|
XR LUMBOSACRAL SPINE W/ OBLIQ
|
Facility
|
OP
|
$5,151.86
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
2002038
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$2,231.00 |
| 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 |
$45.38
|
| 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 |
$86.94
|
| 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 |
$1,339.48
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$772.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$162.80
|
| 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 |
$146.31
|
|
|
XR LUMBOSACRAL SPINE W/ OBLIQ
|
Facility
|
IP
|
$5,151.86
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
2002038
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$772.78 |
| Max. Negotiated Rate |
$772.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$772.78
|
|
|
XR MAMMOGRAPHY SCREEN BI
|
Facility
|
IP
|
$607.60
|
|
|
Service Code
|
HCPCS 77057
|
| Hospital Charge Code |
2000917
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$91.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.14
|
|
|
XR MAMMOGRAPHY SCREEN BI
|
Facility
|
OP
|
$607.60
|
|
|
Service Code
|
HCPCS 77057
|
| Hospital Charge Code |
2000917
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$17.26 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$230.89
|
| Rate for Payer: Aetna Medicare Advantage |
$182.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.94
|
| Rate for Payer: Cigna Commercial |
$303.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.98
|
| Rate for Payer: Oxford Commercial |
$1,688.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,884.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.26
|
|
|
XR MANDIBLE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
2000354
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR MANDIBLE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
2000354
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$2,231.00 |
| 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 |
$33.00
|
| 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 |
$86.94
|
| 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 |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| 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: Wellcare New Jersey Medicaid/Family Care |
$1,627.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
XR MANDIBLE PARTIAL < 4 VIEW
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70100
|
| Hospital Charge Code |
2011080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
XR MANDIBLE PARTIAL < 4 VIEW
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 70100
|
| Hospital Charge Code |
2011080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$2,231.00 |
| 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 |
$27.23
|
| 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 |
$72.37
|
| 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 |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.39
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$216.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
XR MASTOIDS COMP STUDY
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
HCPCS 70130
|
| Hospital Charge Code |
2000438
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$70.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.65
|
|
|
XR MASTOIDS COMP STUDY
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
HCPCS 70130
|
| Hospital Charge Code |
2000438
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$2,231.00 |
| 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 |
$40.54
|
| 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 |
$86.94
|
| 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 |
$122.46
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.88
|
| 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 |
$13.38
|
|
|
XR MECH REMOV TUNN CV CATH
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
5600138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
XR MECH REMOV TUNN CV CATH
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
321036595
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.31 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| 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 |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$3,751.17
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,021.81
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$488.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$439.31
|
|
|
XR MECH REMOV TUNN CV CATH
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
5600138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.31 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| 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 |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$3,751.17
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,021.81
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$488.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$439.31
|
|
|
XR MECH REMOV TUNN CV CATH
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
321036595
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
XR MEC REMOV TUN CV CATH LUMEN
|
Facility
|
OP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
321036596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.88 |
| Max. Negotiated Rate |
$6,783.93 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| 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 |
$6,783.93
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,665.09
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$202.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$181.88
|
|
|
XR MEC REMOV TUN CV CATH LUMEN
|
Facility
|
IP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
5600139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
|
|
XR MEC REMOV TUN CV CATH LUMEN
|
Facility
|
OP
|
$4,914.50
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
366836596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.57 |
| Max. Negotiated Rate |
$6,783.93 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| 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 |
$6,783.93
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,277.77
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$737.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$155.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.57
|
|
|
XR MEC REMOV TUN CV CATH LUMEN
|
Facility
|
IP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
321036596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
|
|
XR MEC REMOV TUN CV CATH LUMEN
|
Facility
|
OP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
5600139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.88 |
| Max. Negotiated Rate |
$6,783.93 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| 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 |
$6,783.93
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,665.09
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$202.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$181.88
|
|
|
XR MEC REMOV TUN CV CATH LUMEN
|
Facility
|
OP
|
$4,914.50
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
411036596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.57 |
| Max. Negotiated Rate |
$6,783.93 |
| Rate for Payer: Aetna Commercial |
$5,086.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6,059.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,783.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,870.14
|
| 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 |
$6,783.93
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,776.63
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,926.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,870.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,277.77
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$737.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$155.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,870.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.57
|
|
|
XR MEC REMOV TUN CV CATH LUMEN
|
Facility
|
IP
|
$4,914.50
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
411036596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$737.17 |
| Max. Negotiated Rate |
$737.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$737.17
|
|
|
XR MEC REMOV TUN CV CATH LUMEN
|
Facility
|
IP
|
$4,914.50
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
366836596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$737.17 |
| Max. Negotiated Rate |
$737.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$737.17
|
|
|
XR MYELOGRAM CERVICAL
|
Facility
|
IP
|
$2,963.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
2004372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.45 |
| Max. Negotiated Rate |
$444.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.45
|
|
|
XR MYELOGRAM CERVICAL
|
Facility
|
OP
|
$2,963.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
2004372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$3,378.36 |
| Rate for Payer: Aetna Commercial |
$2,533.19
|
| Rate for Payer: Aetna Medicare Advantage |
$3,017.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,378.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,378.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$931.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$92.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,378.36
|
| Rate for Payer: Cigna Commercial |
$1,866.82
|
| Rate for Payer: Cigna Medicare Advantage |
$651.92
|
| Rate for Payer: Clover Medicare Advantage |
$884.75
|
| Rate for Payer: EmblemHealth Commercial |
$2,793.96
|
| Rate for Payer: Humana Medicare Advantage |
$959.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$931.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$770.38
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$93.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$931.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$931.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$84.15
|
|
|
XR MYELOGRAM LUMBOSACRAL
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
2000735
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$3,378.36 |
| Rate for Payer: Aetna Commercial |
$2,533.19
|
| Rate for Payer: Aetna Medicare Advantage |
$3,017.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,378.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,378.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$931.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$92.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,378.36
|
| Rate for Payer: Cigna Commercial |
$1,866.82
|
| Rate for Payer: Cigna Medicare Advantage |
$651.92
|
| Rate for Payer: Clover Medicare Advantage |
$884.75
|
| Rate for Payer: EmblemHealth Commercial |
$2,793.96
|
| Rate for Payer: Humana Medicare Advantage |
$959.26
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$931.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$931.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$931.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
