|
BALLOON EVERCROSS PTA 9x40x80
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270671633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
BALLOON EVERCROSS PTA 9X60X130
|
Facility
|
IP
|
$681.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671636S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.17 |
| Max. Negotiated Rate |
$164.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.83
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$149.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.17
|
|
|
BALLOON EVERCROSS PTA 9X60X130
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671636N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
BALLOON EVERCROSS PTA 9X60X130
|
Facility
|
OP
|
$681.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671636S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$340.55 |
| Rate for Payer: Aetna Commercial |
$258.82
|
| Rate for Payer: Aetna Medicare Advantage |
$204.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$173.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$173.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$173.68
|
| Rate for Payer: Cigna Commercial |
$340.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.83
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$149.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.05
|
|
|
BALLOON EVERCROSS PTA 9X60X130
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671636N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
BALLOON EVERCROSS PTA 9x60x135
|
Facility
|
OP
|
$681.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$340.55 |
| Rate for Payer: Aetna Commercial |
$258.82
|
| Rate for Payer: Aetna Medicare Advantage |
$204.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$173.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$173.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$173.68
|
| Rate for Payer: Cigna Commercial |
$340.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.83
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$149.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.05
|
|
|
BALLOON EVERCROSS PTA 9x60x135
|
Facility
|
IP
|
$681.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.17 |
| Max. Negotiated Rate |
$164.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.83
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$149.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.17
|
|
|
BALLOON EVERCROSS PTA 9x60x80
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270671635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
BALLOON EVERCROSS PTA 9x60x80
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270671635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
BALLOON EVERCROSS PTA 9x80x135
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671638N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
BALLOON EVERCROSS PTA 9x80x135
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671638N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
BALLOON EVERCROSS PTA 9x80x135
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
BALLOON EVERCROSS PTA 9x80x135
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671638S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
BALLOON EVERCROSS PTA 9x80x135
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671638S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
BALLOON EVERCROSS PTA 9x80x135
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270671638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
BALLOON EVERCROSS PTA 9x80x80
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270671637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
BALLOON EVERCROSS PTA 9x80x80
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270671637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$126.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
BALLOON EVRCRS AB35W05060135
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270644137C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$175.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$145.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$159.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON EVRCRS AB35W05060135
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270644137C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$145.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$159.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON EXTRACTOR 9mm-12mm
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
270646919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$281.20
|
| Rate for Payer: Aetna Medicare Advantage |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$148.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$188.70
|
| Rate for Payer: Cigna Commercial |
$370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$162.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.61
|
|
|
BALLOON EXTRACTOR 9mm-12mm
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
270646919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$179.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$148.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$162.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.00
|
|
|
BALLOON EXTRACTOR RX
|
Facility
|
IP
|
$26.55
|
|
| Hospital Charge Code |
270654395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.98
|
|
|
BALLOON EXTRACTOR RX
|
Facility
|
OP
|
$26.55
|
|
| Hospital Charge Code |
270654395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna Commercial |
$10.09
|
| Rate for Payer: Aetna Medicare Advantage |
$7.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.77
|
| Rate for Payer: Cigna Commercial |
$13.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.96
|
| Rate for Payer: Oxford Commercial |
$5.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.70
|
|
|
BALLOON EXTRACTOR RX RETRIE
|
Facility
|
IP
|
$752.50
|
|
| Hospital Charge Code |
270655029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$182.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$182.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$165.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.88
|
|
|
BALLOON EXTRACTOR RX RETRIE
|
Facility
|
OP
|
$752.50
|
|
| Hospital Charge Code |
270655029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$376.25 |
| Rate for Payer: Aetna Commercial |
$285.95
|
| Rate for Payer: Aetna Medicare Advantage |
$225.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.89
|
| Rate for Payer: Cigna Commercial |
$376.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$182.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$165.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.94
|
|
