|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
OP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
5100844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$684.89 |
| Max. Negotiated Rate |
$24,528.18 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,528.18
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,270.11
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$762.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$684.89
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
OP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
7412065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$684.89 |
| Max. Negotiated Rate |
$24,528.18 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,528.18
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,270.11
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$762.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$684.89
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
2692136
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$778.07 |
| Max. Negotiated Rate |
$24,528.18 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,528.18
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,123.22
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$865.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$778.07
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
IP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
2692136
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,109.55 |
| Max. Negotiated Rate |
$4,109.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
OP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
366837246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$684.89 |
| Max. Negotiated Rate |
$24,528.18 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,528.18
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,270.11
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$762.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$684.89
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
IP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
2709031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,617.37 |
| Max. Negotiated Rate |
$3,617.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
IP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
321037246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,109.55 |
| Max. Negotiated Rate |
$4,109.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
OP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
2709031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$684.89 |
| Max. Negotiated Rate |
$24,528.18 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,528.18
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,270.11
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$762.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$684.89
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
IP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
5100844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,617.37 |
| Max. Negotiated Rate |
$3,617.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
321037246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$778.07 |
| Max. Negotiated Rate |
$24,528.18 |
| Rate for Payer: Aetna Commercial |
$18,391.91
|
| Rate for Payer: Aetna Medicare Advantage |
$21,908.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24,528.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,761.73
|
| 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 |
$24,528.18
|
| Rate for Payer: Cigna Commercial |
$13,553.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,761.73
|
| Rate for Payer: Clover Medicare Advantage |
$6,423.64
|
| Rate for Payer: EmblemHealth Commercial |
$20,285.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,964.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,761.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,123.22
|
| Rate for Payer: Oxford Commercial |
$13,407.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$14,869.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$865.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,761.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$778.07
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
|
IP
|
$24,115.80
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
366837246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,617.37 |
| Max. Negotiated Rate |
$3,617.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,617.37
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
OP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
2692133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$262.37
|
| Rate for Payer: Aetna Medicare Advantage |
$207.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$176.06
|
| 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 |
$176.06
|
| Rate for Payer: Cigna Commercial |
$345.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.52
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.61
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
IP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
7412062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.57 |
| Max. Negotiated Rate |
$103.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
IP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
2692133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.57 |
| Max. Negotiated Rate |
$103.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
IP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
2709028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.57 |
| Max. Negotiated Rate |
$103.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
OP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
2709028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$262.37
|
| Rate for Payer: Aetna Medicare Advantage |
$207.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$176.06
|
| 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 |
$176.06
|
| Rate for Payer: Cigna Commercial |
$345.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.52
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.61
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
IP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
366836907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.57 |
| Max. Negotiated Rate |
$103.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
OP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
366836907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$262.37
|
| Rate for Payer: Aetna Medicare Advantage |
$207.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$176.06
|
| 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 |
$176.06
|
| Rate for Payer: Cigna Commercial |
$345.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.52
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.61
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
IP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
321036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.57 |
| Max. Negotiated Rate |
$103.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
OP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
321036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$262.37
|
| Rate for Payer: Aetna Medicare Advantage |
$207.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$176.06
|
| 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 |
$176.06
|
| Rate for Payer: Cigna Commercial |
$345.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.52
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.61
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
IP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
5100841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.57 |
| Max. Negotiated Rate |
$103.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
OP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
7412062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$262.37
|
| Rate for Payer: Aetna Medicare Advantage |
$207.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$176.06
|
| 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 |
$176.06
|
| Rate for Payer: Cigna Commercial |
$345.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.52
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.61
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
|
OP
|
$690.45
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
5100841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$262.37
|
| Rate for Payer: Aetna Medicare Advantage |
$207.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$176.06
|
| 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 |
$176.06
|
| Rate for Payer: Cigna Commercial |
$345.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.52
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.61
|
|
|
TBA EA ADD ARTERY (NOT LE)
|
Facility
|
IP
|
$974.90
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
321037247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.24 |
| Max. Negotiated Rate |
$146.24 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.24
|
|
|
TBA EA ADD ARTERY (NOT LE)
|
Facility
|
OP
|
$974.90
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
5100845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$370.46
|
| Rate for Payer: Aetna Medicare Advantage |
$292.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.60
|
| 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 |
$248.60
|
| Rate for Payer: Cigna Commercial |
$487.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$253.47
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.69
|
|
