|
IR-INSERT CANNU VEIN-VEIN
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS 36800
|
| Hospital Charge Code |
2690080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$13,251.23 |
| Rate for Payer: Aetna Commercial |
$1,935.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,935.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,644.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,644.75
|
| 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 |
$1,644.75
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$838.50
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$967.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,851.00
|
|
|
IR-INSERT CATH VEIN
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
HCPCS 36500
|
| Hospital Charge Code |
2690055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.53 |
| Max. Negotiated Rate |
$172.84 |
| Rate for Payer: Aetna Commercial |
$84.30
|
| Rate for Payer: Aetna Medicare Advantage |
$84.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$146.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.66
|
| Rate for Payer: Cigna Commercial |
$172.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.53
|
| Rate for Payer: Oxford Commercial |
$140.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$140.50
|
|
|
IR-INSERT CATH VEIN
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
HCPCS 36500
|
| Hospital Charge Code |
7411446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$42.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.15
|
|
|
IR-INSERT CATH VEIN
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
HCPCS 36500
|
| Hospital Charge Code |
2690055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$42.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.15
|
|
|
IR-INSERT CATH VEIN
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
HCPCS 36500
|
| Hospital Charge Code |
7411446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.53 |
| Max. Negotiated Rate |
$172.84 |
| Rate for Payer: Aetna Commercial |
$84.30
|
| Rate for Payer: Aetna Medicare Advantage |
$84.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$146.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.66
|
| Rate for Payer: Cigna Commercial |
$172.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.53
|
| Rate for Payer: Oxford Commercial |
$140.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$140.50
|
|
|
IR INSERT CV CATHPIC WPORT>5YR
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
2011096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR INSERT CV CATHPIC WPORT>5YR
|
Facility
|
IP
|
$3,317.65
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
7411461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.65 |
| Max. Negotiated Rate |
$497.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$497.65
|
|
|
IR INSERT CV CATHPIC WPORT>5YR
|
Facility
|
IP
|
$3,317.65
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
366836571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.65 |
| Max. Negotiated Rate |
$497.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$497.65
|
|
|
IR INSERT CV CATHPIC WPORT>5YR
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
321036571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR INSERT CV CATHPIC WPORT>5YR
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
321036571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,640.55
|
| Rate for Payer: Aetna Medicare Advantage |
$4,640.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,944.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,944.47
|
| 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 |
$3,944.47
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.90
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INSERT CV CATHPIC WPORT>5YR
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
2011096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,640.55
|
| Rate for Payer: Aetna Medicare Advantage |
$4,640.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,944.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,944.47
|
| 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 |
$3,944.47
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.90
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INSERT CV CATHPIC WPORT>5YR
|
Facility
|
OP
|
$3,317.65
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
7411461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.29 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$995.29
|
| Rate for Payer: Aetna Medicare Advantage |
$995.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$846.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$846.00
|
| 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 |
$846.00
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$431.29
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$497.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INSERT CV CATHPIC WPORT>5YR
|
Facility
|
OP
|
$3,317.65
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
366836571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.29 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$995.29
|
| Rate for Payer: Aetna Medicare Advantage |
$995.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$846.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$846.00
|
| 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 |
$846.00
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$431.29
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$497.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR INSERT CV CATH W/O PORT>5YR
|
Facility
|
IP
|
$7,852.40
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
2011091
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,177.86 |
| Max. Negotiated Rate |
$1,177.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,177.86
|
|
|
IR INSERT CV CATH W/O PORT>5YR
|
Facility
|
OP
|
$7,852.40
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
7411459
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$3,748.67 |
| Rate for Payer: Aetna Commercial |
$2,355.72
|
| Rate for Payer: Aetna Medicare Advantage |
$2,355.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,002.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,002.36
|
| 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 |
$2,002.36
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,020.81
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,177.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR INSERT CV CATH W/O PORT>5YR
|
Facility
|
IP
|
$7,852.40
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
7411459
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,177.86 |
| Max. Negotiated Rate |
$1,177.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,177.86
|
|
|
IR INSERT CV CATH W/O PORT>5YR
|
Facility
|
OP
|
$7,852.40
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
2011091
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$3,748.67 |
| Rate for Payer: Aetna Commercial |
$2,355.72
|
| Rate for Payer: Aetna Medicare Advantage |
$2,355.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,002.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,002.36
|
| 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 |
$2,002.36
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,020.81
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,177.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR INSERT HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 37182
|
| Hospital Charge Code |
321037182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.00
|
|
|
IR INSERT HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 37182
|
| Hospital Charge Code |
7411491
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.00
|
|
|
IR INSERT HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$18,561.00
|
|
|
Service Code
|
HCPCS 37182
|
| Hospital Charge Code |
411037182H
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,784.15 |
| Max. Negotiated Rate |
$2,784.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,784.15
|
|
|
IR INSERT HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 37182
|
| Hospital Charge Code |
321037182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$43,654.87 |
| Rate for Payer: Aetna Commercial |
$480.00
|
| Rate for Payer: Aetna Medicare Advantage |
$480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$408.00
|
| 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 |
$408.00
|
| Rate for Payer: Cigna Commercial |
$43,654.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.00
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,997.00
|
|
|
IR INSERT HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 37182
|
| Hospital Charge Code |
2011292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.00
|
|
|
IR INSERT HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 37182
|
| Hospital Charge Code |
7411491
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$43,654.87 |
| Rate for Payer: Aetna Commercial |
$480.00
|
| Rate for Payer: Aetna Medicare Advantage |
$480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$408.00
|
| 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 |
$408.00
|
| Rate for Payer: Cigna Commercial |
$43,654.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.00
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,997.00
|
|
|
IR INSERT HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 37182
|
| Hospital Charge Code |
2011292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$43,654.87 |
| Rate for Payer: Aetna Commercial |
$480.00
|
| Rate for Payer: Aetna Medicare Advantage |
$480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$408.00
|
| 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 |
$408.00
|
| Rate for Payer: Cigna Commercial |
$43,654.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.00
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,997.00
|
|
|
IR INSERT HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$18,561.00
|
|
|
Service Code
|
HCPCS 37182
|
| Hospital Charge Code |
411037182H
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$43,654.87 |
| Rate for Payer: Aetna Commercial |
$5,568.30
|
| Rate for Payer: Aetna Medicare Advantage |
$5,568.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,733.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,733.06
|
| 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 |
$4,733.06
|
| Rate for Payer: Cigna Commercial |
$43,654.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,412.93
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,784.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,997.00
|
|
