|
BALLOON POWERCROSS PTA 4x20mm
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270671662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
|
BALLOON POWERCROSS PTA 4x20mm
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270671662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
BALLOON POWERCROSS PTA 4x40mm
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270671663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
BALLOON POWERCROSS PTA 4x40mm
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270671663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
|
BALLOON POWERCROSS PTA 4x60mm
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270671664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
BALLOON POWERCROSS PTA 4x60mm
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270671664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
|
BALLOON POWERCROSS PTA 4x80mm
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270671665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
|
BALLOON POWERCROSS PTA 4x80mm
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270671665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
BALLOON POWERCROSS PTA 5x100cm
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270644162S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
|
BALLOON POWERCROSS PTA 5x100cm
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270644162N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$275.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
BALLOON POWERCROSS PTA 5x100cm
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270644162O
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$275.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.12
|
|
|
BALLOON POWERCROSS PTA 5x100cm
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270644162C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
|
BALLOON POWERCROSS PTA 5x100cm
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270644162O
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$275.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
BALLOON POWERCROSS PTA 5x100cm
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270644162S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
BALLOON POWERCROSS PTA 5x100cm
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270644162C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
BALLOON POWERCROSS PTA 5x100cm
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270644162N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$275.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.12
|
|
|
BALLOON POWERCROSS PTA 5x100mm
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270644162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
BALLOON POWERCROSS PTA 5x100mm
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270644162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
|
BALLOON POWER CROSS PTA 5x150m
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270667004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
BALLOON POWER CROSS PTA 5x150m
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270667004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
|
BALLOON POWERCROSS PTA 5x200mm
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270643958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
BALLOON POWERCROSS PTA 5x200mm
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270643958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
|
BALLOON POWERCROSS PTA 5x20mm
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270644456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
BALLOON POWERCROSS PTA 5x20mm
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270644456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
|
BALLOON POWERCROSS PTA 5x40mm
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270643930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$247.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.81
|
|
