|
US PERC RENAL CYST ASP RT
|
Facility
|
IP
|
$4,709.90
|
|
|
Service Code
|
HCPCS 50390RT
|
| Hospital Charge Code |
2101197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$706.49 |
| Max. Negotiated Rate |
$706.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$706.49
|
|
|
US PERC RENAL CYST ASP RT
|
Facility
|
OP
|
$4,709.90
|
|
|
Service Code
|
HCPCS 50390RT
|
| Hospital Charge Code |
2101197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.76 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,789.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,412.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,201.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,201.02
|
| 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 |
$1,201.02
|
| Rate for Payer: Cigna Commercial |
$2,354.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,224.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$706.49
|
| Rate for Payer: UnitedHealthcare Community & State |
$148.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$133.76
|
|
|
US PLACENTA LOCALIZ
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
2100089
|
|
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 PLACENTA LOCALIZ
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
2100089
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.75 |
| 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 |
$57.75
|
| 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 |
$1,742.00
|
| 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 |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
US PLEURAL EFFUSION
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
2100097
|
|
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 PLEURAL EFFUSION
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
2100097
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.75 |
| 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 |
$57.75
|
| 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 |
$1,742.00
|
| 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 |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
US - POPLITEAL-BIL
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
94061183
|
|
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 - POPLITEAL-BIL
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
94061183
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.22 |
| 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 |
$84.22
|
| 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 |
$1,742.00
|
| 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 |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
US PREGNANCY < 14 WEEKS
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
2301052
|
|
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 PREGNANCY < 14 WEEKS
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
64061508
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.75 |
| 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 |
$90.75
|
| 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 |
$1,742.00
|
| 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 |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
US PREGNANCY < 14 WEEKS
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
64061508
|
|
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 PREGNANCY < 14 WEEKS
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
2301052
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.75 |
| 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 |
$90.75
|
| 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 |
$1,742.00
|
| 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 |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
US PREGNT UTERUS LIMITED
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
94061504A
|
|
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 PREGNT UTERUS LIMITED
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
94061504A
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.75 |
| 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 |
$57.75
|
| 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 |
$1,742.00
|
| 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 |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
US PREGN UTERUS COMPL
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
2101114
|
|
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 PREGN UTERUS COMPL
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
2101114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$106.59 |
| 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 |
$106.59
|
| 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 |
$1,742.00
|
| 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 |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$407.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
2301055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$117.99 |
| 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 |
$133.65
|
| 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 |
$1,742.00
|
| 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 |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
2301055
|
|
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-PSEUDOANEURYSM INJ
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
2308001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$136.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.20
|
|
|
US-PSEUDOANEURYSM INJ
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
HCPCS 36002
|
| Hospital Charge Code |
2308001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,703.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| 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 |
$2,703.39
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.08
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.79
|
|
|
US PUNC/ASP CYST BREAST
|
Facility
|
IP
|
$1,874.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
2100547
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.10 |
| Max. Negotiated Rate |
$281.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.10
|
|
|
US PUNC/ASP CYST BREAST
|
Facility
|
OP
|
$1,874.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
2100547
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| 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 |
$3,051.74
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$487.24
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.22
|
|
|
US PUNC/ASP CYST BRST EA ADDL
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
HCPCS 19001
|
| Hospital Charge Code |
2100545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.30 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.30
|
|
|
US PUNC/ASP CYST BRST EA ADDL
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
HCPCS 19001
|
| Hospital Charge Code |
2100545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$243.96
|
| Rate for Payer: Aetna Medicare Advantage |
$192.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$163.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$163.71
|
| 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 |
$163.71
|
| Rate for Payer: Cigna Commercial |
$321.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$166.92
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.23
|
|
|
US RENAL DIAGNOSTIC COMPL
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
2100113
|
|
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
|
|
