|
IR INTRAVASCULAR US ADD ON
|
Facility
|
IP
|
$450.00
|
|
| Hospital Charge Code |
5700294
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
|
|
IR INTRAVASCULAR US ADD ON
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
5700294
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Medicare Advantage |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.75
|
| Rate for Payer: Cigna Commercial |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.50
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR-INTRAVERTEBRAL DISK
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
321062267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-INTRAVERTEBRAL DISK
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
2690225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-INTRAVERTEBRAL DISK
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
321062267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.03 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,017.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$441.03
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR-INTRAVERTEBRAL DISK
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
2690225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.03 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,017.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$441.03
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR-INTRAVERTEBRAL DISK
|
Facility
|
IP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
7411647
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$508.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
|
|
IR-INTRAVERTEBRAL DISK
|
Facility
|
OP
|
$3,392.55
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
7411647
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.03 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,017.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,017.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$865.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$865.10
|
| 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 |
$865.10
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$441.03
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
|
|
IR INTRO CATH VENA CAVA I OR S
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
321036010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
IR INTRO CATH VENA CAVA I OR S
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
411036010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
IR INTRO CATH VENA CAVA I OR S
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
7411414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
IR INTRO CATH VENA CAVA I OR S
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
411036010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.33
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| 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 |
$105.68
|
| Rate for Payer: Cigna Commercial |
$102.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR INTRO CATH VENA CAVA I OR S
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
2004711
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
IR INTRO CATH VENA CAVA I OR S
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
2004711
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.33
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| 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 |
$105.68
|
| Rate for Payer: Cigna Commercial |
$102.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR INTRO CATH VENA CAVA I OR S
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
366836010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.33
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| 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 |
$105.68
|
| Rate for Payer: Cigna Commercial |
$102.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR INTRO CATH VENA CAVA I OR S
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
366836010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
IR INTRO CATH VENA CAVA I OR S
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
7411414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.33
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| 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 |
$105.68
|
| Rate for Payer: Cigna Commercial |
$102.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR INTRO CATH VENA CAVA I OR S
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
321036010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.33
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| 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 |
$105.68
|
| Rate for Payer: Cigna Commercial |
$102.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR-INTRO CTH-EXT ARTERY
|
Facility
|
OP
|
$1,443.00
|
|
|
Service Code
|
HCPCS 3614050
|
| Hospital Charge Code |
321036140B
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.59 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$432.90
|
| Rate for Payer: Aetna Medicare Advantage |
$432.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.96
|
| 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 |
$367.96
|
| Rate for Payer: Cigna Commercial |
$721.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.45
|
|
|
IR-INTRO CTH-EXT ARTERY
|
Facility
|
OP
|
$1,443.00
|
|
|
Service Code
|
HCPCS 3614050
|
| Hospital Charge Code |
411036140B
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.59 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$432.90
|
| Rate for Payer: Aetna Medicare Advantage |
$432.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.96
|
| 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 |
$367.96
|
| Rate for Payer: Cigna Commercial |
$721.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.45
|
|
|
IR-INTRO CTH-EXT ARTERY
|
Facility
|
IP
|
$1,443.00
|
|
|
Service Code
|
HCPCS 3614050
|
| Hospital Charge Code |
411036140B
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.45 |
| Max. Negotiated Rate |
$216.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.45
|
|
|
IR-INTRO CTH-EXT ARTERY
|
Facility
|
IP
|
$1,443.00
|
|
|
Service Code
|
HCPCS 3614050
|
| Hospital Charge Code |
321036140B
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.45 |
| Max. Negotiated Rate |
$216.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.45
|
|
|
IR-INTRO CTH-EXT ARTERY
|
Facility
|
IP
|
$1,443.00
|
|
|
Service Code
|
HCPCS 3614050
|
| Hospital Charge Code |
3668361405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.45 |
| Max. Negotiated Rate |
$216.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.45
|
|
|
IR-INTRO CTH-EXT ARTERY
|
Facility
|
OP
|
$1,443.00
|
|
|
Service Code
|
HCPCS 3614050
|
| Hospital Charge Code |
2670190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.59 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$432.90
|
| Rate for Payer: Aetna Medicare Advantage |
$432.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.96
|
| 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 |
$367.96
|
| Rate for Payer: Cigna Commercial |
$721.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.45
|
|
|
IR-INTRO CTH-EXT ARTERY
|
Facility
|
IP
|
$1,443.00
|
|
|
Service Code
|
HCPCS 3614050
|
| Hospital Charge Code |
2670190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.45 |
| Max. Negotiated Rate |
$216.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.45
|
|
