|
IR-EXT VENOGRAPHY INJ-LT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 36500LT
|
| Hospital Charge Code |
366836500L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$198.74
|
| Rate for Payer: Aetna Medicare Advantage |
$156.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.37
|
| Rate for Payer: Cigna Commercial |
$261.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.86
|
|
|
IR-EXT VENOGRAPHY INJ-RT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 36500RT
|
| Hospital Charge Code |
411036005R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
|
|
IR-EXT VENOGRAPHY INJ-RT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 36500RT
|
| Hospital Charge Code |
411036005R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$198.74
|
| Rate for Payer: Aetna Medicare Advantage |
$156.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.37
|
| Rate for Payer: Cigna Commercial |
$261.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.86
|
|
|
IR-EXT VENOGRAPHY INJ-RT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 36005RT
|
| Hospital Charge Code |
7411896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$261.50 |
| Rate for Payer: Aetna Commercial |
$198.74
|
| Rate for Payer: Aetna Medicare Advantage |
$156.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.37
|
| Rate for Payer: Cigna Commercial |
$261.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.90
|
| Rate for Payer: Oxford Commercial |
$104.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$104.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.86
|
|
|
IR-EXT VENOGRAPHY INJ-RT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 36005RT
|
| Hospital Charge Code |
321036005R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$198.74
|
| Rate for Payer: Aetna Medicare Advantage |
$156.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.37
|
| Rate for Payer: Cigna Commercial |
$261.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.86
|
|
|
IR-EXT VENOGRAPHY INJ-RT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 36500RT
|
| Hospital Charge Code |
366836500R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
|
|
IR-EXT VENOGRAPHY INJ-RT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 36500RT
|
| Hospital Charge Code |
366836500R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$198.74
|
| Rate for Payer: Aetna Medicare Advantage |
$156.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.37
|
| Rate for Payer: Cigna Commercial |
$261.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.86
|
|
|
IR-EXT VENOGRAPHY INJ-RT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 36005RT
|
| Hospital Charge Code |
2691150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
|
|
IR-EXT VENOGRAPHY INJ-RT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 36005RT
|
| Hospital Charge Code |
2691150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$198.74
|
| Rate for Payer: Aetna Medicare Advantage |
$156.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.37
|
| Rate for Payer: Cigna Commercial |
$261.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$156.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.86
|
|
|
IR-EXT VENOGRAPHY INJ-RT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 36005RT
|
| Hospital Charge Code |
7411896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
|
|
IR-EXT VENOGRAPHY INJ-RT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 36005RT
|
| Hospital Charge Code |
321036005R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.45
|
|
|
IR FEM/POPL REVASC STNT & ATHE
|
Facility
|
OP
|
$80,096.45
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
366837227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$40,048.22 |
| Rate for Payer: Aetna Commercial |
$30,436.65
|
| Rate for Payer: Aetna Medicare Advantage |
$24,028.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20,424.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20,424.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20,424.59
|
| Rate for Payer: Cigna Commercial |
$40,048.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,028.94
|
| Rate for Payer: Oxford Commercial |
$11,667.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12,014.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$20,074.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,930.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,122.56
|
|
|
IR FEM/POPL REVASC STNT & ATHE
|
Facility
|
IP
|
$80,096.45
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
366837227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,014.47 |
| Max. Negotiated Rate |
$12,014.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12,014.47
|
|
|
IR FEM/POPL REVASC STNT & ATHE
|
Facility
|
IP
|
$89,914.40
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
5600208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,487.16 |
| Max. Negotiated Rate |
$13,487.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13,487.16
|
|
|
IR FEM/POPL REVASC STNT & ATHE
|
Facility
|
OP
|
$80,096.45
|
|
|
Service Code
|
HCPCS 37275
|
| Hospital Charge Code |
411037227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$78,613.74 |
| Rate for Payer: Aetna Commercial |
$59,237.44
|
| Rate for Payer: Aetna Medicare Advantage |
$70,562.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78,613.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78,613.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21,778.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78,613.74
|
| Rate for Payer: Cigna Commercial |
$43,654.87
|
| Rate for Payer: Cigna Medicare Advantage |
$21,778.47
|
| Rate for Payer: Clover Medicare Advantage |
$20,689.55
|
| Rate for Payer: EmblemHealth Commercial |
$65,335.41
|
| Rate for Payer: Humana Medicare Advantage |
$22,431.82
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21,778.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,028.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12,014.47
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,930.32
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21,778.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$21,778.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,122.56
|
|
|
IR FEM/POPL REVASC STNT & ATHE
|
Facility
|
IP
|
$131,167.45
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
7411517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19,675.12 |
| Max. Negotiated Rate |
$19,675.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19,675.12
|
|
|
IR FEM/POPL REVASC STNT & ATHE
|
Facility
|
IP
|
$89,914.40
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
321037227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,487.16 |
| Max. Negotiated Rate |
$13,487.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13,487.16
|
|
|
IR FEM/POPL REVASC STNT & ATHE
|
Facility
|
OP
|
$89,914.40
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
321037227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$44,957.20 |
| Rate for Payer: Aetna Commercial |
$34,167.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26,974.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22,928.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22,928.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22,928.17
|
| Rate for Payer: Cigna Commercial |
$44,957.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26,974.32
|
| Rate for Payer: Oxford Commercial |
$11,667.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13,487.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$20,074.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,166.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,382.73
|
|
|
IR FEM/POPL REVASC STNT & ATHE
|
Facility
|
OP
|
$89,914.40
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
5600208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$44,957.20 |
| Rate for Payer: Aetna Commercial |
$34,167.47
|
| Rate for Payer: Aetna Medicare Advantage |
$26,974.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22,928.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22,928.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22,928.17
|
| Rate for Payer: Cigna Commercial |
$44,957.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26,974.32
|
| Rate for Payer: Oxford Commercial |
$11,667.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13,487.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$20,074.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,166.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,382.73
|
|
|
IR FEM/POPL REVASC STNT & ATHE
|
Facility
|
IP
|
$80,096.45
|
|
|
Service Code
|
HCPCS 37275
|
| Hospital Charge Code |
411037227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,014.47 |
| Max. Negotiated Rate |
$12,014.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12,014.47
|
|
|
IR FEM/POPL REVASC STNT & ATHE
|
Facility
|
OP
|
$131,167.45
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
7411517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$65,583.73 |
| Rate for Payer: Aetna Commercial |
$49,843.63
|
| Rate for Payer: Aetna Medicare Advantage |
$39,350.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33,447.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33,447.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33,447.70
|
| Rate for Payer: Cigna Commercial |
$65,583.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39,350.24
|
| Rate for Payer: Oxford Commercial |
$11,667.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19,675.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$20,074.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3,161.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3,475.94
|
|
|
IR FEM/POPL REVASC W/STENT
|
Facility
|
OP
|
$52,548.60
|
|
|
Service Code
|
HCPCS 37267
|
| Hospital Charge Code |
411037226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,266.42 |
| Max. Negotiated Rate |
$49,506.31 |
| Rate for Payer: Aetna Commercial |
$37,304.26
|
| Rate for Payer: Aetna Medicare Advantage |
$44,435.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49,506.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49,506.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$13,714.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49,506.31
|
| Rate for Payer: Cigna Commercial |
$27,491.26
|
| Rate for Payer: Cigna Medicare Advantage |
$13,714.80
|
| Rate for Payer: Clover Medicare Advantage |
$13,029.06
|
| Rate for Payer: EmblemHealth Commercial |
$41,144.40
|
| Rate for Payer: Humana Medicare Advantage |
$14,126.24
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$13,714.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,764.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,882.29
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,266.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$13,714.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$13,714.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,392.54
|
|
|
IR FEM/POPL REVASC W/STENT
|
Facility
|
IP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
321037226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,360.60 |
| Max. Negotiated Rate |
$11,360.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
|
|
IR FEM/POPL REVASC W/STENT
|
Facility
|
OP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
7411516
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$37,868.67 |
| Rate for Payer: Aetna Commercial |
$28,780.19
|
| Rate for Payer: Aetna Medicare Advantage |
$22,721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19,313.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19,313.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19,313.02
|
| Rate for Payer: Cigna Commercial |
$37,868.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22,721.20
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,825.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,007.04
|
|
|
IR FEM/POPL REVASC W/STENT
|
Facility
|
IP
|
$52,548.60
|
|
|
Service Code
|
HCPCS 37267
|
| Hospital Charge Code |
411037226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,882.29 |
| Max. Negotiated Rate |
$7,882.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,882.29
|
|
