|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74116034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$530.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.30
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.28
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.60
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74115034
|
|
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 PVR/SEG LOW EXT BI
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74117034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
OP
|
$1,440.90
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
94053250
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$530.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$432.27
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.18
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74115034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$530.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,160.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
ARTERIAL PVR/SEG LOW EXT BI
|
Facility
|
IP
|
$1,440.90
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
94053250
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$216.13 |
| Max. Negotiated Rate |
$216.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.13
|
|
|
ARTERIAL STUDIES LOWER EXTREM
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74116032
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$530.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,160.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
ARTERIAL STUDIES LOWER EXTREM
|
Facility
|
OP
|
$1,440.90
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74117032
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$530.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$432.27
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.18
|
|
|
ARTERIAL STUDIES LOWER EXTREM
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74116032
|
|
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 STUDIES LOWER EXTREM
|
Facility
|
IP
|
$1,440.90
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74115032
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$216.13 |
| Max. Negotiated Rate |
$216.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.13
|
|
|
ARTERIAL STUDIES LOWER EXTREM
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
2684010
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$530.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,160.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
ARTERIAL STUDIES LOWER EXTREM
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
2684010
|
|
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 STUDIES LOWER EXTREM
|
Facility
|
IP
|
$1,440.90
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74117032
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$216.13 |
| Max. Negotiated Rate |
$216.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.13
|
|
|
ARTERIAL STUDIES LOWER EXTREM
|
Facility
|
OP
|
$1,440.90
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
74115032
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$530.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$432.27
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.18
|
|
|
ARTERIAL STUDIES UPP OR LOW
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
421593923
|
|
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 STUDIES UPP OR LOW
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
421593923
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna Commercial |
$697.73
|
| Rate for Payer: Aetna Medicare Advantage |
$831.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$256.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$530.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.96
|
| Rate for Payer: Cigna Commercial |
$514.20
|
| Rate for Payer: Cigna Medicare Advantage |
$256.52
|
| Rate for Payer: Clover Medicare Advantage |
$243.69
|
| Rate for Payer: EmblemHealth Commercial |
$769.56
|
| Rate for Payer: Humana Medicare Advantage |
$264.22
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$256.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,160.00
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
ARTERIAL VENOUS LINE W/IV
|
Facility
|
OP
|
$85.65
|
|
| Hospital Charge Code |
8200180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$42.83 |
| Rate for Payer: Aetna Commercial |
$32.55
|
| Rate for Payer: Aetna Medicare Advantage |
$25.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.84
|
| Rate for Payer: Cigna Commercial |
$42.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.70
|
| Rate for Payer: Oxford Commercial |
$17.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.13
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.27
|
|
|
ARTERIAL VENOUS LINE W/IV
|
Facility
|
IP
|
$85.65
|
|
| Hospital Charge Code |
8200180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.85
|
|
|
ARTERIAL VEVOUS LINE W/O IV
|
Facility
|
OP
|
$65.65
|
|
| Hospital Charge Code |
8200198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: Aetna Medicare Advantage |
$19.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.74
|
| Rate for Payer: Cigna Commercial |
$32.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.70
|
| Rate for Payer: Oxford Commercial |
$13.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.13
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.74
|
|
|
ARTERIAL VEVOUS LINE W/O IV
|
Facility
|
IP
|
$65.65
|
|
| Hospital Charge Code |
8200198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
ARTERION MARK IV INJ SYST150ML
|
Facility
|
OP
|
$43.80
|
|
| Hospital Charge Code |
270699516S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$21.90 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Medicare Advantage |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.17
|
| Rate for Payer: Cigna Commercial |
$21.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.14
|
| Rate for Payer: Oxford Commercial |
$8.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.76
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.16
|
|
|
ARTERION MARK IV INJ SYST150ML
|
Facility
|
IP
|
$43.80
|
|
| Hospital Charge Code |
270699516S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.57
|
|
|
ARTERY XRAY ARM/LEG
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
1600000866
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.79 |
| 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 |
$1,626.00
|
| 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 |
$3,751.17
|
| 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: Qualcare PPO/HMO/WC |
$2,320.28
|
| 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
|
|
|
ARTERY XRAY ARM/LEG
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
1600000866
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
ARTERY X-RAYS ABDOMEN
|
Facility
|
IP
|
$25,628.45
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
2004877
|
|
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
|
|
