|
IR ANGIO MESENTERIC SUP
|
Facility
|
OP
|
$25,628.45
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
2001261
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$275.92 |
| Max. Negotiated Rate |
$23,862.86 |
| Rate for Payer: Aetna Commercial |
$17,981.27
|
| Rate for Payer: Aetna Medicare Advantage |
$21,418.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,862.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6,610.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$275.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,862.86
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: Cigna Medicare Advantage |
$4,627.53
|
| Rate for Payer: Clover Medicare Advantage |
$6,280.22
|
| Rate for Payer: EmblemHealth Commercial |
$19,832.28
|
| Rate for Payer: Humana Medicare Advantage |
$6,809.08
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6,610.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,688.53
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,844.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$617.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$679.15
|
|
|
IR ANGIO MESENTERIC SUP
|
Facility
|
IP
|
$25,628.45
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
2001261
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,844.27 |
| Max. Negotiated Rate |
$3,844.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,844.27
|
|
|
IR ANGIO PULMONARY BILAT SEL
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
2004786
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$338.78 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$338.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,640.55
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$372.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$409.92
|
|
|
IR ANGIO PULMONARY BILAT SEL
|
Facility
|
OP
|
$7,240.05
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
7411699
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$174.49 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$338.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,172.01
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,086.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$174.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$191.86
|
|
|
IR ANGIO PULMONARY BILAT SEL
|
Facility
|
IP
|
$7,240.05
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
7411699
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,086.01 |
| Max. Negotiated Rate |
$1,086.01 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,086.01
|
|
|
IR ANGIO PULMONARY BILAT SEL
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
321075743
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$338.78 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$338.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,640.55
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$372.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$409.92
|
|
|
IR ANGIO PULMONARY BILAT SEL
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
321075743
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR ANGIO PULMONARY BILAT SEL
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
2004786
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR ANGIO PULMONARY UNI SEL
|
Facility
|
OP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
2001220
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$271.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,030.92
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$323.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$356.06
|
|
|
IR ANGIO PULMONARY UNI SEL
|
Facility
|
IP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
2001220
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,015.46 |
| Max. Negotiated Rate |
$2,015.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
|
|
IR ANGIO PULMONARY UNI SEL
|
Facility
|
OP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
7411698
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$271.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,030.92
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$323.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$356.06
|
|
|
IR ANGIO PULMONARY UNI SEL
|
Facility
|
IP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
7411698
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,015.46 |
| Max. Negotiated Rate |
$2,015.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
|
|
IR ANGIO PULMONARY VEN NON/SEL
|
Facility
|
IP
|
$4,914.50
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
366875746
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$737.17 |
| Max. Negotiated Rate |
$737.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$737.17
|
|
|
IR ANGIO PULMONARY VEN NON/SEL
|
Facility
|
OP
|
$4,747.25
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
7411700
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,424.17
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$114.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$125.80
|
|
|
IR ANGIO PULMONARY VEN NON/SEL
|
Facility
|
OP
|
$4,914.50
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
366875746
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,474.35
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$737.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$118.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$130.23
|
|
|
IR ANGIO PULMONARY VEN NON/SEL
|
Facility
|
IP
|
$4,747.25
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
7411700
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$712.09 |
| Max. Negotiated Rate |
$712.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.09
|
|
|
IR ANGIO PULMONARY VEN NON/SEL
|
Facility
|
IP
|
$4,914.50
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
411075746
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$737.17 |
| Max. Negotiated Rate |
$737.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$737.17
|
|
|
IR ANGIO PULMONARY VEN NON/SEL
|
Facility
|
IP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
2004794
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
|
|
IR ANGIO PULMONARY VEN NON/SEL
|
Facility
|
OP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
2004794
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,921.26
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$154.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$169.71
|
|
|
IR ANGIO PULMONARY VEN NON/SEL
|
Facility
|
IP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
321075746
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
|
|
IR ANGIO PULMONARY VEN NON/SEL
|
Facility
|
OP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
321075746
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,921.26
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$154.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$169.71
|
|
|
IR ANGIO PULMONARY VEN NON/SEL
|
Facility
|
OP
|
$4,914.50
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
411075746
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,474.35
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$737.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$118.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$130.23
|
|
|
IR ANGIO RENAL BILAT SEL
|
Facility
|
IP
|
$7,240.05
|
|
| Hospital Charge Code |
2004802
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,086.01 |
| Max. Negotiated Rate |
$1,086.01 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,086.01
|
|
|
IR ANGIO RENAL BILAT SEL
|
Facility
|
OP
|
$7,240.05
|
|
| Hospital Charge Code |
2004802
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$174.49 |
| Max. Negotiated Rate |
$3,620.03 |
| Rate for Payer: Aetna Commercial |
$2,751.22
|
| Rate for Payer: Aetna Medicare Advantage |
$2,172.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,846.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,846.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,846.21
|
| Rate for Payer: Cigna Commercial |
$3,620.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,172.01
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,086.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$174.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$191.86
|
|
|
IR ANGIO RENAL UNILAT SEL
|
Facility
|
OP
|
$13,436.40
|
|
| Hospital Charge Code |
2000891
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$323.82 |
| Max. Negotiated Rate |
$6,718.20 |
| Rate for Payer: Aetna Commercial |
$5,105.83
|
| Rate for Payer: Aetna Medicare Advantage |
$4,030.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,426.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,426.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,426.28
|
| Rate for Payer: Cigna Commercial |
$6,718.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,030.92
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$323.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$356.06
|
|
