|
IR ANGIO RENAL UNILAT SEL
|
Facility
|
IP
|
$13,436.40
|
|
| Hospital Charge Code |
2000891
|
|
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 SEL EA ADD
|
Facility
|
IP
|
$3,054.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
321075774
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$458.10 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$458.10
|
|
|
IR ANGIO SEL EA ADD
|
Facility
|
IP
|
$3,958.15
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
7411703
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$593.72 |
| Max. Negotiated Rate |
$593.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$593.72
|
|
|
IR ANGIO SEL EA ADD
|
Facility
|
IP
|
$3,054.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
5100450
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$458.10 |
| Max. Negotiated Rate |
$458.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$458.10
|
|
|
IR ANGIO SEL EA ADD
|
Facility
|
OP
|
$3,054.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
5100450
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$1,160.52
|
| Rate for Payer: Aetna Medicare Advantage |
$916.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$778.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$778.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$352.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$778.77
|
| Rate for Payer: Cigna Commercial |
$1,527.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$916.20
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$458.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$73.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$80.93
|
|
|
IR ANGIO SEL EA ADD
|
Facility
|
OP
|
$3,054.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
321075774
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$1,160.52
|
| Rate for Payer: Aetna Medicare Advantage |
$916.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$778.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$778.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$352.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$778.77
|
| Rate for Payer: Cigna Commercial |
$1,527.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$916.20
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$458.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$73.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$80.93
|
|
|
IR ANGIO SEL EA ADD
|
Facility
|
OP
|
$3,958.15
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
7411703
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$1,979.08 |
| Rate for Payer: Aetna Commercial |
$1,504.10
|
| Rate for Payer: Aetna Medicare Advantage |
$1,187.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,009.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,009.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$352.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,009.33
|
| Rate for Payer: Cigna Commercial |
$1,979.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,187.44
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$593.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$95.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$104.89
|
|
|
IR ANGIO SEL PELV S&I
|
Facility
|
OP
|
$7,240.05
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
5100345
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$174.49 |
| 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 |
$292.72
|
| 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 |
$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 |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$191.86
|
|
|
IR ANGIO SEL PELV S&I
|
Facility
|
IP
|
$7,240.05
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
5100345
|
|
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 SHUNTOGRAM AV
|
Facility
|
IP
|
$1,268.00
|
|
| Hospital Charge Code |
2004752
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$190.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$190.20
|
|
|
IR ANGIO SHUNTOGRAM AV
|
Facility
|
OP
|
$1,268.00
|
|
| Hospital Charge Code |
2004752
|
|
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
|
|
|
IR ANGIO SHUNTOGRAM AV COMPLET
|
Facility
|
IP
|
$1,310.20
|
|
|
Service Code
|
HCPCS 75791
|
| Hospital Charge Code |
5600193
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$196.53 |
| Max. Negotiated Rate |
$196.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.53
|
|
|
IR ANGIO SHUNTOGRAM AV COMPLET
|
Facility
|
OP
|
$1,310.20
|
|
|
Service Code
|
HCPCS 75791
|
| Hospital Charge Code |
5600193
|
|
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
|
|
|
IR ANGIO THRU EXISTNG CATHETER
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
7411729
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR ANGIO THRU EXISTNG CATHETER
|
Facility
|
OP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
321075898
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.34 |
| 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 |
$212.96
|
| 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 THRU EXISTNG CATHETER
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
366875898
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
IR ANGIO THRU EXISTNG CATHETER
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
7411729
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.91 |
| 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 |
$212.96
|
| 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 |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| 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 |
$135.15
|
|
|
IR ANGIO THRU EXISTNG CATHETER
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
366875898
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.91 |
| 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 |
$212.96
|
| 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 |
$1,530.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.91
|
| 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 |
$135.15
|
|
|
IR ANGIO THRU EXISTNG CATHETER
|
Facility
|
IP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
2600007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
|
|
IR ANGIO THRU EXISTNG CATHETER
|
Facility
|
IP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
321075898
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
|
|
IR ANGIO THRU EXISTNG CATHETER
|
Facility
|
OP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75898
|
| Hospital Charge Code |
2600007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.34 |
| 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 |
$212.96
|
| 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 VERTEBRAL CERV/INTRAC
|
Facility
|
IP
|
$7,240.05
|
|
| Hospital Charge Code |
2004422
|
|
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 VERTEBRAL CERV/INTRAC
|
Facility
|
OP
|
$7,240.05
|
|
| Hospital Charge Code |
2004422
|
|
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 VISCERAL SEL/SUPRASEL
|
Facility
|
OP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
2600040
|
|
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 |
$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 |
$6,610.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$6,610.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$356.06
|
|
|
IR ANGIO VISCERAL SEL/SUPRASEL
|
Facility
|
IP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
2600040
|
|
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
|
|
