|
ARTERIAL DUPLEX U/L LE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
74115038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
ARTERIAL DUPLEX U/L LE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
74117038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$2,301.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$240.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$2,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,301.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
ARTERIAL DUPLEX U/L LE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
74116038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
ARTERIAL DUPLEX U/L LE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
74116038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$2,301.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$240.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,326.00
|
| Rate for Payer: Oxford Commercial |
$2,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,301.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.16
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.84
|
|
|
ARTERIAL DUPLEX U/L LE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
74117038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74115042
|
|
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 DUPLEX U/L UE
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74117042
|
|
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 DUPLEX U/L UE
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74115042
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
ARTERIAL DUPLEX U/L UE
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74117042
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
2692135
|
|
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 DUPLEX UPPER EXT LTD
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
2692135
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74115043
|
|
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 DUPLEX UPPER EXT LTD
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74117043
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74115043
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74117043
|
|
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 DUPLEX UPPER EXT LTD
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74116043
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$7,555.00 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare Advantage |
$402.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$450.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$450.54
|
| Rate for Payer: Cigna Commercial |
$248.96
|
| Rate for Payer: Cigna Medicare Advantage |
$124.20
|
| Rate for Payer: Clover Medicare Advantage |
$117.99
|
| Rate for Payer: EmblemHealth Commercial |
$372.60
|
| Rate for Payer: Humana Medicare Advantage |
$127.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$124.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,472.00
|
| Rate for Payer: Oxford Commercial |
$6,888.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,555.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$543.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$488.48
|
|
|
ARTERIAL DUPLEX UPPER EXT LTD
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
74116043
|
|
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 EMBOLECTOMY CATHETER
|
Facility
|
OP
|
$291.00
|
|
| Hospital Charge Code |
270331786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Aetna Commercial |
$110.58
|
| Rate for Payer: Aetna Medicare Advantage |
$87.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$74.20
|
| Rate for Payer: Cigna Commercial |
$145.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.26
|
|
|
ARTERIAL EMBOLECTOMY CATHETER
|
Facility
|
IP
|
$291.00
|
|
| Hospital Charge Code |
270331786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$70.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.65
|
|
|
ARTERIAL LINE INSERTION
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
83091005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$157.32
|
| 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 |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.57
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.64
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.76
|
|
|
ARTERIAL LINE INSERTION
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
83080005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$157.32
|
| 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 |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.57
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.64
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.76
|
|
|
ARTERIAL LINE INSERTION
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
83080005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
|
|
ARTERIAL LINE INSERTION
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
83091005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
|
|
ARTERIAL LINE INSERTION
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
83092005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
|
|
ARTERIAL LINE INSERTION
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
83092005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$157.32
|
| 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 |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.57
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.64
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.76
|
|
