|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
321037229L
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
7411936
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
7411936
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
366837229L
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
321037229L
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
366837229L
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
2691420
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
2691420
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
321037229R
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
IP
|
$8,231.00
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
7411937
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,234.65 |
| Max. Negotiated Rate |
$1,234.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,234.65
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
411037229R
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
OP
|
$8,231.00
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
7411937
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,070.03 |
| Max. Negotiated Rate |
$4,115.50 |
| Rate for Payer: Aetna Commercial |
$2,469.30
|
| Rate for Payer: Aetna Medicare Advantage |
$2,469.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,098.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,098.91
|
| 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 |
$2,098.91
|
| Rate for Payer: Cigna Commercial |
$4,115.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,070.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,234.65
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
366837229R
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
2691425
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
321037229R
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
411037229R
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
366837229R
|
|
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
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
2691425
|
|
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
|
|
|
IR ATHERECTOMY VISCERAL
|
Facility
|
OP
|
$3,084.40
|
|
| Hospital Charge Code |
2600047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$400.97 |
| Max. Negotiated Rate |
$1,542.20 |
| Rate for Payer: Aetna Commercial |
$925.32
|
| Rate for Payer: Aetna Medicare Advantage |
$925.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$786.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$786.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$786.52
|
| Rate for Payer: Cigna Commercial |
$1,542.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$400.97
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR ATHERECTOMY VISCERAL
|
Facility
|
IP
|
$3,084.40
|
|
| Hospital Charge Code |
2600047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$462.66 |
| Max. Negotiated Rate |
$462.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.66
|
|
|
IR AV FISTULA OR GRAFT VENOUS
|
Facility
|
OP
|
$21,962.30
|
|
|
Service Code
|
HCPCS 35476
|
| Hospital Charge Code |
7411409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$10,981.15 |
| Rate for Payer: Aetna Commercial |
$6,588.69
|
| Rate for Payer: Aetna Medicare Advantage |
$6,588.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,600.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,600.39
|
| 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 |
$5,600.39
|
| Rate for Payer: Cigna Commercial |
$10,981.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,855.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,294.34
|
|
|
IR AV FISTULA OR GRAFT VENOUS
|
Facility
|
OP
|
$21,962.30
|
|
|
Service Code
|
HCPCS 35476
|
| Hospital Charge Code |
5600184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$10,981.15 |
| Rate for Payer: Aetna Commercial |
$6,588.69
|
| Rate for Payer: Aetna Medicare Advantage |
$6,588.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,600.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,600.39
|
| 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 |
$5,600.39
|
| Rate for Payer: Cigna Commercial |
$10,981.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,855.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,294.34
|
|
|
IR AV FISTULA OR GRAFT VENOUS
|
Facility
|
IP
|
$21,962.30
|
|
|
Service Code
|
HCPCS 35476
|
| Hospital Charge Code |
7411409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,294.34 |
| Max. Negotiated Rate |
$3,294.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,294.34
|
|
|
IR AV FISTULA OR GRAFT VENOUS
|
Facility
|
IP
|
$21,962.30
|
|
|
Service Code
|
HCPCS 35476
|
| Hospital Charge Code |
5600184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,294.34 |
| Max. Negotiated Rate |
$3,294.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,294.34
|
|
|
IR AVM THORACIC SPINAL CRD VES
|
Facility
|
IP
|
$38,895.00
|
|
|
Service Code
|
HCPCS 63251
|
| Hospital Charge Code |
5700252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,834.25 |
| Max. Negotiated Rate |
$5,834.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,834.25
|
|