|
FEM-POP ATHER W/STENT-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227LT
|
| Hospital Charge Code |
366837227L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227LT
|
| Hospital Charge Code |
321037227L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
FEM-POP ATHER W/STENT-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227LT
|
| Hospital Charge Code |
2691400
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227LT
|
| Hospital Charge Code |
2691400
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
FEM-POP ATHER W/STENT-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227LT
|
| Hospital Charge Code |
7411932
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
7411933
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
366837227R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
366837227R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
2691405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
2691405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
321037227R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
321037227R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
FEM-POP ATHER W/STENT-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37227RT
|
| Hospital Charge Code |
7411933
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
FEM/POPL REVASC W/STENT
|
Facility
|
OP
|
$108,318.30
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
1600000503
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,076.24 |
| Max. Negotiated Rate |
$54,159.15 |
| Rate for Payer: Aetna Commercial |
$41,160.95
|
| Rate for Payer: Aetna Medicare Advantage |
$32,495.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27,621.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27,621.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27,621.17
|
| Rate for Payer: Cigna Commercial |
$54,159.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28,162.76
|
| Rate for Payer: Oxford Commercial |
$14,968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16,247.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,639.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3,422.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3,076.24
|
|
|
FEM/POPL REVASC W/STENT
|
Facility
|
IP
|
$108,318.30
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
1600000503
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,247.75 |
| Max. Negotiated Rate |
$16,247.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16,247.75
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
IP
|
$47,711.75
|
|
|
Service Code
|
HCPCS 37225
|
| Hospital Charge Code |
2709016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,156.76 |
| Max. Negotiated Rate |
$7,156.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,156.76
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
OP
|
$47,711.75
|
|
|
Service Code
|
HCPCS 37225
|
| Hospital Charge Code |
2709016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,355.01 |
| Max. Negotiated Rate |
$23,855.88 |
| Rate for Payer: Aetna Commercial |
$18,130.47
|
| Rate for Payer: Aetna Medicare Advantage |
$14,313.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,166.50
|
| Rate for Payer: Cigna Commercial |
$23,855.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,405.06
|
| Rate for Payer: Oxford Commercial |
$14,968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,156.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,639.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,507.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,355.01
|
|
|
FEM-POP STENT W/PTA-LT
|
Facility
|
IP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 37226LT
|
| Hospital Charge Code |
7411930
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,360.60 |
| Max. Negotiated Rate |
$11,360.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
|
|
FEM-POP STENT W/PTA-LT
|
Facility
|
OP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 37226LT
|
| Hospital Charge Code |
7411930
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,150.94 |
| Max. Negotiated Rate |
$37,868.67 |
| Rate for Payer: Aetna Commercial |
$28,780.19
|
| Rate for Payer: Aetna Medicare Advantage |
$22,721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19,313.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19,313.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19,313.02
|
| Rate for Payer: Cigna Commercial |
$37,868.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19,691.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,393.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,150.94
|
|
|
FEM-POP STENT W/PTA-LT
|
Facility
|
IP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 37226LT
|
| Hospital Charge Code |
2691390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,360.60 |
| Max. Negotiated Rate |
$11,360.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
|
|
FEM-POP STENT W/PTA-LT
|
Facility
|
OP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 37226LT
|
| Hospital Charge Code |
321037226L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,150.94 |
| Max. Negotiated Rate |
$37,868.67 |
| Rate for Payer: Aetna Commercial |
$28,780.19
|
| Rate for Payer: Aetna Medicare Advantage |
$22,721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19,313.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19,313.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19,313.02
|
| Rate for Payer: Cigna Commercial |
$37,868.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19,691.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,393.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,150.94
|
|
|
FEM-POP STENT W/PTA-LT
|
Facility
|
OP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 37226LT
|
| Hospital Charge Code |
366837226L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,150.94 |
| Max. Negotiated Rate |
$37,868.67 |
| Rate for Payer: Aetna Commercial |
$28,780.19
|
| Rate for Payer: Aetna Medicare Advantage |
$22,721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19,313.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19,313.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19,313.02
|
| Rate for Payer: Cigna Commercial |
$37,868.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19,691.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,393.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,150.94
|
|
|
FEM-POP STENT W/PTA-LT
|
Facility
|
IP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 37226LT
|
| Hospital Charge Code |
321037226L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,360.60 |
| Max. Negotiated Rate |
$11,360.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
|
|
FEM-POP STENT W/PTA-LT
|
Facility
|
IP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 37226LT
|
| Hospital Charge Code |
366837226L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,360.60 |
| Max. Negotiated Rate |
$11,360.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
|
|
FEM-POP STENT W/PTA-LT
|
Facility
|
OP
|
$75,737.34
|
|
|
Service Code
|
HCPCS 37226LT
|
| Hospital Charge Code |
2691390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,150.94 |
| Max. Negotiated Rate |
$37,868.67 |
| Rate for Payer: Aetna Commercial |
$28,780.19
|
| Rate for Payer: Aetna Medicare Advantage |
$22,721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19,313.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19,313.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19,313.02
|
| Rate for Payer: Cigna Commercial |
$37,868.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19,691.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11,360.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,393.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,150.94
|
|