|
IR VENOGRAM SINUS
|
Facility
|
IP
|
$2,237.55
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
7411719
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$335.63 |
| Max. Negotiated Rate |
$335.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$335.63
|
|
|
IR VENOGRAM SINUS
|
Facility
|
OP
|
$2,237.55
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
2600137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.88 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$671.26
|
| Rate for Payer: Aetna Medicare Advantage |
$671.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$353.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.58
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$290.88
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$335.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR VENOGRAM SINUS
|
Facility
|
OP
|
$2,237.55
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
7411719
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.88 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$671.26
|
| Rate for Payer: Aetna Medicare Advantage |
$671.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$353.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.58
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$290.88
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$335.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR VENOGRAPHY EXTRM BI W/S&I
|
Facility
|
OP
|
$4,693.75
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
7411711
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$3,748.67 |
| Rate for Payer: Aetna Commercial |
$1,408.12
|
| Rate for Payer: Aetna Medicare Advantage |
$1,408.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,196.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,196.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,196.91
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$610.19
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$704.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR VENOGRAPHY EXTRM BI W/S&I
|
Facility
|
IP
|
$4,693.75
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
7411711
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$704.06 |
| Max. Negotiated Rate |
$704.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$704.06
|
|
|
IR VENOGRAPHY EXTRM BI W/S&I
|
Facility
|
IP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
5600186
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.63
|
|
|
IR VENOGRAPHY EXTRM BI W/S&I
|
Facility
|
OP
|
$6,404.20
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
5600186
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$3,748.67 |
| 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 |
$147.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,633.07
|
| Rate for Payer: Cigna Commercial |
$3,748.67
|
| 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 VENOGRAPHY REN BILAT SELECT
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
321075833
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,640.55
|
| Rate for Payer: Aetna Medicare Advantage |
$4,640.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,944.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,944.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,944.47
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.90
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR VENOGRAPHY REN BILAT SELECT
|
Facility
|
IP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
366875833
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,015.46 |
| Max. Negotiated Rate |
$2,015.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
|
|
IR VENOGRAPHY REN BILAT SELECT
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
321075833
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR VENOGRAPHY REN BILAT SELECT
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
2002232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR VENOGRAPHY REN BILAT SELECT
|
Facility
|
IP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
411075833U
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,015.46 |
| Max. Negotiated Rate |
$2,015.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
|
|
IR VENOGRAPHY REN BILAT SELECT
|
Facility
|
IP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
7411715
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,015.46 |
| Max. Negotiated Rate |
$2,015.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,015.46
|
|
|
IR VENOGRAPHY REN BILAT SELECT
|
Facility
|
OP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
366875833
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$7,519.21 |
| 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 |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,426.28
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| 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 VENOGRAPHY REN BILAT SELECT
|
Facility
|
OP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
411075833U
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$7,519.21 |
| 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 |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,426.28
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| 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 VENOGRAPHY REN BILAT SELECT
|
Facility
|
OP
|
$13,436.40
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
7411715
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$7,519.21 |
| 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 |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,426.28
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| 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 VENOGRAPHY REN BILAT SELECT
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
2002232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$4,640.55
|
| Rate for Payer: Aetna Medicare Advantage |
$4,640.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,944.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,944.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,944.47
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,010.90
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
IR VENOUS MECH THROMBECTOMY LT
|
Facility
|
OP
|
$18,307.80
|
|
|
Service Code
|
HCPCS 37187LT
|
| Hospital Charge Code |
7411916
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$9,153.90 |
| Rate for Payer: Aetna Commercial |
$5,492.34
|
| Rate for Payer: Aetna Medicare Advantage |
$5,492.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,668.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,668.49
|
| 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 |
$4,668.49
|
| Rate for Payer: Cigna Commercial |
$9,153.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,380.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,746.17
|
|
|
IR VENOUS MECH THROMBECTOMY LT
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37187LT
|
| Hospital Charge Code |
366837187L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$13,698.50 |
| Rate for Payer: Aetna Commercial |
$8,219.10
|
| Rate for Payer: Aetna Medicare Advantage |
$8,219.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,986.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,986.23
|
| 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 |
$6,986.23
|
| Rate for Payer: Cigna Commercial |
$13,698.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,561.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
IR VENOUS MECH THROMBECTOMY LT
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37187LT
|
| Hospital Charge Code |
321037187L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$13,698.50 |
| Rate for Payer: Aetna Commercial |
$8,219.10
|
| Rate for Payer: Aetna Medicare Advantage |
$8,219.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,986.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,986.23
|
| 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 |
$6,986.23
|
| Rate for Payer: Cigna Commercial |
$13,698.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,561.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
IR VENOUS MECH THROMBECTOMY LT
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37187LT
|
| Hospital Charge Code |
411037187L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$13,698.50 |
| Rate for Payer: Aetna Commercial |
$8,219.10
|
| Rate for Payer: Aetna Medicare Advantage |
$8,219.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,986.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,986.23
|
| 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 |
$6,986.23
|
| Rate for Payer: Cigna Commercial |
$13,698.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,561.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
IR VENOUS MECH THROMBECTOMY LT
|
Facility
|
IP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37187LT
|
| Hospital Charge Code |
411037187L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,109.55 |
| Max. Negotiated Rate |
$4,109.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
IR VENOUS MECH THROMBECTOMY LT
|
Facility
|
IP
|
$18,307.80
|
|
|
Service Code
|
HCPCS 37187LT
|
| Hospital Charge Code |
7411916
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,746.17 |
| Max. Negotiated Rate |
$2,746.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,746.17
|
|
|
IR VENOUS MECH THROMBECTOMY LT
|
Facility
|
OP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37187LT
|
| Hospital Charge Code |
5700191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$13,698.50 |
| Rate for Payer: Aetna Commercial |
$8,219.10
|
| Rate for Payer: Aetna Medicare Advantage |
$8,219.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,986.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,986.23
|
| 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 |
$6,986.23
|
| Rate for Payer: Cigna Commercial |
$13,698.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,561.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
|
IR VENOUS MECH THROMBECTOMY LT
|
Facility
|
IP
|
$27,397.00
|
|
|
Service Code
|
HCPCS 37187LT
|
| Hospital Charge Code |
366837187L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,109.55 |
| Max. Negotiated Rate |
$4,109.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,109.55
|
|
