|
IR ANGIO FEMORAL BILAT
|
Facility
|
OP
|
$21,359.77
|
|
|
Service Code
|
HCPCS 75716
|
| Hospital Charge Code |
2001139
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$207.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$5,553.54
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,203.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$674.97
|
| 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 |
$606.62
|
|
|
IR ANGIO FEMORAL UNI
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
2001121
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$124.74 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$4,021.81
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$488.80
|
| 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 |
$439.31
|
|
|
IR ANGIO FEMORAL UNI
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
2001121
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR ANGIO FEMORAL UNI
|
Facility
|
OP
|
$13,882.22
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
741100110
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$124.74 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$3,609.38
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,082.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$438.68
|
| 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 |
$394.26
|
|
|
IR ANGIO FEMORAL UNI
|
Facility
|
IP
|
$13,882.22
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
741100110
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,082.33 |
| Max. Negotiated Rate |
$2,082.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,082.33
|
|
|
IR ANGIO FEMORAL UNI
|
Facility
|
OP
|
$13,882.22
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
366875710
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$124.74 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$3,609.38
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,082.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$438.68
|
| 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 |
$394.26
|
|
|
IR ANGIO FEMORAL UNI
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
321075710
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR ANGIO FEMORAL UNI
|
Facility
|
IP
|
$13,882.22
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
366875710
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,082.33 |
| Max. Negotiated Rate |
$2,082.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,082.33
|
|
|
IR ANGIO FEMORAL UNI
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
321075710
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$124.74 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$4,021.81
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$488.80
|
| 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 |
$439.31
|
|
|
IR ANGIOGRAM ADRENAL BILATERAL
|
Facility
|
OP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75733
|
| Hospital Charge Code |
7411696
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$291.09 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$291.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$3,128.06
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$380.18
|
| 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 |
$341.68
|
|
|
IR ANGIOGRAM ADRENAL BILATERAL
|
Facility
|
IP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75733
|
| Hospital Charge Code |
7411696
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,804.65 |
| Max. Negotiated Rate |
$1,804.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
|
|
IR ANGIOGRAM ADRENAL BILATERAL
|
Facility
|
IP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75733
|
| Hospital Charge Code |
2600009
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,804.65 |
| Max. Negotiated Rate |
$1,804.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
|
|
IR ANGIOGRAM ADRENAL BILATERAL
|
Facility
|
OP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75733
|
| Hospital Charge Code |
2600009
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$291.09 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$291.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$3,128.06
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$380.18
|
| 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 |
$341.68
|
|
|
IR ANGIOGRAM ADRENAL LEFT
|
Facility
|
IP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75731
|
| Hospital Charge Code |
2600010
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,804.65 |
| Max. Negotiated Rate |
$1,804.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
|
|
IR ANGIOGRAM ADRENAL LEFT
|
Facility
|
OP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75731
|
| Hospital Charge Code |
7411694
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$215.62 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$215.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$3,128.06
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$380.18
|
| 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 |
$341.68
|
|
|
IR ANGIOGRAM ADRENAL LEFT
|
Facility
|
IP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75731
|
| Hospital Charge Code |
7411694
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,804.65 |
| Max. Negotiated Rate |
$1,804.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
|
|
IR ANGIOGRAM ADRENAL LEFT
|
Facility
|
OP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75731
|
| Hospital Charge Code |
2600010
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$215.62 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$215.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$3,128.06
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$380.18
|
| 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 |
$341.68
|
|
|
IR ANGIOGRAM ADRENAL RIGHT
|
Facility
|
OP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75731
|
| Hospital Charge Code |
7411695
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$215.62 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$215.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$3,128.06
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$380.18
|
| 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 |
$341.68
|
|
|
IR ANGIOGRAM ADRENAL RIGHT
|
Facility
|
IP
|
$12,031.00
|
|
|
Service Code
|
HCPCS 75731
|
| Hospital Charge Code |
7411695
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,804.65 |
| Max. Negotiated Rate |
$1,804.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,804.65
|
|
|
IR ANGIOGRAM EXTRMTY BILATERAL
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75716
|
| Hospital Charge Code |
321075716
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$207.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$4,021.81
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$488.80
|
| 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 |
$439.31
|
|
|
IR ANGIOGRAM EXTRMTY BILATERAL
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75716
|
| Hospital Charge Code |
321075716
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR ANGIOGRAM EXTRMTY BILATERAL
|
Facility
|
IP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75716
|
| Hospital Charge Code |
2600025
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,320.28 |
| Max. Negotiated Rate |
$2,320.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
|
|
IR ANGIOGRAM EXTRMTY BILATERAL
|
Facility
|
OP
|
$15,468.50
|
|
|
Service Code
|
HCPCS 75716
|
| Hospital Charge Code |
2600025
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$207.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$4,021.81
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,320.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$488.80
|
| 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 |
$439.31
|
|
|
IR ANGIOGRAM INTERNAL MAMMARY
|
Facility
|
OP
|
$4,267.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
2600028
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$114.76 |
| Max. Negotiated Rate |
$13,607.37 |
| 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 |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| 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 |
$114.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$2,625.82
|
| 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 |
$1,109.42
|
| Rate for Payer: Oxford Commercial |
$1,955.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$640.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$134.84
|
| 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 |
$121.18
|
|
|
IR ANGIOGRAM INTERNAL MAMMARY
|
Facility
|
IP
|
$4,267.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
2600028
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$640.05 |
| Max. Negotiated Rate |
$640.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$640.05
|
|
