|
ARTERIAL DUPLEX U/L UE
|
Facility
|
IP
|
$757.65
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
94053200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$113.65 |
| Max. Negotiated Rate |
$113.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.65
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74116042
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$182.40
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.11
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
7411766
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.20
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
2692060
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$182.40
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.11
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74116042
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.20
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74117042
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
7411766
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$182.40
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.11
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74117042
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$5,160.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
OP
|
$757.65
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
94053200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$227.29
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.08
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74115042
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$5,160.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74117043
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$5,160.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74116043
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74117043
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
2692135
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
2692135
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$5,160.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74115043
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74116043
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$5,160.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74115043
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$5,160.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
OP
|
$757.65
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
94053235
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$6,760.00 |
| 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 |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.32
|
| 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 |
$487.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.32
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| 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 |
$227.29
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.08
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
IP
|
$757.65
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
94053235
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$113.65 |
| Max. Negotiated Rate |
$113.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.65
|
|
|
ARTERIAL EMBOLECTOMY CATHETER
|
Facility
|
IP
|
$291.00
|
|
| Hospital Charge Code |
270331786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$70.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.42
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$64.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.65
|
|
|
ARTERIAL EMBOLECTOMY CATHETER
|
Facility
|
OP
|
$291.00
|
|
| Hospital Charge Code |
270331786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Aetna Commercial |
$110.58
|
| Rate for Payer: Aetna Medicare Advantage |
$87.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$74.20
|
| Rate for Payer: Cigna Commercial |
$145.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.42
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$64.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.71
|
|
|
ARTERIAL GRAFT COMPONENT
|
Facility
|
IP
|
$4,600.00
|
|
| Hospital Charge Code |
270645660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$690.00
|
|
|
ARTERIAL GRAFT COMPONENT
|
Facility
|
OP
|
$4,600.00
|
|
| Hospital Charge Code |
270645660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.86 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,748.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,380.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,173.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,173.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$2,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,380.00
|
| Rate for Payer: Oxford Commercial |
$920.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$690.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$920.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$110.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$121.90
|
|
|
ARTERIAL LINE INSERTION
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
83080005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
|
