|
ARTERIAL LINE INSERTION
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
83092005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.57
|
| 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 |
$105.57
|
| Rate for Payer: Cigna Commercial |
$84.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.82
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
ARTERIAL LINE INSERTION
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
83080005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.57
|
| 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 |
$105.57
|
| Rate for Payer: Cigna Commercial |
$84.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.82
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
ARTERIAL LINE KIT 20G 3
|
Facility
|
OP
|
$88.68
|
|
| Hospital Charge Code |
270650554
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$44.34 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Medicare Advantage |
$26.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.61
|
| Rate for Payer: Cigna Commercial |
$44.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.53
|
| Rate for Payer: Oxford Commercial |
$44.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.34
|
|
|
ARTERIAL LINE KIT 20G 3
|
Facility
|
IP
|
$88.68
|
|
| Hospital Charge Code |
270650554
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.30
|
|
|
ARTERIAL LINE KIT 20G 6
|
Facility
|
IP
|
$78.02
|
|
| Hospital Charge Code |
270649796
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
|
|
ARTERIAL LINE KIT 20G 6
|
Facility
|
OP
|
$78.02
|
|
| Hospital Charge Code |
270649796
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$39.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare Advantage |
$23.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.90
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.14
|
| Rate for Payer: Oxford Commercial |
$39.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$39.01
|
|
|
ARTERIAL LINE KIT 20GA 12CM
|
Facility
|
OP
|
$303.42
|
|
| Hospital Charge Code |
270663684S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.44 |
| Max. Negotiated Rate |
$151.71 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare Advantage |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$77.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$77.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$77.37
|
| Rate for Payer: Cigna Commercial |
$151.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.44
|
| Rate for Payer: Oxford Commercial |
$151.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$151.71
|
|
|
ARTERIAL LINE KIT 20GA 12CM
|
Facility
|
IP
|
$303.42
|
|
| Hospital Charge Code |
270663684S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.51 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.51
|
|
|
ARTERIAL PVR DOPPLER UP EXT BI
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74115033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$315.10 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$5,160.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,386.00
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,236.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,061.00
|
|
|
ARTERIAL PVR DOPPLER UP EXT BI
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74117033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
|
|
ARTERIAL PVR DOPPLER UP EXT BI
|
Facility
|
OP
|
$1,440.90
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
94053245
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$187.32 |
| Max. Negotiated Rate |
$5,061.00 |
| Rate for Payer: Aetna Commercial |
$432.27
|
| Rate for Payer: Aetna Medicare Advantage |
$432.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$367.43
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.32
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,061.00
|
|
|
ARTERIAL PVR DOPPLER UP EXT BI
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
2692145
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$315.10 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$5,160.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,386.00
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,236.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,061.00
|
|
|
ARTERIAL PVR DOPPLER UP EXT BI
|
Facility
|
IP
|
$1,440.90
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
94053245
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$216.13 |
| Max. Negotiated Rate |
$216.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.13
|
|
|
ARTERIAL PVR DOPPLER UP EXT BI
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
2692145
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
ARTERIAL PVR DOPPLER UP EXT BI
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74115033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
ARTERIAL PVR DOPPLER UP EXT BI
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74117033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$5,061.00 |
| Rate for Payer: Aetna Commercial |
$165.30
|
| Rate for Payer: Aetna Medicare Advantage |
$165.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.50
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.63
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,061.00
|
|
|
ARTERIAL PVR DOPPLER UP EXT BI
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74116033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
|
|
ARTERIAL PVR DOPPLER UP EXT BI
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74116033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$5,061.00 |
| Rate for Payer: Aetna Commercial |
$165.30
|
| Rate for Payer: Aetna Medicare Advantage |
$165.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.50
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.63
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,061.00
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74115034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74116034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$5,061.00 |
| Rate for Payer: Aetna Commercial |
$165.30
|
| Rate for Payer: Aetna Medicare Advantage |
$165.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.50
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.63
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,061.00
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
OP
|
$1,440.90
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
94053250
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$187.32 |
| Max. Negotiated Rate |
$5,061.00 |
| Rate for Payer: Aetna Commercial |
$432.27
|
| Rate for Payer: Aetna Medicare Advantage |
$432.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$367.43
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.32
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,061.00
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74117034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$5,061.00 |
| Rate for Payer: Aetna Commercial |
$165.30
|
| Rate for Payer: Aetna Medicare Advantage |
$165.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.50
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.63
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,061.00
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74116034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
IP
|
$1,440.90
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
94053250
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$216.13 |
| Max. Negotiated Rate |
$216.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.13
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
2692150
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
