|
STREPTOCOCCUS, GROUP A
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
38472339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$44.96
|
| Rate for Payer: Aetna Medicare Advantage |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.96
|
| Rate for Payer: Cigna Commercial |
$38.50
|
| Rate for Payer: Cigna Medicare Advantage |
$16.53
|
| Rate for Payer: Clover Medicare Advantage |
$15.70
|
| Rate for Payer: EmblemHealth Commercial |
$49.59
|
| Rate for Payer: Humana Medicare Advantage |
$17.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.19
|
|
|
STREPTOCOCCUS GROUP A POC
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87430
|
| Hospital Charge Code |
412387430
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
STREPTOCOCCUS GROUP A POC
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87430
|
| Hospital Charge Code |
412387430
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$45.72
|
| Rate for Payer: Aetna Medicare Advantage |
$54.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.98
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$16.81
|
| Rate for Payer: Clover Medicare Advantage |
$15.97
|
| Rate for Payer: EmblemHealth Commercial |
$50.43
|
| Rate for Payer: Humana Medicare Advantage |
$17.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
STREPTOMYCIN SULFATE 1 GM VIAL
|
Facility
|
IP
|
$150.75
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
6063943246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$36.48 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.61
|
|
|
STREPTOMYCIN SULFATE 1 GM VIAL
|
Facility
|
OP
|
$150.75
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
6063943246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$75.38 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: Aetna Medicare Advantage |
$45.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.44
|
| Rate for Payer: Cigna Commercial |
$75.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.28
|
|
|
STRESS ECHO
|
Facility
|
IP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
74115026
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$885.00 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$885.00
|
|
|
STRESS ECHO
|
Facility
|
OP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
5307010
|
|
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 |
$547.80
|
| 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
|
|
|
STRESS ECHO
|
Facility
|
IP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
74116026
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$885.00 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$885.00
|
|
|
STRESS ECHO
|
Facility
|
IP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
5307010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$885.00 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$885.00
|
|
|
STRESS ECHO
|
Facility
|
IP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
74117026
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$885.00 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$885.00
|
|
|
STRESS ECHO
|
Facility
|
OP
|
$2,389.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
36540012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$67.85 |
| 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 |
$547.80
|
| 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 |
$621.14
|
| Rate for Payer: Oxford Commercial |
$2,338.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$358.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,244.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$75.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$649.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$67.85
|
|
|
STRESS ECHO
|
Facility
|
IP
|
$2,389.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
36540012
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$358.35 |
| Max. Negotiated Rate |
$358.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$358.35
|
|
|
STRESS ECHO
|
Facility
|
OP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
74115026
|
|
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 |
$547.80
|
| 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
|
|
|
STRESS ECHO
|
Facility
|
OP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
74116026
|
|
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 |
$547.80
|
| 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
|
|
|
STRESS ECHO
|
Facility
|
OP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
74117026
|
|
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 |
$547.80
|
| 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
|
|
|
STRESS ECHO WITH CONTRAST
|
Facility
|
IP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
36540020
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$885.00 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$885.00
|
|
|
STRESS ECHO WITH CONTRAST
|
Facility
|
OP
|
$5,900.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
36540020
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$153.45 |
| 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 |
$153.45
|
| 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
|
|
|
STRESS LEXISCAN THALLIUM
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
94053040
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
STRESS LEXISCAN THALLIUM
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
94053040
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$4,554.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$930.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$930.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$930.53
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,860.00
|
| Rate for Payer: Oxford Commercial |
$4,336.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,554.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$347.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$312.40
|
|
|
STRESS TEST
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
5300058
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$4,554.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$930.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$930.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$930.53
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,860.00
|
| Rate for Payer: Oxford Commercial |
$4,336.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,554.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$347.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$312.40
|
|
|
STRESS TEST
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
74115009
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$4,554.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$930.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$930.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$930.53
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,860.00
|
| Rate for Payer: Oxford Commercial |
$4,336.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,554.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$347.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$312.40
|
|
|
STRESS TEST
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
36540004
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
STRESS TEST
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
36540004
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$4,554.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$930.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$930.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$930.53
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,860.00
|
| Rate for Payer: Oxford Commercial |
$4,336.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,554.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$347.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$312.40
|
|
|
STRESS TEST
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
74116009
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
STRESS TEST
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
74115009
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
