Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

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	$164.84
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$380.40
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	$164.84
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$190.20
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

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	$170.33
Max. Negotiated Rate	$2,773.00
Rate for Payer: Aetna Commercial	$393.06
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	$170.33
Rate for Payer: Oxford Commercial	$2,443.00
Rate for Payer: Qualcare PPO/HMO/WC	$196.53
Rate for Payer: UnitedHealthcare Commercial	$2,773.00

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	$205.70
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

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

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

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

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

OP

$6,404.20

Service Code	HCPCS 75898
Hospital Charge Code	2600007
Hospital Revenue Code	320
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$1,921.26
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,633.07
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$832.55
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

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	$205.70
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$1,530.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

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	$205.70
Max. Negotiated Rate	$7,519.21
Rate for Payer: Aetna Commercial	$1,921.26
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,633.07
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$832.55
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

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	$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

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

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	$266.51
Max. Negotiated Rate	$13,251.23
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) NJ Health	$266.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,426.28
Rate for Payer: Cigna Commercial	$13,251.23
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

IR ANGIO VISCERAL SER/SUPRASEL

Facility

IP

$13,436.40

Service Code	HCPCS 75726
Hospital Charge Code	7411693
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 VISCERAL SER/SUPRASEL

Facility

OP

$23,077.91

Service Code	HCPCS 75726
Hospital Charge Code	741100109
Hospital Revenue Code	323
Min. Negotiated Rate	$266.51
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$6,923.37
Rate for Payer: Aetna Medicare Advantage	$6,923.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,884.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,884.87
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	$5,884.87
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,000.13
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,461.69
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR ANGIO VISCERAL SER/SUPRASEL

Facility

IP

$23,077.91

Service Code	HCPCS 75726
Hospital Charge Code	741100109
Hospital Revenue Code	323
Min. Negotiated Rate	$3,461.69
Max. Negotiated Rate	$3,461.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,461.69

IR ANGIO VISCERAL SER/SUPRASEL

Facility

OP

$23,077.91

Service Code	HCPCS 75726
Hospital Charge Code	366875726
Hospital Revenue Code	323
Min. Negotiated Rate	$266.51
Max. Negotiated Rate	$13,251.23
Rate for Payer: Aetna Commercial	$6,923.37
Rate for Payer: Aetna Medicare Advantage	$6,923.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,884.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,884.87
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	$5,884.87
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,000.13
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,461.69
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR ANGIO VISCERAL SER/SUPRASEL

Facility

IP

$23,077.91

Service Code	HCPCS 75726
Hospital Charge Code	366875726
Hospital Revenue Code	323
Min. Negotiated Rate	$3,461.69
Max. Negotiated Rate	$3,461.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,461.69

IR ANGIO VISCERAL SER/SUPRASEL

Facility

OP

$13,436.40

Service Code	HCPCS 75726
Hospital Charge Code	7411693
Hospital Revenue Code	323
Min. Negotiated Rate	$266.51
Max. Negotiated Rate	$13,251.23
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) NJ Health	$266.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,426.28
Rate for Payer: Cigna Commercial	$13,251.23
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

IR ANKLE ARTHROGRAPHY

Facility

OP

$1,667.37

Service Code	HCPCS 73615
Hospital Charge Code	7411670
Hospital Revenue Code	322
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$500.21
Rate for Payer: Aetna Medicare Advantage	$500.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$425.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$425.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$425.18
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.76
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$250.11
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

IR ANKLE ARTHROGRAPHY

Facility

IP

$1,667.37

Service Code	HCPCS 73615
Hospital Charge Code	7411670
Hospital Revenue Code	322
Min. Negotiated Rate	$250.11
Max. Negotiated Rate	$250.11
Rate for Payer: Qualcare PPO/HMO/WC	$250.11

IR ANKLE ARTHROGRAPHY

Facility

OP

$1,667.37

Service Code	HCPCS 73615
Hospital Charge Code	2680295
Hospital Revenue Code	322
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$500.21
Rate for Payer: Aetna Medicare Advantage	$500.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$425.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$425.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$425.18
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.76
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$250.11
Rate for Payer: UnitedHealthcare Commercial	$1,489.00