|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
270653593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$387.60
|
| Rate for Payer: Aetna Medicare Advantage |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$260.10
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.03
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
IP
|
$857.50
|
|
| Hospital Charge Code |
270653601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.62 |
| Max. Negotiated Rate |
$207.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$188.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
OP
|
$857.50
|
|
| Hospital Charge Code |
270653601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$428.75 |
| Rate for Payer: Aetna Commercial |
$325.85
|
| Rate for Payer: Aetna Medicare Advantage |
$257.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.66
|
| Rate for Payer: Cigna Commercial |
$428.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$188.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.72
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
IP
|
$857.50
|
|
| Hospital Charge Code |
270653603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.62 |
| Max. Negotiated Rate |
$207.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$188.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
270653605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$387.60
|
| Rate for Payer: Aetna Medicare Advantage |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$260.10
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.03
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
270653613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$246.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
IP
|
$204.00
|
|
| Hospital Charge Code |
270653595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$49.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.37
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$44.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2706533611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$246.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
270653617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$314.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.90
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
270653618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$246.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
272653615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$246.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
270653611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$246.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
270653611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$387.60
|
| Rate for Payer: Aetna Medicare Advantage |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$260.10
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.03
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
270653613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$387.60
|
| Rate for Payer: Aetna Medicare Advantage |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$260.10
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.03
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
OP
|
$204.00
|
|
| Hospital Charge Code |
270653595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$77.52
|
| Rate for Payer: Aetna Medicare Advantage |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.02
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.37
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$44.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.41
|
|
|
CATHETER BALLOON UT/SDS OTW 10
|
Facility
|
OP
|
$857.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270655037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$428.75 |
| Rate for Payer: Aetna Commercial |
$325.85
|
| Rate for Payer: Aetna Medicare Advantage |
$257.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.66
|
| Rate for Payer: Cigna Commercial |
$428.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$188.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.72
|
|
|
CATHETER BALLOON UT/SDS OTW 10
|
Facility
|
IP
|
$857.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270655037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.62 |
| Max. Negotiated Rate |
$207.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$188.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
|
|
CATHETER BALLOON VOYAGER RX CO
|
Facility
|
IP
|
$850.00
|
|
| Hospital Charge Code |
270CH0007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
|
|
CATHETER BALLOON VOYAGER RX CO
|
Facility
|
IP
|
$1,275.00
|
|
| Hospital Charge Code |
270CH0035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$191.25
|
|
|
CATHETER BALLOON VOYAGER RX CO
|
Facility
|
OP
|
$850.00
|
|
| Hospital Charge Code |
270CH0007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Medicare Advantage |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$216.75
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$255.00
|
| Rate for Payer: Oxford Commercial |
$170.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$170.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.52
|
|
|
CATHETER BALLOON VOYAGER RX CO
|
Facility
|
IP
|
$850.00
|
|
| Hospital Charge Code |
270643206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$187.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
|
|
CATHETER BALLOON VOYAGER RX CO
|
Facility
|
IP
|
$850.00
|
|
| Hospital Charge Code |
270643214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$187.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
|
|
CATHETER BALLOON VOYAGER RX CO
|
Facility
|
OP
|
$850.00
|
|
| Hospital Charge Code |
270643214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Medicare Advantage |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$216.75
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$187.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.52
|
|
|
CATHETER BALLOON VOYAGER RX CO
|
Facility
|
OP
|
$850.00
|
|
| Hospital Charge Code |
270643206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Medicare Advantage |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$216.75
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$187.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.52
|
|
|
CATHETER BALLOON VOYAGER RX CO
|
Facility
|
IP
|
$850.00
|
|
| Hospital Charge Code |
270CH0034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
|
