|
IR REP TUND CV CATH W/O PORT
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
321036581
|
|
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 REP TUND CV CATH W/O PORT
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 36581
|
| Hospital Charge Code |
2011276
|
|
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 RETRIV INTRAVASC VENA CAVA
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
2670100
|
|
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 RETRIV INTRAVASC VENA CAVA
|
Facility
|
IP
|
$12,618.93
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
411037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,892.84 |
| Max. Negotiated Rate |
$1,892.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,892.84
|
|
|
IR RETRIV INTRAVASC VENA CAVA
|
Facility
|
OP
|
$12,618.93
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
366837193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,640.46 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$3,785.68
|
| Rate for Payer: Aetna Medicare Advantage |
$3,785.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,217.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,217.83
|
| 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 |
$3,217.83
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,640.46
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,892.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR RETRIV INTRAVASC VENA CAVA
|
Facility
|
OP
|
$12,618.93
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
7411499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,640.46 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$3,785.68
|
| Rate for Payer: Aetna Medicare Advantage |
$3,785.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,217.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,217.83
|
| 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 |
$3,217.83
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,640.46
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,892.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR RETRIV INTRAVASC VENA CAVA
|
Facility
|
IP
|
$12,618.93
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
7411499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,892.84 |
| Max. Negotiated Rate |
$1,892.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,892.84
|
|
|
IR RETRIV INTRAVASC VENA CAVA
|
Facility
|
OP
|
$12,618.93
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
411037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,640.46 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$3,785.68
|
| Rate for Payer: Aetna Medicare Advantage |
$3,785.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,217.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,217.83
|
| 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 |
$3,217.83
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,640.46
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,892.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
IR RETRIV INTRAVASC VENA CAVA
|
Facility
|
IP
|
$12,618.93
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
366837193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,892.84 |
| Max. Negotiated Rate |
$1,892.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,892.84
|
|
|
IR RETRIV INTRAVASC VENA CAVA
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
321037193
|
|
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 RETRIV INTRAVASC VENA CAVA
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
2670100
|
|
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 RETRIV INTRAVASC VENA CAVA
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
321037193
|
|
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 REVASC OPN/PRQ TIB/PER STN
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37285
|
| Hospital Charge Code |
411037234
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$163.61 |
| Max. Negotiated Rate |
$6,732.42 |
| Rate for Payer: Aetna Commercial |
$6,732.42
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,917.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR REVASC OPN/PRQ TIB/PER STN
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37234
|
| Hospital Charge Code |
366837234
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$11,220.70 |
| Rate for Payer: Aetna Commercial |
$6,732.42
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,917.38
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,851.00
|
|
|
IR REVASC OPN/PRQ TIB/PER STN
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37234
|
| Hospital Charge Code |
366837234
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR REVASC OPN/PRQ TIB/PER STN
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37285
|
| Hospital Charge Code |
411037234
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR-REVIS/REINSERTION TRANS TUB
|
Facility
|
IP
|
$6,757.27
|
|
| Hospital Charge Code |
2670165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,013.59 |
| Max. Negotiated Rate |
$1,013.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,013.59
|
|
|
IR-REVIS/REINSERTION TRANS TUB
|
Facility
|
OP
|
$6,757.27
|
|
| Hospital Charge Code |
2670165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$878.45 |
| Max. Negotiated Rate |
$3,378.64 |
| Rate for Payer: Aetna Commercial |
$2,027.18
|
| Rate for Payer: Aetna Medicare Advantage |
$2,027.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,723.10
|
| 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 |
$1,723.10
|
| Rate for Payer: Cigna Commercial |
$3,378.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$878.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,013.59
|
|
|
IR REVSC OPN/PRQ TIB/PERO STEN
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37234
|
| Hospital Charge Code |
321037234
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR REVSC OPN/PRQ TIB/PERO STEN
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37234
|
| Hospital Charge Code |
7411524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR REVSC OPN/PRQ TIB/PERO STEN
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37234
|
| Hospital Charge Code |
5600215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$11,220.70 |
| Rate for Payer: Aetna Commercial |
$6,732.42
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,917.38
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,851.00
|
|
|
IR REVSC OPN/PRQ TIB/PERO STEN
|
Facility
|
IP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37234
|
| Hospital Charge Code |
5600215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.21 |
| Max. Negotiated Rate |
$3,366.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
|
|
IR REVSC OPN/PRQ TIB/PERO STEN
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37234
|
| Hospital Charge Code |
7411524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$11,220.70 |
| Rate for Payer: Aetna Commercial |
$6,732.42
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,917.38
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,851.00
|
|
|
IR REVSC OPN/PRQ TIB/PERO STEN
|
Facility
|
OP
|
$22,441.40
|
|
|
Service Code
|
HCPCS 37234
|
| Hospital Charge Code |
321037234
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$11,220.70 |
| Rate for Payer: Aetna Commercial |
$6,732.42
|
| Rate for Payer: Aetna Medicare Advantage |
$6,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,722.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,722.56
|
| 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 |
$5,722.56
|
| Rate for Payer: Cigna Commercial |
$11,220.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,917.38
|
| Rate for Payer: Oxford Commercial |
$8,679.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,366.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,851.00
|
|
|
IR-RFA KIDNEY-BI
|
Facility
|
IP
|
$15,231.00
|
|
|
Service Code
|
HCPCS 5059250
|
| Hospital Charge Code |
7411826
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,284.65 |
| Max. Negotiated Rate |
$2,284.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,284.65
|
|
