|
BALLOON STERLING 2.0x20mm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270645081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$361.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 2.0x20mm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270645081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|
|
BALLOON STERLING 2x40mm 142cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270645210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|
|
BALLOON STERLING 2x40mm 142cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270645210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$361.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 2x40MMx142CM
|
Facility
|
IP
|
$1,824.50
|
|
| Hospital Charge Code |
270645210C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.68 |
| Max. Negotiated Rate |
$441.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$364.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$441.53
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$401.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.68
|
|
|
BALLOON STERLING 2x40MMx142CM
|
Facility
|
OP
|
$1,824.50
|
|
| Hospital Charge Code |
270645210C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$912.25 |
| Rate for Payer: Aetna Commercial |
$693.31
|
| Rate for Payer: Aetna Medicare Advantage |
$547.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$465.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$465.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$364.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$465.25
|
| Rate for Payer: Cigna Commercial |
$912.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$441.53
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$401.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.35
|
|
|
BALLOON STERLING 3.5x40 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270637588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|
|
BALLOON STERLING 3.5x40 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270637588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$361.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 3x20mm 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270643335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$361.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 3x20mm 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270643335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|
|
BALLOON STERLING 3x40mm 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270637716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$361.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 3x40mm 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270637716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|
|
BALLOON STERLING 3x60mm 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270644095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$361.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 3x60mm 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270644095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|
|
BALLOON STERLING 4.5x20 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270637589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$361.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 4.5x20 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270637589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|
|
BALLOON STERLING 4x100 135cm
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
27064222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$556.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$506.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.00
|
|
|
BALLOON STERLING 4x100 135cm
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
27064222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.43 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$874.00
|
| Rate for Payer: Aetna Medicare Advantage |
$690.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$506.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.95
|
|
|
BALLOON STERLING 4x100 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270642222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|
|
BALLOON STERLING 4x100 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270642222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$361.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 4x20mm 135cm
|
Facility
|
IP
|
$1,493.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270643004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$361.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 4x20mm 135cm
|
Facility
|
OP
|
$1,493.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270643004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|
|
BALLOON STERLING 4x20mm 80cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270637555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|
|
BALLOON STERLING 4x20mm 80cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270637555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$361.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 4x40mm 135cm
|
Facility
|
OP
|
$1,493.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270639030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$567.53
|
| Rate for Payer: Aetna Medicare Advantage |
$448.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$380.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$380.84
|
| Rate for Payer: Cigna Commercial |
$746.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$328.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.58
|
|