|
IR-EST ACCE CAR/VET AR-RT
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 36100RT
|
| Hospital Charge Code |
2691195
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$71.70
|
| Rate for Payer: Aetna Medicare Advantage |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.95
|
| 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 |
$60.95
|
| Rate for Payer: Cigna Commercial |
$119.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.85
|
|
|
IR-EST ACCE CAR/VET AR-RT
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 36100RT
|
| Hospital Charge Code |
2691195
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.85
|
|
|
IR-EST ACCE CAR/VET AR-RT
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 36100RT
|
| Hospital Charge Code |
7411907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$119.50 |
| Rate for Payer: Aetna Commercial |
$71.70
|
| Rate for Payer: Aetna Medicare Advantage |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$60.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$60.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$60.95
|
| Rate for Payer: Cigna Commercial |
$119.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.07
|
| Rate for Payer: Oxford Commercial |
$119.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$119.50
|
|
|
IR-EST ACCES BRACH ART-BI
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 3612050
|
| Hospital Charge Code |
2690450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES BRACH ART-BI
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 3612050
|
| Hospital Charge Code |
2690450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES BRACH ART-LT
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140LT
|
| Hospital Charge Code |
2691200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Oxford Commercial |
$77.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$77.00
|
|
|
IR-EST ACCES BRACH ART-LT
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140LT
|
| Hospital Charge Code |
2691200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES BRACH ART-RT
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140RT
|
| Hospital Charge Code |
2691205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES BRACH ART-RT
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140RT
|
| Hospital Charge Code |
2691205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-LT
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140LT
|
| Hospital Charge Code |
366836140L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-LT
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140LT
|
| Hospital Charge Code |
321036140L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-LT
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140LT
|
| Hospital Charge Code |
411036140L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-LT
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140LT
|
| Hospital Charge Code |
2691210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-LT
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140LT
|
| Hospital Charge Code |
2691210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-LT
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140LT
|
| Hospital Charge Code |
321036140L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-LT
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140LT
|
| Hospital Charge Code |
411036140L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-LT
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140LT
|
| Hospital Charge Code |
366836140L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-RT
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140RT
|
| Hospital Charge Code |
366836140R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-RT
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140RT
|
| Hospital Charge Code |
321036140R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-RT
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140RT
|
| Hospital Charge Code |
2691215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-RT
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140RT
|
| Hospital Charge Code |
321036140R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-RT
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140RT
|
| Hospital Charge Code |
411036140R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-RT
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140RT
|
| Hospital Charge Code |
366836140R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-RT
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140RT
|
| Hospital Charge Code |
411036140R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
IR-EST ACCES EXTRE ART-RT
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 36140RT
|
| Hospital Charge Code |
2691215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| 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 |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|