|
US DUPLEX EXTREM VEIN LOWER UN
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2100410
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
US DUPLEX EXTREM VEIN UP-BILAT
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
2100980
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$7,555.00 |
| 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 |
$496.10
|
| 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 |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
US DUPLEX EXTREM VEIN UP-BILAT
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
2100980
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
US DUPLEX EXTREM VEIN UPPER UN
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2100394
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
US DUPLEX EXTREM VEIN UPPER UN
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2100394
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$479.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
US DUPLEX EXTRM LOWER ARTR BI
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
2100329
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$2,301.00 |
| 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 |
$394.90
|
| 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 |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$2,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,301.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
US DUPLEX EXTRM LOWER ARTR BI
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
2100329
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
US DUPLEX EXTRM LOWER ARTR UNI
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
2100311
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
US DUPLEX EXTRM LOWER ARTR UNI
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
2100311
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$2,301.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$240.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$2,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,301.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
US DUPLEX EXTRM UPPER ARTR UNI
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
2100337
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
US DUPLEX EXTRM UPPER ARTR UNI
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
2100337
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
US DUPLEX HEMODIALYSIS ACCESS
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
2101110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
US DUPLEX HEMODIALYSIS ACCESS
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
2101110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$345.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
US DUPLEX PENILE ART/VEIN LMTD
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
HCPCS 93981
|
| Hospital Charge Code |
2301008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$136.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.20
|
|
|
US DUPLEX PENILE ART/VEIN LMTD
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
HCPCS 93981
|
| Hospital Charge Code |
2301008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$42.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.08
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.79
|
|
|
US DUPLEX PENILE ART/VEINS CMP
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
HCPCS 93980
|
| Hospital Charge Code |
2301007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$136.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.20
|
|
|
US DUPLEX PENILE ART/VEINS CMP
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
HCPCS 93980
|
| Hospital Charge Code |
2301007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.08
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.79
|
|
|
US-ECHOENCEPHALALOGRAPHY
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76506
|
| Hospital Charge Code |
2307005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$288.34
|
| Rate for Payer: Oxford Commercial |
$2,697.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$166.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,904.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.50
|
|
|
US-ECHOENCEPHALALOGRAPHY
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76506
|
| Hospital Charge Code |
2307005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$166.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$166.35
|
|
|
US ECHO INFANT HIPS DYNAMIC
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
2100016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$152.25 |
| Max. Negotiated Rate |
$152.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$152.25
|
|
|
US ECHO INFANT HIPS DYNAMIC
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
2100016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna Commercial |
$281.22
|
| Rate for Payer: Aetna Medicare Advantage |
$334.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$375.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$375.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$103.39
|
| 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 |
$375.05
|
| Rate for Payer: Cigna Commercial |
$207.24
|
| Rate for Payer: Cigna Medicare Advantage |
$103.39
|
| Rate for Payer: Clover Medicare Advantage |
$98.22
|
| Rate for Payer: EmblemHealth Commercial |
$310.17
|
| Rate for Payer: Humana Medicare Advantage |
$106.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$103.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$263.90
|
| Rate for Payer: Oxford Commercial |
$2,697.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$152.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,904.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.83
|
|
|
US ECHO INFANT HIPS STATIC
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
2100017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.36 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna Commercial |
$281.22
|
| Rate for Payer: Aetna Medicare Advantage |
$334.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$375.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$375.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$103.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$66.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$375.05
|
| Rate for Payer: Cigna Commercial |
$207.24
|
| Rate for Payer: Cigna Medicare Advantage |
$103.39
|
| Rate for Payer: Clover Medicare Advantage |
$98.22
|
| Rate for Payer: EmblemHealth Commercial |
$310.17
|
| Rate for Payer: Humana Medicare Advantage |
$106.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$103.39
|
| 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: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
US ECHO INFANT HIPS STATIC
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
2100017
|
|
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
|
|
|
US ECHO INTRAOPERATIVE
|
Facility
|
IP
|
$1,981.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
2101128
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.15 |
| Max. Negotiated Rate |
$297.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$297.15
|
|
|
US ECHO INTRAOPERATIVE
|
Facility
|
OP
|
$1,981.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
2101128
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$56.26 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna Commercial |
$752.78
|
| Rate for Payer: Aetna Medicare Advantage |
$594.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$505.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$505.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$116.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$505.15
|
| Rate for Payer: Cigna Commercial |
$990.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$515.06
|
| Rate for Payer: Oxford Commercial |
$2,697.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$297.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,904.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.26
|
|
