|
FEM-POP ATHER W/STENT-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227LT
|
| Hospital Charge Code |
366837227L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$28,175.37
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,209.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227LT
|
| Hospital Charge Code |
7411932
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227LT
|
| Hospital Charge Code |
321037227L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$28,175.37
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,209.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227LT
|
| Hospital Charge Code |
321037227L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227LT
|
| Hospital Charge Code |
7411932
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$28,175.37
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,209.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
2691405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
7411933
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$28,175.37
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,209.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
366837227R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$28,175.37
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,209.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
321037227R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
321037227R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$28,175.37
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,209.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
7411933
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
366837227R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
2691405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$28,175.37
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,209.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM/POPL REVASC W/STENT
|
Facility
|
OP
|
$108,318.30
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
1600000503
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$54,159.15 |
| Rate for Payer: Aetna Commercial |
$32,495.49
|
| Rate for Payer: Aetna Medicare Advantage |
$32,495.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27,621.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27,621.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27,621.17
|
| Rate for Payer: Cigna Commercial |
$54,159.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14,081.38
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16,247.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,997.00
|
|
|
FEM/POPL REVASC W/STENT
|
Facility
|
IP
|
$108,318.30
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
1600000503
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,247.75 |
| Max. Negotiated Rate |
$16,247.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16,247.75
|
|
|
FEM/POPL REVAS W ARTHER
|
Facility
|
OP
|
$52,548.60
|
|
|
Service Code
|
HCPCS 37273
|
| Hospital Charge Code |
404637273
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,350.00 |
| Max. Negotiated Rate |
$43,654.87 |
| Rate for Payer: Aetna Commercial |
$15,764.58
|
| Rate for Payer: Aetna Medicare Advantage |
$15,764.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,399.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,399.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,399.89
|
| Rate for Payer: Cigna Commercial |
$43,654.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,831.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,882.29
|
|
|
FEM/POPL REVAS W ARTHER
|
Facility
|
IP
|
$52,548.60
|
|
|
Service Code
|
HCPCS 37273
|
| Hospital Charge Code |
404637273
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,882.29 |
| Max. Negotiated Rate |
$7,882.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,882.29
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
IP
|
$47,711.75
|
|
|
Service Code
|
HCPCS 37225
|
| Hospital Charge Code |
2709016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,156.76 |
| Max. Negotiated Rate |
$7,156.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,156.76
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
OP
|
$52,548.60
|
|
|
Service Code
|
HCPCS 37273
|
| Hospital Charge Code |
40437273
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,350.00 |
| Max. Negotiated Rate |
$43,654.87 |
| Rate for Payer: Aetna Commercial |
$15,764.58
|
| Rate for Payer: Aetna Medicare Advantage |
$15,764.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,399.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,399.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,399.89
|
| Rate for Payer: Cigna Commercial |
$43,654.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,831.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,882.29
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
OP
|
$47,711.75
|
|
|
Service Code
|
HCPCS 37225
|
| Hospital Charge Code |
2709016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$23,855.88 |
| Rate for Payer: Aetna Commercial |
$14,313.52
|
| Rate for Payer: Aetna Medicare Advantage |
$14,313.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,166.50
|
| Rate for Payer: Cigna Commercial |
$23,855.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,202.53
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,156.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,997.00
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
IP
|
$52,548.60
|
|
|
Service Code
|
HCPCS 37273
|
| Hospital Charge Code |
40437273
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,882.29 |
| Max. Negotiated Rate |
$7,882.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,882.29
|
|
|
FEM-POP STENT W/PTA-BI
|
Facility
|
OP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 3722650
|
| Hospital Charge Code |
7411805
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$37,868.67 |
| Rate for Payer: Aetna Commercial |
$22,721.20
|
| 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 |
$1,864.00
|
| 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 |
$9,845.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
|
|
FEM-POP STENT W/PTA-BI
|
Facility
|
IP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 3722650
|
| Hospital Charge Code |
7411805
|
|
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
|
|
|
FEM-POP STENT W/PTA-BI
|
Facility
|
IP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 3722650
|
| Hospital Charge Code |
2690530
|
|
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
|
|
|
FEM-POP STENT W/PTA-BI
|
Facility
|
OP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 3722650
|
| Hospital Charge Code |
2690530
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$37,868.67 |
| Rate for Payer: Aetna Commercial |
$22,721.20
|
| 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 |
$1,864.00
|
| 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 |
$9,845.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
|