|
DIAB NUTRITION COUNSEL NEW PT
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
9200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$405.00
|
|
|
DIAB NUTRITION COUNSEL NEW PT
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
9200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,026.00
|
| Rate for Payer: Aetna Medicare Advantage |
$810.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$688.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$688.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$702.00
|
| Rate for Payer: Oxford Commercial |
$1,060.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$405.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,203.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$85.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.68
|
|
|
DIAB NUTRITION COUNSEL NEW PT
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
9300006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$1,203.00 |
| Rate for Payer: Aetna Commercial |
$42.56
|
| Rate for Payer: Aetna Medicare Advantage |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.56
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.12
|
| Rate for Payer: Oxford Commercial |
$1,060.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,203.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.18
|
|
|
DIAB NUTRITION COUNSEL NEW PT
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
9300006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.80
|
|
|
DIAG LAPARO,SEPARATE PROC
|
Facility
|
OP
|
$45,838.40
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
160000209
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,301.81 |
| Max. Negotiated Rate |
$26,053.61 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$26,053.61
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,917.98
|
| Rate for Payer: Oxford Commercial |
$11,677.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,875.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,906.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,448.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,301.81
|
|
|
DIAG LAPARO,SEPARATE PROC
|
Facility
|
IP
|
$45,838.40
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
160000209
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,875.76 |
| Max. Negotiated Rate |
$6,875.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,875.76
|
|
|
DIAG LAPARO,SEPARATE PROC
|
Facility
|
OP
|
$45,838.40
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
1600000547
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,301.81 |
| Max. Negotiated Rate |
$26,053.61 |
| Rate for Payer: Aetna Commercial |
$19,535.72
|
| Rate for Payer: Aetna Medicare Advantage |
$23,270.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26,053.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$7,182.25
|
| 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 |
$26,053.61
|
| Rate for Payer: Cigna Commercial |
$14,396.79
|
| Rate for Payer: Cigna Medicare Advantage |
$7,182.25
|
| Rate for Payer: Clover Medicare Advantage |
$6,823.14
|
| Rate for Payer: EmblemHealth Commercial |
$21,546.75
|
| Rate for Payer: Humana Medicare Advantage |
$7,397.72
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$7,182.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,917.98
|
| Rate for Payer: Oxford Commercial |
$11,677.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,875.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,906.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,448.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$7,182.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,301.81
|
|
|
DIAG LAPARO,SEPARATE PROC
|
Facility
|
IP
|
$45,838.40
|
|
|
Service Code
|
HCPCS 49320
|
| Hospital Charge Code |
1600000547
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,875.76 |
| Max. Negotiated Rate |
$6,875.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,875.76
|
|
|
DIAGNOSTIC ANOSCOPY
|
Facility
|
IP
|
$2,349.65
|
|
|
Service Code
|
HCPCS 46601
|
| Hospital Charge Code |
1600000609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$352.45 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$352.45
|
|
|
DIAGNOSTIC ANOSCOPY
|
Facility
|
OP
|
$2,349.65
|
|
|
Service Code
|
HCPCS 46601
|
| Hospital Charge Code |
1600000609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$66.73 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$1,443.56
|
| Rate for Payer: Aetna Medicare Advantage |
$1,719.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,925.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,925.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$530.72
|
| 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 |
$1,925.19
|
| Rate for Payer: Cigna Commercial |
$1,063.82
|
| Rate for Payer: Cigna Medicare Advantage |
$530.72
|
| Rate for Payer: Clover Medicare Advantage |
$504.18
|
| Rate for Payer: EmblemHealth Commercial |
$1,592.16
|
| Rate for Payer: Humana Medicare Advantage |
$546.64
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$530.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$610.91
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$352.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.25
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$530.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$66.73
|
|
|
DIAGNOSTIC ANOSCOPY & BIOPSY
|
Facility
|
IP
|
$6,942.80
|
|
|
Service Code
|
HCPCS 46607
|
| Hospital Charge Code |
1600000555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,041.42 |
| Max. Negotiated Rate |
$1,041.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,041.42
|
|
|
DIAGNOSTIC ANOSCOPY & BIOPSY
|
Facility
|
OP
|
$6,942.80
|
|
|
Service Code
|
HCPCS 46607
|
| Hospital Charge Code |
1600000555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$197.18 |
| Max. Negotiated Rate |
$5,347.00 |
| Rate for Payer: Aetna Commercial |
$3,866.86
|
| Rate for Payer: Aetna Medicare Advantage |
$4,606.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,157.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,157.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,421.64
|
| 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 |
$5,157.00
|
| Rate for Payer: Cigna Commercial |
$2,849.67
|
| Rate for Payer: Cigna Medicare Advantage |
$1,421.64
|
| Rate for Payer: Clover Medicare Advantage |
$1,350.56
|
| Rate for Payer: EmblemHealth Commercial |
$4,264.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,464.29
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,421.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,805.13
|
| Rate for Payer: Oxford Commercial |
$5,018.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,041.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,347.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$219.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,421.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,421.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$197.18
|
|
|
DIAGNOSTIC CATH 5FR JL5
|
Facility
|
OP
|
$47.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658157S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare Advantage |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.11
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.35
|
|
|
DIAGNOSTIC CATH 5FR JL5
|
Facility
|
IP
|
$47.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658157S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
|
|
DIAGNOSTIC CATH 5FR JL5
|
Facility
|
IP
|
$47.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658157N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
|
|
DIAGNOSTIC CATH 5FR JL5
|
Facility
|
OP
|
$47.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270658157N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare Advantage |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.11
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.35
|
|
|
DIAGNOSTIC MAMMO BILAT INC CAD
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
94061496
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,170.00
|
| Rate for Payer: Oxford Commercial |
$1,688.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,884.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$142.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$127.80
|
|
|
DIAGNOSTIC MAMMO BILAT INC CAD
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
85000902
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
DIAGNOSTIC MAMMO BILAT INC CAD
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
9406404
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
DIAGNOSTIC MAMMO BILAT INC CAD
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
94061496
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
DIAGNOSTIC MAMMO BILAT INC CAD
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
2709036
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,170.00
|
| Rate for Payer: Oxford Commercial |
$1,688.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,884.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$142.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$127.80
|
|
|
DIAGNOSTIC MAMMO BILAT INC CAD
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
2709036
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
DIAGNOSTIC MAMMO BILAT INC CAD
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
85000902
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,170.00
|
| Rate for Payer: Oxford Commercial |
$1,688.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,884.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$142.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$127.80
|
|
|
DIAGNOSTIC MAMMO BILAT INC CAD
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
9406404
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,170.00
|
| Rate for Payer: Oxford Commercial |
$1,688.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,884.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$142.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$127.80
|
|
|
DIAGNOSTIC MAMMO UNI INC CAD
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 77065
|
| Hospital Charge Code |
94061495
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$106.36 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,170.00
|
| Rate for Payer: Oxford Commercial |
$1,688.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,884.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$142.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$127.80
|
|
