|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2250411
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$66.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2300904
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.47 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$840.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73092070
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.47 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$840.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
5100779
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.47 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$840.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73237025
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.27
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.68
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
4501032
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.27
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.68
|
|
|
IV PUSH (NON-CHEMO)***
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
3401010
|
|
Hospital Revenue Code
|
289
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
|
|
IV PUSH (NON-CHEMO)***
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
3401010
|
|
Hospital Revenue Code
|
289
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2,789.00 |
| Rate for Payer: Aetna Commercial |
$22.80
|
| Rate for Payer: Aetna Medicare Advantage |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.30
|
| Rate for Payer: Cigna Commercial |
$30.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.00
|
| Rate for Payer: Oxford Commercial |
$1,591.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,789.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.59
|
|
|
IV SET PUSH BUTTON W/LUER 25GX
|
Facility
|
OP
|
$321.90
|
|
| Hospital Charge Code |
270664447
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$160.95 |
| Rate for Payer: Aetna Commercial |
$122.32
|
| Rate for Payer: Aetna Medicare Advantage |
$96.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.08
|
| Rate for Payer: Cigna Commercial |
$160.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.57
|
| Rate for Payer: Oxford Commercial |
$64.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$64.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.53
|
|
|
IV SET PUSH BUTTON W/LUER 25GX
|
Facility
|
IP
|
$321.90
|
|
| Hospital Charge Code |
270664447
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$48.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.28
|
|
|
IV SOLUTION
|
Facility
|
IP
|
$8.75
|
|
| Hospital Charge Code |
270000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.31
|
|
|
IV SOLUTION
|
Facility
|
OP
|
$8.75
|
|
| Hospital Charge Code |
270000001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna Medicare Advantage |
$2.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.23
|
| Rate for Payer: Cigna Commercial |
$4.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.62
|
| Rate for Payer: Oxford Commercial |
$1.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
IV START KIT ******
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
7000813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.27
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.50
|
| Rate for Payer: Oxford Commercial |
$1.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.13
|
|
|
IV START KIT ******
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
7000813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
|
|
IV START KIT *******
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
8004418
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
IV START KIT *******
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
8004418
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.20
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
IVUS NON-CORONARY 1ST
|
Facility
|
IP
|
$5,170.30
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
2600243
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.54 |
| Max. Negotiated Rate |
$775.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$775.54
|
|
|
IVUS NON-CORONARY 1ST
|
Facility
|
OP
|
$5,170.30
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
7411535
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$2,585.15 |
| Rate for Payer: Aetna Commercial |
$1,964.71
|
| Rate for Payer: Aetna Medicare Advantage |
$1,551.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,318.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,318.43
|
| 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 |
$1,318.43
|
| Rate for Payer: Cigna Commercial |
$2,585.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,551.09
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$775.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$124.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$137.01
|
|
|
IVUS NON-CORONARY 1ST
|
Facility
|
IP
|
$5,170.30
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
7411535
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.54 |
| Max. Negotiated Rate |
$775.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$775.54
|
|
|
IVUS NON-CORONARY 1ST
|
Facility
|
OP
|
$5,170.30
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
321037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$2,585.15 |
| Rate for Payer: Aetna Commercial |
$1,964.71
|
| Rate for Payer: Aetna Medicare Advantage |
$1,551.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,318.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,318.43
|
| 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 |
$1,318.43
|
| Rate for Payer: Cigna Commercial |
$2,585.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,551.09
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$775.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$124.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$137.01
|
|
|
IVUS NON-CORONARY 1ST
|
Facility
|
IP
|
$5,170.30
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
321037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.54 |
| Max. Negotiated Rate |
$775.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$775.54
|
|
|
IVUS NON-CORONARY 1ST
|
Facility
|
OP
|
$5,170.30
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
2600243
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$2,585.15 |
| Rate for Payer: Aetna Commercial |
$1,964.71
|
| Rate for Payer: Aetna Medicare Advantage |
$1,551.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,318.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,318.43
|
| 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 |
$1,318.43
|
| Rate for Payer: Cigna Commercial |
$2,585.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,551.09
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$775.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$124.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$137.01
|
|
|
IVUS NON-CORONARY EA ADDL
|
Facility
|
IP
|
$5,170.30
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
2600244
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.54 |
| Max. Negotiated Rate |
$775.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$775.54
|
|
|
IVUS NON-CORONARY EA ADDL
|
Facility
|
OP
|
$5,170.30
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
2600244
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$2,585.15 |
| Rate for Payer: Aetna Commercial |
$1,964.71
|
| Rate for Payer: Aetna Medicare Advantage |
$1,551.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,318.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,318.43
|
| 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 |
$1,318.43
|
| Rate for Payer: Cigna Commercial |
$2,585.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,551.09
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$775.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$124.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$137.01
|
|
|
IVUS NON-CORONARY EA ADDL
|
Facility
|
IP
|
$5,170.30
|
|
|
Service Code
|
HCPCS 37253
|
| Hospital Charge Code |
321037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.54 |
| Max. Negotiated Rate |
$775.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$775.54
|
|
