|
CATHBALLOONHIGHPRESS 4X20X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 4X60X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 4X60X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 4X80X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 4X80X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 5X20X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 5X20X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 5X40X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 5X40X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 5X80X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 5X80X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 5X80X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2706507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 5X80X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2706507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 6X20X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 6X20X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 6X40X80
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 6X40X80
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 6X60X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 6X60X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 6X60X80
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 6X60X80
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 6X80X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|
|
CATHBALLOONHIGHPRESS 6X80X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 7X20X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 7X20X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.84
|
|