|
US TRANSVAGINAL PREGNANT UTERU
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
94061501
|
|
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 TRANSVAGINAL PREGNANT UTERU
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
2307010
|
|
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 TRANSVAGINAL PREGNANT UTERU
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
94061501
|
|
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 TRANSVAGINAL PREGNANT UTERU
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
2307010
|
|
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 UE ARTRAL DPPLR SNGL LVL BL
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
2301061
|
|
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 UE ARTRAL DPPLR SNGL LVL BL
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
2301061
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$150.16 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$429.92
|
| Rate for Payer: Aetna Medicare Advantage |
$512.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$158.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$242.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.36
|
| Rate for Payer: Cigna Commercial |
$316.85
|
| Rate for Payer: Cigna Medicare Advantage |
$158.06
|
| Rate for Payer: Clover Medicare Advantage |
$150.16
|
| Rate for Payer: EmblemHealth Commercial |
$474.18
|
| Rate for Payer: Humana Medicare Advantage |
$162.80
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$158.06
|
| 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 |
$158.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
US UE ARTRAL DPPLR SNGL UNI LT
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 9392252LT
|
| Hospital Charge Code |
2101104
|
|
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 UE ARTRAL DPPLR SNGL UNI LT
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 9392252LT
|
| Hospital Charge Code |
2101104
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$488.48 |
| Max. Negotiated Rate |
$8,600.00 |
| Rate for Payer: Aetna Commercial |
$6,536.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,386.00
|
| Rate for Payer: Cigna Commercial |
$8,600.00
|
| 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: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
US UE ARTRAL DPPLR SNGL UNI RT
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 9392252RT
|
| Hospital Charge Code |
2101103
|
|
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 UE ARTRAL DPPLR SNGL UNI RT
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 9392252RT
|
| Hospital Charge Code |
2101103
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$488.48 |
| Max. Negotiated Rate |
$8,600.00 |
| Rate for Payer: Aetna Commercial |
$6,536.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,386.00
|
| Rate for Payer: Cigna Commercial |
$8,600.00
|
| 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: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
US UNI.DUP SCAN-UPP.EXT.VEINS
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2308030
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$157.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.80
|
|
|
US UNI.DUP SCAN-UPP.EXT.VEINS
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2308030
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$29.88 |
| 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 |
$273.52
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.88
|
|
|
US UNLISTED PROCEDURE
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 76999
|
| Hospital Charge Code |
2301090
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$55.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.50
|
|
|
US UNLISTED PROCEDURE
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 76999
|
| Hospital Charge Code |
2301090
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$10.51 |
| 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) 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 |
$96.20
|
| Rate for Payer: Oxford Commercial |
$2,697.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,904.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.51
|
|
|
US VL-DUP SCAN LOWER EXT VEIN-
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2308020
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$157.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.80
|
|
|
US VL-DUP SCAN LOWER EXT VEIN-
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2308020
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$29.88 |
| 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 |
$273.52
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.88
|
|
|
US VL-DUP.SCAN LOWER EXT.VEIN-
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2308025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$29.88 |
| 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 |
$273.52
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.88
|
|
|
US VL-DUP.SCAN LOWER EXT.VEIN-
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2308025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$157.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.80
|
|
|
US VL-DUP SCAN-UPPER EXT.VEIN-
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2308015
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$157.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.80
|
|
|
US VL-DUP SCAN-UPPER EXT.VEIN-
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
2308015
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$29.88 |
| 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 |
$273.52
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.88
|
|
|
US XTR NON-VASC COMPLETE
|
Facility
|
IP
|
$1,170.20
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
1600000790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.53 |
| Max. Negotiated Rate |
$175.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.53
|
|
|
US XTR NON-VASC COMPLETE
|
Facility
|
OP
|
$1,170.20
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
1600000790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$3,536.00 |
| 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 |
$3,536.00
|
| 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 |
$304.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.23
|
|
|
US XTR NON-VASC LMTD
|
Facility
|
OP
|
$534.78
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
7411751
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$15.19 |
| 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 |
$21.55
|
| 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 |
$139.04
|
| Rate for Payer: Oxford Commercial |
$2,697.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,904.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.90
|
| 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 |
$298.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.19
|
|
|
US XTR NON-VASC LMTD
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
321076882
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$21.55 |
| 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 |
$21.55
|
| 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 |
$298.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
|
US XTR NON-VASC LMTD
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
2600210
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$21.55 |
| 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 |
$21.55
|
| 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 |
$298.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$190.28
|
|
