Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR VENOGRAM CAVA SUPERIOR

Facility

$4,267.00

Service Code	HCPCS 75827
Hospital Charge Code	7411713
Hospital Revenue Code	320
Min. Negotiated Rate	$640.05
Max. Negotiated Rate	$640.05
Rate for Payer: Qualcare PPO/HMO/WC	$640.05

IR VENOGRAM CAVA SUPERIOR

Facility

$4,267.00

Service Code	HCPCS 75827
Hospital Charge Code	2600128
Hospital Revenue Code	320
Min. Negotiated Rate	$640.05
Max. Negotiated Rate	$640.05
Rate for Payer: Qualcare PPO/HMO/WC	$640.05

IR VENOGRAM CAVA SUPERIOR

Facility

$4,267.00

Service Code	HCPCS 75827
Hospital Charge Code	2600128
Hospital Revenue Code	320
Min. Negotiated Rate	$121.18
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$343.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
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	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$121.18

IR VENOGRAM EXTREMITY UNI

Facility

$3,630.70

Service Code	HCPCS 75820
Hospital Charge Code	2001360
Hospital Revenue Code	320
Min. Negotiated Rate	$103.11
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.98
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$544.61
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$114.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$103.11

IR VENOGRAM EXTREMITY UNI

Facility

$3,630.70

Service Code	HCPCS 75820
Hospital Charge Code	2001360
Hospital Revenue Code	320
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$544.61
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

IR VENOGRAM EXTREMITY UNI

Facility

$3,630.70

Service Code	HCPCS 75820
Hospital Charge Code	321075820
Hospital Revenue Code	320
Min. Negotiated Rate	$103.11
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.98
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$544.61
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$114.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$103.11

IR VENOGRAM EXTREMITY UNI

Facility

$3,630.70

Service Code	HCPCS 75820
Hospital Charge Code	321075820
Hospital Revenue Code	320
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$544.61
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

IR VENOGRAM EXTREMITY UNI

Facility

$4,267.00

Service Code	HCPCS 75820
Hospital Charge Code	7411708
Hospital Revenue Code	320
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
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	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$121.18

IR VENOGRAM EXTREMITY UNI

Facility

$4,267.00

Service Code	HCPCS 75820
Hospital Charge Code	7411708
Hospital Revenue Code	320
Min. Negotiated Rate	$640.05
Max. Negotiated Rate	$640.05
Rate for Payer: Qualcare PPO/HMO/WC	$640.05

IR VENOGRAM ORBITAL

Facility

$5,444.00

Service Code	HCPCS 75880
Hospital Charge Code	7411722
Hospital Revenue Code	320
Min. Negotiated Rate	$816.60
Max. Negotiated Rate	$816.60
Rate for Payer: Qualcare PPO/HMO/WC	$816.60

IR VENOGRAM ORBITAL

Facility

$5,444.00

Service Code	HCPCS 75880
Hospital Charge Code	7411722
Hospital Revenue Code	320
Min. Negotiated Rate	$105.81
Max. Negotiated Rate	$2,703.39
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,703.39
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$521.67
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,415.44
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$816.60
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$172.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$154.61

IR VENOGRAM ORBITAL

Facility

$5,444.00

Service Code	HCPCS 75880
Hospital Charge Code	2600133
Hospital Revenue Code	320
Min. Negotiated Rate	$105.81
Max. Negotiated Rate	$2,703.39
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,703.39
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$521.67
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,415.44
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$816.60
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$172.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$154.61

IR VENOGRAM ORBITAL

Facility

$5,444.00

Service Code	HCPCS 75880
Hospital Charge Code	2600133
Hospital Revenue Code	320
Min. Negotiated Rate	$816.60
Max. Negotiated Rate	$816.60
Rate for Payer: Qualcare PPO/HMO/WC	$816.60

IR VENOGRAPHY EXTRM BI W/S&I

Facility

$6,404.20

Service Code	HCPCS 75822
Hospital Charge Code	5600186
Hospital Revenue Code	320
Min. Negotiated Rate	$130.35
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
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	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$181.88

IR VENOGRAPHY EXTRM BI W/S&I

Facility

$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 REN BILAT SELECT

Facility

$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

$13,436.40

Service Code	HCPCS 75833
Hospital Charge Code	411075833U
Hospital Revenue Code	320
Min. Negotiated Rate	$346.50
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	$346.50
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	$3,493.46
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,015.46
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$424.59
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	$381.59

IR VENOGRAPHY REN BILAT SELECT

Facility

$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

$15,468.50

Service Code	HCPCS 75833
Hospital Charge Code	2002232
Hospital Revenue Code	320
Min. Negotiated Rate	$346.50
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	$346.50
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 VENOGRAPHY REN BILAT SELECT

Facility

$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

$15,468.50

Service Code	HCPCS 75833
Hospital Charge Code	321075833
Hospital Revenue Code	320
Min. Negotiated Rate	$346.50
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	$346.50
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 VENOGRAPHY REN BILAT SELECT

Facility

$13,436.40

Service Code	HCPCS 75833
Hospital Charge Code	366875833
Hospital Revenue Code	320
Min. Negotiated Rate	$346.50
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	$346.50
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	$3,493.46
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,015.46
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$424.59
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	$381.59

IR VENOGRAPHY REN BILAT SELECT

Facility

$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 VENOUS MECH THROMBECTOMY LT

Facility

$27,397.00

Service Code	HCPCS 37187LT
Hospital Charge Code	366837187L
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
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	$3,536.00
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	$7,123.22
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

IR VENOUS MECH THROMBECTOMY LT

Facility

$27,397.00

Service Code	HCPCS 37187LT
Hospital Charge Code	5700191
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
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	$3,536.00
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	$7,123.22
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

Know your out-of-pocket cost for care.

All Charges