Rate for Payer: Aetna Medicare Advantage |
$1,079.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$917.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$917.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$917.29
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$935.27
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$539.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$113.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$102.16
|
|
|
MRI ORBIT
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
94061023
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI ORBIT
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
94061023
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,028.29
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
|
MRI ORBIT FACE AND NECK W/O
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
2400059
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,028.29
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
|
MRI ORBIT FACE AND NECK W/O
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
2400059
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI ORBIT W/ & W/O CONTRAST
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
2400603
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI ORBIT W/ & W/O CONTRAST
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
2400603
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$1,127.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$414.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$807.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,503.49
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: Cigna Medicare Advantage |
$414.47
|
| Rate for Payer: Clover Medicare Advantage |
$393.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.41
|
| Rate for Payer: Humana Medicare Advantage |
$426.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$414.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
|
MRI - PELVIS
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
94061093
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
MRI - PELVIS
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
94061093
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare Advantage |
$918.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,028.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$283.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$453.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,028.29
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: Cigna Medicare Advantage |
$283.47
|
| Rate for Payer: Clover Medicare Advantage |
$269.30
|
| Rate for Payer: EmblemHealth Commercial |
$850.41
|
| Rate for Payer: Humana Medicare Advantage |
$291.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$283.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
|
MRI PELVIS W/ CONTRAST
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
2400224
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$6,130.00 |
| Rate for Payer: Aetna Commercial |
$1,127.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,503.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$414.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,503.49
|
| Rate for Payer: Cigna Commercial |
$830.80
|
| Rate for Payer: Cigna Medicare Advantage |
$414.47
|
| Rate for Payer: Clover Medicare Advantage |
$393.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.41
|
| Rate for Payer: Humana Medicare Advantage |
$426.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$414.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,510.00
|
| Rate for Payer: Oxford Commercial |
$5,427.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,130.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$426.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$383.40
|
|
