Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR ANGIO HEPATIC SELECTIVE

Facility

$3,958.15

Service Code	HCPCS 75774
Hospital Charge Code	411075774
Hospital Revenue Code	323
Min. Negotiated Rate	$593.72
Max. Negotiated Rate	$593.72
Rate for Payer: Qualcare PPO/HMO/WC	$593.72

IR ANGIO MESENTERIC SUP

Facility

$25,628.45

Service Code	HCPCS 75726
Hospital Charge Code	2001261
Hospital Revenue Code	323
Min. Negotiated Rate	$235.16
Max. Negotiated Rate	$23,980.53
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,980.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,980.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,980.53
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$4,627.53
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,663.40
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$809.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$727.85

IR ANGIO MESENTERIC SUP

Facility

$25,628.45

Service Code	HCPCS 75726
Hospital Charge Code	2001261
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

IR ANGIO PULMONARY BILAT SEL

Facility

$15,468.50

Service Code	HCPCS 75743
Hospital Charge Code	2004786
Hospital Revenue Code	323
Min. Negotiated Rate	$288.73
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	$288.73
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 PULMONARY BILAT SEL

Facility

$15,468.50

Service Code	HCPCS 75743
Hospital Charge Code	2004786
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 PULMONARY BILAT SEL

Facility

$12,031.00

Service Code	HCPCS 75743
Hospital Charge Code	7411699
Hospital Revenue Code	323
Min. Negotiated Rate	$288.73
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	$288.73
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 ANGIO PULMONARY BILAT SEL

Facility

$12,031.00

Service Code	HCPCS 75743
Hospital Charge Code	7411699
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 ANGIO PULMONARY BILAT SEL

Facility

$15,468.50

Service Code	HCPCS 75743
Hospital Charge Code	321075743
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 PULMONARY BILAT SEL

Facility

$15,468.50

Service Code	HCPCS 75743
Hospital Charge Code	321075743
Hospital Revenue Code	323
Min. Negotiated Rate	$288.73
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	$288.73
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 PULMONARY UNI SEL

Facility

$12,031.00

Service Code	HCPCS 75741
Hospital Charge Code	7411698
Hospital Revenue Code	323
Min. Negotiated Rate	$231.00
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	$231.00
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 ANGIO PULMONARY UNI SEL

Facility

$12,031.00

Service Code	HCPCS 75741
Hospital Charge Code	7411698
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 ANGIO PULMONARY UNI SEL

Facility

$12,031.00

Service Code	HCPCS 75741
Hospital Charge Code	2001220
Hospital Revenue Code	323
Min. Negotiated Rate	$231.00
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	$231.00
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 ANGIO PULMONARY UNI SEL

Facility

$12,031.00

Service Code	HCPCS 75741
Hospital Charge Code	2001220
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 ANGIO PULMONARY VEN NON/SEL

Facility

$6,404.20

Service Code	HCPCS 75746
Hospital Charge Code	2004794
Hospital Revenue Code	323
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

IR ANGIO PULMONARY VEN NON/SEL

Facility

$6,404.20

Service Code	HCPCS 75746
Hospital Charge Code	2004794
Hospital Revenue Code	323
Min. Negotiated Rate	$89.10
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	$89.10
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	$1,665.09
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$202.37
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	$181.88

IR ANGIO PULMONARY VEN NON/SEL

Facility

$6,404.20

Service Code	HCPCS 75746
Hospital Charge Code	321075746
Hospital Revenue Code	323
Min. Negotiated Rate	$89.10
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	$89.10
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	$1,665.09
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$202.37
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	$181.88

IR ANGIO PULMONARY VEN NON/SEL

Facility

$4,914.50

Service Code	HCPCS 75746
Hospital Charge Code	366875746
Hospital Revenue Code	323
Min. Negotiated Rate	$89.10
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	$89.10
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	$1,277.77
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$737.17
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$155.30
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	$139.57

IR ANGIO PULMONARY VEN NON/SEL

Facility

$4,267.00

Service Code	HCPCS 75746
Hospital Charge Code	7411700
Hospital Revenue Code	323
Min. Negotiated Rate	$89.10
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	$89.10
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 ANGIO PULMONARY VEN NON/SEL

Facility

$4,914.50

Service Code	HCPCS 75746
Hospital Charge Code	411075746
Hospital Revenue Code	323
Min. Negotiated Rate	$89.10
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	$89.10
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	$1,277.77
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$737.17
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$155.30
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	$139.57

IR ANGIO PULMONARY VEN NON/SEL

Facility

$4,914.50

Service Code	HCPCS 75746
Hospital Charge Code	366875746
Hospital Revenue Code	323
Min. Negotiated Rate	$737.17
Max. Negotiated Rate	$737.17
Rate for Payer: Qualcare PPO/HMO/WC	$737.17

IR ANGIO PULMONARY VEN NON/SEL

Facility

$6,404.20

Service Code	HCPCS 75746
Hospital Charge Code	321075746
Hospital Revenue Code	323
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

IR ANGIO PULMONARY VEN NON/SEL

Facility

$4,267.00

Service Code	HCPCS 75746
Hospital Charge Code	7411700
Hospital Revenue Code	323
Min. Negotiated Rate	$640.05
Max. Negotiated Rate	$640.05
Rate for Payer: Qualcare PPO/HMO/WC	$640.05

IR ANGIO PULMONARY VEN NON/SEL

Facility

$4,914.50

Service Code	HCPCS 75746
Hospital Charge Code	411075746
Hospital Revenue Code	323
Min. Negotiated Rate	$737.17
Max. Negotiated Rate	$737.17
Rate for Payer: Qualcare PPO/HMO/WC	$737.17

IR ANGIO SEL EA ADD

Facility

$3,054.00

Service Code	HCPCS 75774
Hospital Charge Code	5100450
Hospital Revenue Code	323
Min. Negotiated Rate	$86.73
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$1,160.52
Rate for Payer: Aetna Medicare Advantage	$916.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$778.77
Rate for Payer: Cigna Commercial	$1,527.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$794.04
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.10
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$96.51
Rate for Payer: Wellpoint Medicaid Managed Care	$86.73

IR ANGIO SEL EA ADD

Facility

$3,054.00

Service Code	HCPCS 75774
Hospital Charge Code	321075774
Hospital Revenue Code	323
Min. Negotiated Rate	$86.73
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$1,160.52
Rate for Payer: Aetna Medicare Advantage	$916.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$778.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$778.77
Rate for Payer: Cigna Commercial	$1,527.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$794.04
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.10
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$96.51
Rate for Payer: Wellpoint Medicaid Managed Care	$86.73

Know your out-of-pocket cost for care.

All Charges