|
THROMBOSTAT/10KU
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
60634024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare Advantage |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.55
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.30
|
| Rate for Payer: Oxford Commercial |
$105.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$105.00
|
|
|
THROMBO W/RFLX
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
3035086B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.30
|
| Rate for Payer: Cigna Commercial |
$55.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.43
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
THROMBO W/RFLX
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
3035086B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
|
|
THROMBO W/RFLX
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
3035086D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.77
|
| Rate for Payer: Cigna Commercial |
$52.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.65
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
THROMBO W/RFLX
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
3035086A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
|
|
THROMBO W/RFLX
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
3035086H
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$36.30
|
| Rate for Payer: Aetna Medicare Advantage |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.86
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.73
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
THROMBO W/RFLX
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
3035086F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$38.40
|
| Rate for Payer: Aetna Medicare Advantage |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.64
|
| Rate for Payer: Cigna Commercial |
$64.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.64
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
THROMBO W/RFLX
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
3035086E
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
|
|
THROMBO W/RFLX
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
3035086A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.30
|
| Rate for Payer: Cigna Commercial |
$55.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.43
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
THROMBO W/RFLX
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
3035086D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
|
|
THROMBO W/RFLX
|
Facility
|
IP
|
$635.25
|
|
| Hospital Charge Code |
3035086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.29 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.29
|
|
|
THROMBO W/RFLX
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
3035086E
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.77
|
| Rate for Payer: Cigna Commercial |
$52.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.65
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
THROMBO W/RFLX
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3035086H
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
THROMBO W/RFLX
|
Facility
|
OP
|
$635.25
|
|
| Hospital Charge Code |
3035086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.58 |
| Max. Negotiated Rate |
$317.62 |
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna Medicare Advantage |
$190.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.99
|
| Rate for Payer: Cigna Commercial |
$317.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.58
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
THROMBO W/RFLX
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
3035086C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.77
|
| Rate for Payer: Cigna Commercial |
$52.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.65
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
THROMBO W/RFLX
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
3035086C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
|
|
THROMBO W/RFLX
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
3035086I
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
|
|
THROMBO W/RFLX
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
3035086I
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.30
|
| Rate for Payer: Cigna Commercial |
$55.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.43
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
THROMBO W/RFLX
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
3035086F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.20
|
|
|
THROMB+STENT PERIPH DIALYS SEG
|
Facility
|
IP
|
$73,789.50
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
5100840
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,068.42 |
| Max. Negotiated Rate |
$11,068.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,068.42
|
|
|
THROMB+STENT PERIPH DIALYS SEG
|
Facility
|
IP
|
$73,789.50
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
7412061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,068.42 |
| Max. Negotiated Rate |
$11,068.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,068.42
|
|
|
THROMB+STENT PERIPH DIALYS SEG
|
Facility
|
IP
|
$89,914.40
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
2692132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,487.16 |
| Max. Negotiated Rate |
$13,487.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13,487.16
|
|
|
THROMB+STENT PERIPH DIALYS SEG
|
Facility
|
OP
|
$73,789.50
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
2709027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$43,654.87 |
| Rate for Payer: Aetna Commercial |
$22,136.85
|
| Rate for Payer: Aetna Medicare Advantage |
$22,136.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18,816.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18,816.32
|
| 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 |
$18,816.32
|
| Rate for Payer: Cigna Commercial |
$43,654.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,592.64
|
| Rate for Payer: Oxford Commercial |
$11,667.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,068.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$13,243.00
|
|
|
THROMB+STENT PERIPH DIALYS SEG
|
Facility
|
OP
|
$89,914.40
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
321036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$43,654.87 |
| Rate for Payer: Aetna Commercial |
$26,974.32
|
| Rate for Payer: Aetna Medicare Advantage |
$26,974.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22,928.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22,928.17
|
| 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 |
$22,928.17
|
| Rate for Payer: Cigna Commercial |
$43,654.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,688.87
|
| Rate for Payer: Oxford Commercial |
$11,667.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13,487.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$13,243.00
|
|
|
THROMB+STENT PERIPH DIALYS SEG
|
Facility
|
IP
|
$89,914.40
|
|
|
Service Code
|
HCPCS 36906
|
| Hospital Charge Code |
321036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,487.16 |
| Max. Negotiated Rate |
$13,487.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13,487.16
|
|
