|
ANGIOSEAL VIP 8FR 610131
|
Facility
|
IP
|
$12,000.00
|
|
| Hospital Charge Code |
270637741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,904.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,800.00
|
|
|
ANGIOSEAL VIP 8FR 610131
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270637741N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$278.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$230.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$278.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.50
|
|
|
ANGIOSEAL VIP 8FR 610131
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270637741N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna Commercial |
$345.00
|
| Rate for Payer: Aetna Medicare Advantage |
$345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$293.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$230.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$293.25
|
| Rate for Payer: Cigna Commercial |
$575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$278.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.50
|
|
|
ANGIOSEAL VIP 8FR 610131
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
270637741S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$278.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$230.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$278.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.50
|
|
|
ANGIOSEAL VIP 8FR 610131
|
Facility
|
OP
|
$12,000.00
|
|
| Hospital Charge Code |
270637741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna Commercial |
$3,600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,060.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,060.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,060.00
|
| Rate for Payer: Cigna Commercial |
$6,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,904.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,800.00
|
|
|
ANGIO SELECT RENAL BI S&L
|
Facility
|
IP
|
$7,240.05
|
|
| Hospital Charge Code |
74110001
|
|
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
|
|
|
ANGIO SELECT RENAL BI S&L
|
Facility
|
OP
|
$7,240.05
|
|
| Hospital Charge Code |
5100012
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$941.21 |
| Max. Negotiated Rate |
$3,620.03 |
| Rate for Payer: Aetna Commercial |
$2,172.01
|
| 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 |
$941.21
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,086.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
ANGIO SELECT RENAL BI S&L
|
Facility
|
OP
|
$7,240.05
|
|
| Hospital Charge Code |
74110001
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$941.21 |
| Max. Negotiated Rate |
$3,620.03 |
| Rate for Payer: Aetna Commercial |
$2,172.01
|
| 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 |
$941.21
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,086.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
ANGIO SELECT RENAL BI S&L
|
Facility
|
IP
|
$7,240.05
|
|
| Hospital Charge Code |
5100012
|
|
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
|
|
|
ANGIO SELECT RENAL UNI S&I
|
Facility
|
IP
|
$7,240.05
|
|
| Hospital Charge Code |
74110002
|
|
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
|
|
|
ANGIO SELECT RENAL UNI S&I
|
Facility
|
OP
|
$13,436.40
|
|
| Hospital Charge Code |
5100013
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$6,718.20 |
| Rate for Payer: Aetna Commercial |
$4,030.92
|
| 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 |
$1,746.73
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
ANGIO SELECT RENAL UNI S&I
|
Facility
|
IP
|
$13,436.40
|
|
| Hospital Charge Code |
5100013
|
|
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
|
|
|
ANGIO SELECT RENAL UNI S&I
|
Facility
|
OP
|
$7,240.05
|
|
| Hospital Charge Code |
74110002
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$941.21 |
| Max. Negotiated Rate |
$3,620.03 |
| Rate for Payer: Aetna Commercial |
$2,172.01
|
| 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 |
$941.21
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,086.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
ANGIO SELECT VISCERAL S&I
|
Facility
|
IP
|
$1,351.70
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
5100344
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$202.75 |
| Max. Negotiated Rate |
$202.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$202.75
|
|
|
ANGIO SELECT VISCERAL S&I
|
Facility
|
OP
|
$1,351.70
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
5100344
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$175.72 |
| Max. Negotiated Rate |
$13,251.23 |
| Rate for Payer: Aetna Commercial |
$405.51
|
| Rate for Payer: Aetna Medicare Advantage |
$405.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$344.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$344.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$266.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$344.68
|
| Rate for Payer: Cigna Commercial |
$13,251.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.72
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$202.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
ANGIO SET IV CATH SYSTEM-20X1
|
Facility
|
IP
|
$8.95
|
|
| Hospital Charge Code |
270612019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.34
|
|
|
ANGIO SET IV CATH SYSTEM-20X1
|
Facility
|
OP
|
$8.95
|
|
| Hospital Charge Code |
270612019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna Medicare Advantage |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.28
|
| Rate for Payer: Cigna Commercial |
$4.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.16
|
| Rate for Payer: Oxford Commercial |
$4.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.47
|
|
|
ANGIOTENSIN CONV ENZY,CSF
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
39900326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ANGIOTENSIN CONV ENZY,CSF
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
39900326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$47.30
|
| Rate for Payer: Aetna Medicare Advantage |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.49
|
| Rate for Payer: Cigna Commercial |
$14.60
|
| Rate for Payer: Cigna Medicare Advantage |
$7.30
|
| Rate for Payer: Clover Medicare Advantage |
$13.87
|
| Rate for Payer: EmblemHealth Commercial |
$43.80
|
| Rate for Payer: Humana Medicare Advantage |
$15.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.60
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.60
|
|
|
ANGIOTENSIN CONVERTING EN
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
39900043
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$47.30
|
| Rate for Payer: Aetna Medicare Advantage |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.49
|
| Rate for Payer: Cigna Commercial |
$14.60
|
| Rate for Payer: Cigna Medicare Advantage |
$7.30
|
| Rate for Payer: Clover Medicare Advantage |
$13.87
|
| Rate for Payer: EmblemHealth Commercial |
$43.80
|
| Rate for Payer: Humana Medicare Advantage |
$15.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.60
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.60
|
|
|
ANGIOTENSIN CONVERTING EN
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
39900043
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ANGIOTENSIN CONVERTING ENZYME
|
Facility
|
OP
|
$181.65
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
3004074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$47.30
|
| Rate for Payer: Aetna Medicare Advantage |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.49
|
| Rate for Payer: Cigna Commercial |
$14.60
|
| Rate for Payer: Cigna Medicare Advantage |
$7.30
|
| Rate for Payer: Clover Medicare Advantage |
$13.87
|
| Rate for Payer: EmblemHealth Commercial |
$43.80
|
| Rate for Payer: Humana Medicare Advantage |
$15.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.61
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.60
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.60
|
|
|
ANGIOTENSIN CONVERTING ENZYME
|
Facility
|
IP
|
$181.65
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
3004074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.25
|
|
|
ANGIOTENSIN CONVERTING ENZYME
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
38472113
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$47.30
|
| Rate for Payer: Aetna Medicare Advantage |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.49
|
| Rate for Payer: Cigna Commercial |
$14.60
|
| Rate for Payer: Cigna Medicare Advantage |
$7.30
|
| Rate for Payer: Clover Medicare Advantage |
$13.87
|
| Rate for Payer: EmblemHealth Commercial |
$43.80
|
| Rate for Payer: Humana Medicare Advantage |
$15.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$66.17
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.60
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.60
|
|
|
ANGIOTENSIN CONVERTING ENZYME
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
38472113
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.35 |
| Max. Negotiated Rate |
$76.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.35
|
|