|
IR ILIAC REVASC ADD-ON
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
5700303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR ILIAC REVASC ADD-ON
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
5700303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$540.84 |
| Max. Negotiated Rate |
$14,834.00 |
| Rate for Payer: Aetna Commercial |
$8,527.73
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,732.42
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$540.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$594.70
|
|
|
IR ILIAC REVASC ADD-ON
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
7411512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR ILIAC REVASC ADD-ON
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
321037222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR ILIAC REVASC ADD-ON
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
7411512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$540.84 |
| Max. Negotiated Rate |
$14,834.00 |
| Rate for Payer: Aetna Commercial |
$8,527.73
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,732.42
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$540.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$594.70
|
|
|
IR ILIAC REVASC ADD-ON
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37255
|
| Hospital Charge Code |
411037222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$540.84 |
| Max. Negotiated Rate |
$11,220.70 |
| Rate for Payer: Aetna Commercial |
$8,527.73
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,732.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$540.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$594.70
|
|
|
IR ILIAC REVASC ADD-ON
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
321037222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$540.84 |
| Max. Negotiated Rate |
$14,834.00 |
| Rate for Payer: Aetna Commercial |
$8,527.73
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,732.42
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$540.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$594.70
|
|
|
IR ILIAC REVASC ADD-ON
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37255
|
| Hospital Charge Code |
411037222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR ILIAC REVASC ADD-ON
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
5600203
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR ILIAC REVASC ADD-ON
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37222
|
| Hospital Charge Code |
5600203
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$540.84 |
| Max. Negotiated Rate |
$14,834.00 |
| Rate for Payer: Aetna Commercial |
$8,527.73
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,732.42
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$540.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$594.70
|
|
|
IR ILIAC REVASC W/STENT
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
5700302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$540.84 |
| Max. Negotiated Rate |
$16,605.00 |
| Rate for Payer: Aetna Commercial |
$8,527.73
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,732.42
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$540.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$594.70
|
|
|
IR ILIAC REVASC W/STENT
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
5700302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR ILIAC REVASC W/STENT
|
Facility
|
IP
|
$56,620.95
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
321037221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,493.14 |
| Max. Negotiated Rate |
$8,493.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,493.14
|
|
|
IR ILIAC REVASC W/STENT
|
Facility
|
OP
|
$56,620.95
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
5600202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,364.56 |
| Max. Negotiated Rate |
$28,310.47 |
| Rate for Payer: Aetna Commercial |
$21,515.96
|
| Rate for Payer: Aetna Medicare Advantage |
$16,986.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,438.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,438.34
|
| 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 |
$14,438.34
|
| Rate for Payer: Cigna Commercial |
$28,310.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,986.28
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,493.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,364.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,500.46
|
|
|
IR ILIAC REVASC W/STENT
|
Facility
|
OP
|
$56,620.95
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
321037221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,364.56 |
| Max. Negotiated Rate |
$28,310.47 |
| Rate for Payer: Aetna Commercial |
$21,515.96
|
| Rate for Payer: Aetna Medicare Advantage |
$16,986.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,438.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,438.34
|
| 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 |
$14,438.34
|
| Rate for Payer: Cigna Commercial |
$28,310.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,986.28
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,493.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,364.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,500.46
|
|
|
IR ILIAC REVASC W/STENT
|
Facility
|
IP
|
$56,620.95
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
5600202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,493.14 |
| Max. Negotiated Rate |
$8,493.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8,493.14
|
|
|
IR ILIAC REVASC W/STENT
|
Facility
|
OP
|
$35,674.97
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
7411511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$859.77 |
| Max. Negotiated Rate |
$17,837.49 |
| Rate for Payer: Aetna Commercial |
$13,556.49
|
| Rate for Payer: Aetna Medicare Advantage |
$10,702.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,097.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,097.12
|
| 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 |
$9,097.12
|
| Rate for Payer: Cigna Commercial |
$17,837.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,702.49
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,351.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$859.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$945.39
|
|
|
IR ILIAC REVASC W/STENT
|
Facility
|
IP
|
$35,674.97
|
|
|
Service Code
|
HCPCS 37221
|
| Hospital Charge Code |
7411511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,351.25 |
| Max. Negotiated Rate |
$5,351.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,351.25
|
|
|
IR ILIAC REVASC W/STENT ADD-ON
|
Facility
|
IP
|
$35,674.97
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
321037223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,351.25 |
| Max. Negotiated Rate |
$5,351.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,351.25
|
|
|
IR ILIAC REVASC W/STENT ADD-ON
|
Facility
|
IP
|
$22,441.40
|
|
| Hospital Charge Code |
5700304
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR ILIAC REVASC W/STENT ADD-ON
|
Facility
|
OP
|
$22,441.40
|
|
| Hospital Charge Code |
5700304
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$540.84 |
| Max. Negotiated Rate |
$11,220.70 |
| Rate for Payer: Aetna Commercial |
$8,527.73
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,732.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$540.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$594.70
|
|
|
IR ILIAC REVASC W/STENT ADD-ON
|
Facility
|
OP
|
$35,674.97
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
5600204
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$859.77 |
| Max. Negotiated Rate |
$17,837.49 |
| Rate for Payer: Aetna Commercial |
$13,556.49
|
| Rate for Payer: Aetna Medicare Advantage |
$10,702.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,097.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,097.12
|
| 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 |
$9,097.12
|
| Rate for Payer: Cigna Commercial |
$17,837.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,702.49
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,351.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,834.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$859.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$945.39
|
|
|
IR ILIAC REVASC W/STENT ADD-ON
|
Facility
|
IP
|
$15,877.00
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
366837223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,381.55 |
| Max. Negotiated Rate |
$2,381.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,381.55
|
|
|
IR ILIAC REVASC W/STENT ADD-ON
|
Facility
|
IP
|
$35,674.97
|
|
|
Service Code
|
HCPCS 37223
|
| Hospital Charge Code |
5600204
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,351.25 |
| Max. Negotiated Rate |
$5,351.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,351.25
|
|
|
IR ILIAC REVASC W/STENT ADD-ON
|
Facility
|
OP
|
$15,877.00
|
|
|
Service Code
|
HCPCS 37259
|
| Hospital Charge Code |
411037223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.64 |
| Max. Negotiated Rate |
$7,938.50 |
| Rate for Payer: Aetna Commercial |
$6,033.26
|
| Rate for Payer: Aetna Medicare Advantage |
$4,763.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,048.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,048.64
|
| 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 |
$4,048.64
|
| Rate for Payer: Cigna Commercial |
$7,938.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,763.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,381.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$382.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$420.74
|
|
