|
PTCA DRU ELU STEN 1VES-RC
|
Facility
|
IP
|
$28,383.00
|
|
| Hospital Charge Code |
7411273
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,257.45 |
| Max. Negotiated Rate |
$4,257.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA-EA ADDTL VESSEL-LC
|
Facility
|
OP
|
$14,507.00
|
|
|
Service Code
|
HCPCS 92984LC
|
| Hospital Charge Code |
7411205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,885.91 |
| Max. Negotiated Rate |
$7,253.50 |
| Rate for Payer: Aetna Commercial |
$4,352.10
|
| Rate for Payer: Aetna Medicare Advantage |
$4,352.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,699.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,699.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,699.28
|
| Rate for Payer: Cigna Commercial |
$7,253.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,885.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,176.05
|
|
|
PTCA-EA ADDTL VESSEL-LC
|
Facility
|
IP
|
$14,507.00
|
|
|
Service Code
|
HCPCS 92984LC
|
| Hospital Charge Code |
7411205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,176.05 |
| Max. Negotiated Rate |
$2,176.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,176.05
|
|
|
PTCA-EA ADDTL VESSEL-LD
|
Facility
|
OP
|
$14,507.00
|
|
|
Service Code
|
HCPCS 92984LD
|
| Hospital Charge Code |
7411207
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,885.91 |
| Max. Negotiated Rate |
$7,253.50 |
| Rate for Payer: Aetna Commercial |
$4,352.10
|
| Rate for Payer: Aetna Medicare Advantage |
$4,352.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,699.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,699.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,699.28
|
| Rate for Payer: Cigna Commercial |
$7,253.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,885.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,176.05
|
|
|
PTCA-EA ADDTL VESSEL-LD
|
Facility
|
IP
|
$14,507.00
|
|
|
Service Code
|
HCPCS 92984LD
|
| Hospital Charge Code |
7411207
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,176.05 |
| Max. Negotiated Rate |
$2,176.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,176.05
|
|
|
PTCA-EA ADDTL VESSEL-RC
|
Facility
|
OP
|
$14,507.00
|
|
|
Service Code
|
HCPCS 92984RC
|
| Hospital Charge Code |
7411209
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,885.91 |
| Max. Negotiated Rate |
$7,253.50 |
| Rate for Payer: Aetna Commercial |
$4,352.10
|
| Rate for Payer: Aetna Medicare Advantage |
$4,352.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,699.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,699.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,699.28
|
| Rate for Payer: Cigna Commercial |
$7,253.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,885.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,176.05
|
|
|
PTCA-EA ADDTL VESSEL-RC
|
Facility
|
IP
|
$14,507.00
|
|
|
Service Code
|
HCPCS 92984RC
|
| Hospital Charge Code |
7411209
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,176.05 |
| Max. Negotiated Rate |
$2,176.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,176.05
|
|
|
PTCA NDRC ELU STEN 1VE-LD
|
Facility
|
OP
|
$28,383.00
|
|
|
Service Code
|
HCPCS 92928LD
|
| Hospital Charge Code |
7411189
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,689.79 |
| Max. Negotiated Rate |
$14,191.50 |
| Rate for Payer: Aetna Commercial |
$8,514.90
|
| Rate for Payer: Aetna Medicare Advantage |
$8,514.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,237.66
|
| Rate for Payer: Cigna Commercial |
$14,191.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,689.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRC ELU STEN 1VE-LD
|
Facility
|
IP
|
$28,383.00
|
|
| Hospital Charge Code |
7411281
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,257.45 |
| Max. Negotiated Rate |
$4,257.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRC ELU STEN 1VE-LD
|
Facility
|
IP
|
$28,383.00
|
|
|
Service Code
|
HCPCS 92928LD
|
| Hospital Charge Code |
7411189
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,257.45 |
| Max. Negotiated Rate |
$4,257.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRC ELU STEN 1VE-LD
|
Facility
|
OP
|
$28,383.00
|
|
| Hospital Charge Code |
7411281
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,689.79 |
| Max. Negotiated Rate |
$14,191.50 |
| Rate for Payer: Aetna Commercial |
$8,514.90
|
| Rate for Payer: Aetna Medicare Advantage |
$8,514.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,237.66
|
| Rate for Payer: Cigna Commercial |
$14,191.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,689.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-LC
|
Facility
|
OP
|
$28,383.00
|
|
|
Service Code
|
HCPCS 92981LC
|
| Hospital Charge Code |
7411193
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,689.79 |
| Max. Negotiated Rate |
$14,191.50 |
| Rate for Payer: Aetna Commercial |
$8,514.90
|
| Rate for Payer: Aetna Medicare Advantage |
$8,514.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,237.66
|
| Rate for Payer: Cigna Commercial |
$14,191.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,689.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-LC
|
Facility
|
OP
|
$28,383.00
|
|
| Hospital Charge Code |
7411285
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,689.79 |
| Max. Negotiated Rate |
$14,191.50 |
| Rate for Payer: Aetna Commercial |
$8,514.90
|
| Rate for Payer: Aetna Medicare Advantage |
$8,514.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,237.66
|
| Rate for Payer: Cigna Commercial |
$14,191.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,689.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-LC
|
Facility
|
IP
|
$28,383.00
|
|
|
Service Code
|
HCPCS 92981LC
|
| Hospital Charge Code |
7411193
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,257.45 |
| Max. Negotiated Rate |
$4,257.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-LC
|
Facility
|
IP
|
$28,383.00
|
|
| Hospital Charge Code |
7411285
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,257.45 |
| Max. Negotiated Rate |
$4,257.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-LD
|
Facility
|
OP
|
$28,383.00
|
|
|
Service Code
|
HCPCS 92981LD
|
| Hospital Charge Code |
7411197
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,689.79 |
| Max. Negotiated Rate |
$14,191.50 |
| Rate for Payer: Aetna Commercial |
$8,514.90
|
| Rate for Payer: Aetna Medicare Advantage |
$8,514.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,237.66
|
| Rate for Payer: Cigna Commercial |
$14,191.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,689.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-LD
|
Facility
|
IP
|
$28,383.00
|
|
|
Service Code
|
HCPCS 92981LD
|
| Hospital Charge Code |
7411197
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,257.45 |
| Max. Negotiated Rate |
$4,257.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-LD
|
Facility
|
IP
|
$28,383.00
|
|
| Hospital Charge Code |
7411295
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,257.45 |
| Max. Negotiated Rate |
$4,257.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-LD
|
Facility
|
OP
|
$28,383.00
|
|
| Hospital Charge Code |
7411295
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,689.79 |
| Max. Negotiated Rate |
$14,191.50 |
| Rate for Payer: Aetna Commercial |
$8,514.90
|
| Rate for Payer: Aetna Medicare Advantage |
$8,514.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,237.66
|
| Rate for Payer: Cigna Commercial |
$14,191.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,689.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-RC
|
Facility
|
OP
|
$28,383.00
|
|
|
Service Code
|
HCPCS 92981RC
|
| Hospital Charge Code |
7411195
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,689.79 |
| Max. Negotiated Rate |
$14,191.50 |
| Rate for Payer: Aetna Commercial |
$8,514.90
|
| Rate for Payer: Aetna Medicare Advantage |
$8,514.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,237.66
|
| Rate for Payer: Cigna Commercial |
$14,191.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,689.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-RC
|
Facility
|
IP
|
$28,383.00
|
|
| Hospital Charge Code |
7411287
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,257.45 |
| Max. Negotiated Rate |
$4,257.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-RC
|
Facility
|
OP
|
$28,383.00
|
|
| Hospital Charge Code |
7411287
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,689.79 |
| Max. Negotiated Rate |
$14,191.50 |
| Rate for Payer: Aetna Commercial |
$8,514.90
|
| Rate for Payer: Aetna Medicare Advantage |
$8,514.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,237.66
|
| Rate for Payer: Cigna Commercial |
$14,191.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,689.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU EL STE AD/VE-RC
|
Facility
|
IP
|
$28,383.00
|
|
|
Service Code
|
HCPCS 92981RC
|
| Hospital Charge Code |
7411195
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,257.45 |
| Max. Negotiated Rate |
$4,257.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU ELU STEN 1VE-LC
|
Facility
|
IP
|
$28,383.00
|
|
|
Service Code
|
HCPCS 92980LC
|
| Hospital Charge Code |
7411191
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,257.45 |
| Max. Negotiated Rate |
$4,257.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|
|
PTCA NDRU ELU STEN 1VE-LC
|
Facility
|
OP
|
$28,383.00
|
|
| Hospital Charge Code |
7411283
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,689.79 |
| Max. Negotiated Rate |
$14,191.50 |
| Rate for Payer: Aetna Commercial |
$8,514.90
|
| Rate for Payer: Aetna Medicare Advantage |
$8,514.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,237.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,237.66
|
| Rate for Payer: Cigna Commercial |
$14,191.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,689.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,257.45
|
|