|
IR INTRO NDLE/CATH AV SNT ADDI
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36148
|
| Hospital Charge Code |
7411424
|
|
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 NDLE/CATH AV SNT ADDI
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36148
|
| Hospital Charge Code |
5600192
|
|
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 |
$207.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
IR INTRO NDLE/CATH AV SNT ADDI
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36148
|
| Hospital Charge Code |
7411424
|
|
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 |
$207.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
IR INTRO NDLE/CATH AV SNT ADDI
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36148
|
| Hospital Charge Code |
5600192
|
|
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 NDLE/CATH AV SNT INIT
|
Facility
|
IP
|
$1,310.20
|
|
|
Service Code
|
HCPCS 36147
|
| Hospital Charge Code |
5600191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$196.53 |
| Max. Negotiated Rate |
$196.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.53
|
|
|
IR INTRO NDLE/CATH AV SNT INIT
|
Facility
|
OP
|
$1,310.20
|
|
|
Service Code
|
HCPCS 36147
|
| Hospital Charge Code |
5600191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.33 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$393.06
|
| Rate for Payer: Aetna Medicare Advantage |
$393.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$334.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$334.10
|
| 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 |
$334.10
|
| Rate for Payer: Cigna Commercial |
$655.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.53
|
|
|
IR INTRO NDLE/CATH AV SNT INIT
|
Facility
|
OP
|
$1,310.20
|
|
|
Service Code
|
HCPCS 36147
|
| Hospital Charge Code |
7411423
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.33 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$393.06
|
| Rate for Payer: Aetna Medicare Advantage |
$393.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$334.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$334.10
|
| 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 |
$334.10
|
| Rate for Payer: Cigna Commercial |
$655.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.53
|
|
|
IR INTRO NDLE/CATH AV SNT INIT
|
Facility
|
IP
|
$1,310.20
|
|
|
Service Code
|
HCPCS 36147
|
| Hospital Charge Code |
7411423
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$196.53 |
| Max. Negotiated Rate |
$196.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.53
|
|
|
IR INTRO NEEDLE AORTA TRNSLUMB
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36160
|
| Hospital Charge Code |
2001345
|
|
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 NEEDLE AORTA TRNSLUMB
|
Facility
|
OP
|
$1,780.85
|
|
|
Service Code
|
HCPCS 36160
|
| Hospital Charge Code |
411036160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.91 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$534.25
|
| Rate for Payer: Aetna Medicare Advantage |
$534.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$454.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$454.12
|
| 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 |
$454.12
|
| Rate for Payer: Cigna Commercial |
$114.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.51
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR INTRO NEEDLE AORTA TRNSLUMB
|
Facility
|
IP
|
$1,780.85
|
|
|
Service Code
|
HCPCS 36160
|
| Hospital Charge Code |
411036160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.13 |
| Max. Negotiated Rate |
$267.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.13
|
|
|
IR INTRO NEEDLE AORTA TRNSLUMB
|
Facility
|
OP
|
$1,780.85
|
|
|
Service Code
|
HCPCS 36160
|
| Hospital Charge Code |
7411425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.91 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$534.25
|
| Rate for Payer: Aetna Medicare Advantage |
$534.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$454.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$454.12
|
| 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 |
$454.12
|
| Rate for Payer: Cigna Commercial |
$114.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.51
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR INTRO NEEDLE AORTA TRNSLUMB
|
Facility
|
IP
|
$1,780.85
|
|
|
Service Code
|
HCPCS 36160
|
| Hospital Charge Code |
7411425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.13 |
| Max. Negotiated Rate |
$267.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.13
|
|
|
IR INTRO NEEDLE AORTA TRNSLUMB
|
Facility
|
IP
|
$1,780.45
|
|
|
Service Code
|
HCPCS 36160
|
| Hospital Charge Code |
366836160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.07 |
| Max. Negotiated Rate |
$267.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.07
|
|
|
IR INTRO NEEDLE AORTA TRNSLUMB
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36160
|
| Hospital Charge Code |
321036160
|
|
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 NEEDLE AORTA TRNSLUMB
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36160
|
| Hospital Charge Code |
321036160
|
|
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 |
$114.91
|
| 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 NEEDLE AORTA TRNSLUMB
|
Facility
|
OP
|
$1,780.45
|
|
|
Service Code
|
HCPCS 36160
|
| Hospital Charge Code |
366836160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.91 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$534.13
|
| Rate for Payer: Aetna Medicare Advantage |
$534.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$454.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$454.01
|
| 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 |
$454.01
|
| Rate for Payer: Cigna Commercial |
$114.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.46
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR INTRO NEEDLE AORTA TRNSLUMB
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36160
|
| Hospital Charge Code |
2001345
|
|
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 |
$114.91
|
| 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 NEEDLE/INTRACATH VEIN
|
Facility
|
OP
|
$621.65
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
7411411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$186.50
|
| Rate for Payer: Aetna Medicare Advantage |
$186.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.52
|
| 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 |
$158.52
|
| Rate for Payer: Cigna Commercial |
$310.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.81
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR INTRO NEEDLE/INTRACATH VEIN
|
Facility
|
IP
|
$621.65
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
7411411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$93.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.25
|
|
|
IR INTRO NEEDLE/INTRACATH VEIN
|
Facility
|
OP
|
$621.65
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
2004687
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$186.50
|
| Rate for Payer: Aetna Medicare Advantage |
$186.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.52
|
| 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 |
$158.52
|
| Rate for Payer: Cigna Commercial |
$310.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.81
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR INTRO NEEDLE/INTRACATH VEIN
|
Facility
|
IP
|
$621.65
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
2004687
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$93.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.25
|
|
|
IR INTRO NEPHROST TUBE CHANGE
|
Facility
|
OP
|
$7,084.55
|
|
| Hospital Charge Code |
2004414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$920.99 |
| Max. Negotiated Rate |
$3,542.28 |
| Rate for Payer: Aetna Commercial |
$2,125.36
|
| Rate for Payer: Aetna Medicare Advantage |
$2,125.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,806.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,806.56
|
| 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 |
$1,806.56
|
| Rate for Payer: Cigna Commercial |
$3,542.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$920.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,062.68
|
|
|
IR INTRO NEPHROST TUBE CHANGE
|
Facility
|
IP
|
$7,084.55
|
|
| Hospital Charge Code |
2004414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,062.68 |
| Max. Negotiated Rate |
$1,062.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,062.68
|
|
|
IR INTRO OF PERC TRANS CATH
|
Facility
|
OP
|
$13,811.90
|
|
| Hospital Charge Code |
2000937
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,795.55 |
| Max. Negotiated Rate |
$6,905.95 |
| Rate for Payer: Aetna Commercial |
$4,143.57
|
| Rate for Payer: Aetna Medicare Advantage |
$4,143.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,522.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,522.03
|
| 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 |
$3,522.03
|
| Rate for Payer: Cigna Commercial |
$6,905.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,795.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,071.78
|
|
