|
IR VASC SEL CATH INTR 1ST T/B
|
Facility
|
OP
|
$1,517.65
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
2004307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.29 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$455.30
|
| Rate for Payer: Aetna Medicare Advantage |
$455.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$387.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$387.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$387.00
|
| Rate for Payer: Cigna Commercial |
$203.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$197.29
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$227.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR VASC SEL CATH INTR 1ST T/B
|
Facility
|
IP
|
$1,517.65
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
2004307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.65 |
| Max. Negotiated Rate |
$227.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$227.65
|
|
|
IR VASC SEL CATH INTR 1ST T/B
|
Facility
|
OP
|
$1,517.65
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
7411426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.29 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$455.30
|
| Rate for Payer: Aetna Medicare Advantage |
$455.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$387.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$387.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$387.00
|
| Rate for Payer: Cigna Commercial |
$203.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$197.29
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$227.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR VASC SEL CATH INTRO 2ND T/B
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
2004315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.33
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.68
|
| Rate for Payer: Cigna Commercial |
$262.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR VASC SEL CATH INTRO 2ND T/B
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
7411427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
IR VASC SEL CATH INTRO 2ND T/B
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
7411427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.33
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.68
|
| Rate for Payer: Cigna Commercial |
$262.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR VASC SEL CATH INTRO 2ND T/B
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
2004315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
IR VASC SEL CATH INTRO 3RD T/B
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
321036217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Aetna Medicare Advantage |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$123.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$123.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$123.93
|
| Rate for Payer: Cigna Commercial |
$325.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.18
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR VASC SEL CATH INTRO 3RD T/B
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
2004158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Aetna Medicare Advantage |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$123.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$123.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$123.93
|
| Rate for Payer: Cigna Commercial |
$325.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.18
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR VASC SEL CATH INTRO 3RD T/B
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
2004158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.90 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.90
|
|
|
IR VASC SEL CATH INTRO 3RD T/B
|
Facility
|
IP
|
$414.45
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
7411428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
|
|
IR VASC SEL CATH INTRO 3RD T/B
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
321036217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.90 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.90
|
|
|
IR VASC SEL CATH INTRO 3RD T/B
|
Facility
|
OP
|
$414.45
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
7411428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$124.33
|
| Rate for Payer: Aetna Medicare Advantage |
$124.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.68
|
| Rate for Payer: Cigna Commercial |
$325.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.88
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
IR VASOGRAPHY
|
Facility
|
IP
|
$906.25
|
|
|
Service Code
|
HCPCS 74440
|
| Hospital Charge Code |
2600123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.94 |
| Max. Negotiated Rate |
$135.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.94
|
|
|
IR VASOGRAPHY
|
Facility
|
OP
|
$906.25
|
|
|
Service Code
|
HCPCS 74440
|
| Hospital Charge Code |
2600123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$271.88
|
| Rate for Payer: Aetna Medicare Advantage |
$271.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.09
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.81
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR VASOGRAPHY VESICULOGRAPHYEP
|
Facility
|
IP
|
$1,092.60
|
|
|
Service Code
|
HCPCS 74440
|
| Hospital Charge Code |
7411680
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.89 |
| Max. Negotiated Rate |
$163.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$163.89
|
|
|
IR VASOGRAPHY VESICULOGRAPHYEP
|
Facility
|
OP
|
$1,092.60
|
|
|
Service Code
|
HCPCS 74440
|
| Hospital Charge Code |
2680305
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$327.78
|
| Rate for Payer: Aetna Medicare Advantage |
$327.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$278.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$278.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$278.61
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$142.04
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$163.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR VASOGRAPHY VESICULOGRAPHYEP
|
Facility
|
OP
|
$1,092.60
|
|
|
Service Code
|
HCPCS 74440
|
| Hospital Charge Code |
7411680
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$327.78
|
| Rate for Payer: Aetna Medicare Advantage |
$327.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$278.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$278.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$278.61
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$142.04
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$163.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR VASOGRAPHY VESICULOGRAPHYEP
|
Facility
|
IP
|
$1,092.60
|
|
|
Service Code
|
HCPCS 74440
|
| Hospital Charge Code |
2680305
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.89 |
| Max. Negotiated Rate |
$163.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$163.89
|
|
|
IR VENA CAVAGRAM SUPERIOR
|
Facility
|
OP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 75827
|
| Hospital Charge Code |
2002228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$388.96 |
| Max. Negotiated Rate |
$3,748.67 |
| Rate for Payer: Aetna Commercial |
$1,089.21
|
| Rate for Payer: Aetna Medicare Advantage |
$1,089.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$388.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.83
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$471.99
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR VENA CAVAGRAM SUPERIOR
|
Facility
|
IP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 75827
|
| Hospital Charge Code |
2002228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$544.61 |
| Max. Negotiated Rate |
$544.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
|
|
IR VENA CAVAGRAM SUPERIOR
|
Facility
|
IP
|
$3,084.40
|
|
|
Service Code
|
HCPCS 75827
|
| Hospital Charge Code |
7411712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$462.66 |
| Max. Negotiated Rate |
$462.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.66
|
|
|
IR VENA CAVAGRAM SUPERIOR
|
Facility
|
IP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 75827
|
| Hospital Charge Code |
321075827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$544.61 |
| Max. Negotiated Rate |
$544.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
|
|
IR VENA CAVAGRAM SUPERIOR
|
Facility
|
OP
|
$3,084.40
|
|
|
Service Code
|
HCPCS 75827
|
| Hospital Charge Code |
7411712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$388.96 |
| Max. Negotiated Rate |
$3,748.67 |
| Rate for Payer: Aetna Commercial |
$925.32
|
| Rate for Payer: Aetna Medicare Advantage |
$925.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$786.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$786.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$388.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$786.52
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$400.97
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR VENA CAVAGRAM SUPERIOR
|
Facility
|
OP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 75827
|
| Hospital Charge Code |
321075827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$388.96 |
| Max. Negotiated Rate |
$3,748.67 |
| Rate for Payer: Aetna Commercial |
$1,089.21
|
| Rate for Payer: Aetna Medicare Advantage |
$1,089.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$925.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$925.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$388.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$925.83
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$471.99
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
