|
ANGIO AV SHUNT COMPLETE
|
Facility
|
OP
|
$1,310.20
|
|
|
Service Code
|
HCPCS 75791
|
| Hospital Charge Code |
74110062
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$31.58 |
| Max. Negotiated Rate |
$3,354.00 |
| Rate for Payer: Aetna Commercial |
$497.88
|
| Rate for Payer: Aetna Medicare Advantage |
$393.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$334.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$334.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$334.10
|
| Rate for Payer: Cigna Commercial |
$655.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$393.06
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,354.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.72
|
|
|
ANGIO AV SHUNT COMPLETE
|
Facility
|
OP
|
$1,310.20
|
|
|
Service Code
|
HCPCS 75791
|
| Hospital Charge Code |
5100652
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$31.58 |
| Max. Negotiated Rate |
$3,354.00 |
| Rate for Payer: Aetna Commercial |
$497.88
|
| Rate for Payer: Aetna Medicare Advantage |
$393.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$334.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$334.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$334.10
|
| Rate for Payer: Cigna Commercial |
$655.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$393.06
|
| Rate for Payer: Oxford Commercial |
$2,443.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,354.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.72
|
|
|
ANGIO AV SHUNT S&I
|
Facility
|
OP
|
$1,268.00
|
|
| Hospital Charge Code |
5100346
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$481.84
|
| Rate for Payer: Aetna Medicare Advantage |
$380.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$323.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$323.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$323.34
|
| Rate for Payer: Cigna Commercial |
$634.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$380.40
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$190.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.60
|
|
|
ANGIO AV SHUNT S&I
|
Facility
|
IP
|
$1,268.00
|
|
| Hospital Charge Code |
5100346
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$190.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$190.20
|
|
|
ANGIO CAROTID/CERVICAL UNI S&I
|
Facility
|
IP
|
$1,453.45
|
|
|
Service Code
|
HCPCS 75676
|
| Hospital Charge Code |
5100343
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$218.02 |
| Max. Negotiated Rate |
$218.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$218.02
|
|
|
ANGIO CAROTID/CERVICAL UNI S&I
|
Facility
|
OP
|
$1,453.45
|
|
|
Service Code
|
HCPCS 75676
|
| Hospital Charge Code |
5100343
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$552.31
|
| Rate for Payer: Aetna Medicare Advantage |
$436.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$370.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$370.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$370.63
|
| Rate for Payer: Cigna Commercial |
$726.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$436.04
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$218.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.52
|
|
|
ANGIOCATH 14G *******
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
7000565
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.50
|
|
|
ANGIOCATH 14G *******
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
7000565
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Aetna Medicare Advantage |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.55
|
| Rate for Payer: Cigna Commercial |
$5.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.00
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.27
|
|
|
ANGIOCATH 14GAX2 381167
|
Facility
|
OP
|
$16.85
|
|
| Hospital Charge Code |
270620471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Aetna Commercial |
$6.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.30
|
| Rate for Payer: Cigna Commercial |
$8.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.05
|
| Rate for Payer: Oxford Commercial |
$3.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.45
|
|
|
ANGIOCATH 14GAX2 381167
|
Facility
|
IP
|
$16.85
|
|
| Hospital Charge Code |
270620471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
|
|
ANGIOCATH 14GX1-1/4
|
Facility
|
IP
|
$2.15
|
|
| Hospital Charge Code |
270651391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.32
|
|
|
ANGIOCATH 14GX1-1/4
|
Facility
|
OP
|
$2.15
|
|
| Hospital Charge Code |
270651391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Aetna Commercial |
$0.82
|
| Rate for Payer: Aetna Medicare Advantage |
$0.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.55
|
| Rate for Payer: Cigna Commercial |
$1.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.65
|
| Rate for Payer: Oxford Commercial |
$0.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.06
|
|
|
ANGIOCATH 16G - 24G****
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
7000557
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.65
|
|
|
ANGIOCATH 16G - 24G****
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
7000557
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Medicare Advantage |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.81
|
| Rate for Payer: Cigna Commercial |
$5.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.30
|
| Rate for Payer: Oxford Commercial |
$2.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.29
|
|
|
ANGIOCATH 16G 2 IN
|
Facility
|
IP
|
$11.25
|
|
| Hospital Charge Code |
270041005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.69
|
|
|
ANGIOCATH 16G 2 IN
|
Facility
|
OP
|
$11.25
|
|
| Hospital Charge Code |
270041005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare Advantage |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.87
|
| Rate for Payer: Cigna Commercial |
$5.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.38
|
| Rate for Payer: Oxford Commercial |
$2.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.30
|
|
|
ANGIOCATH 16G 5-1/4 YELLOW
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
270311614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$25.08
|
| Rate for Payer: Aetna Medicare Advantage |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.83
|
| Rate for Payer: Cigna Commercial |
$33.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.80
|
| Rate for Payer: Oxford Commercial |
$13.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.75
|
|
|
ANGIOCATH 16G 5-1/4 YELLOW
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
270311614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
|
|
ANGIOCATH 16G 5-1/4YELLOW
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
270331614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$25.08
|
| Rate for Payer: Aetna Medicare Advantage |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.83
|
| Rate for Payer: Cigna Commercial |
$33.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.80
|
| Rate for Payer: Oxford Commercial |
$13.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.75
|
|
|
ANGIOCATH 16G 5-1/4YELLOW
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
270331614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
|
|
ANGIOCATH 16GAX2 381157
|
Facility
|
IP
|
$16.85
|
|
| Hospital Charge Code |
270620472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
|
|
ANGIOCATH 16GAX2 381157
|
Facility
|
OP
|
$16.85
|
|
| Hospital Charge Code |
270620472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Aetna Commercial |
$6.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.30
|
| Rate for Payer: Cigna Commercial |
$8.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.05
|
| Rate for Payer: Oxford Commercial |
$3.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.45
|
|
|
ANGIOCATH 16G INSYTE AUTOGUARD
|
Facility
|
OP
|
$8.71
|
|
| Hospital Charge Code |
270645440
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna Medicare Advantage |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.22
|
| Rate for Payer: Cigna Commercial |
$4.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.61
|
| Rate for Payer: Oxford Commercial |
$1.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.74
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
ANGIOCATH 16G INSYTE AUTOGUARD
|
Facility
|
IP
|
$8.71
|
|
| Hospital Charge Code |
270645440
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.31
|
|
|
ANGIOCATH 18G 1 1/4 IN
|
Facility
|
IP
|
$24.21
|
|
| Hospital Charge Code |
270041004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.63
|
|