|
BALLOON STERLING 4x80mm 135cm
|
Facility
|
IP
|
$1,824.50
|
|
| Hospital Charge Code |
270638626C
|
|
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: Qualcare PPO/HMO/WC |
$273.68
|
|
|
BALLOON STERLING 4x80mm 135cm
|
Facility
|
OP
|
$1,824.50
|
|
| Hospital Charge Code |
270638626C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.68 |
| Max. Negotiated Rate |
$912.25 |
| Rate for Payer: Aetna Commercial |
$547.35
|
| 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: Qualcare PPO/HMO/WC |
$273.68
|
|
|
BALLOON STERLING 5.5x20 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270638670
|
|
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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5.5x20 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270638670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$448.05
|
| 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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5x100 135cm
|
Facility
|
IP
|
$1,493.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270637615
|
|
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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5x100 135cm
|
Facility
|
OP
|
$1,493.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270637615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$448.05
|
| 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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5x20mm 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270637714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$448.05
|
| 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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5x20mm 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270637714
|
|
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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5x20mm 135cm
|
Facility
|
IP
|
$2,400.00
|
|
| Hospital Charge Code |
270637714C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$580.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$480.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$580.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$360.00
|
|
|
BALLOON STERLING 5x20mm 135cm
|
Facility
|
OP
|
$2,400.00
|
|
| Hospital Charge Code |
270637714C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Medicare Advantage |
$720.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$580.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$360.00
|
|
|
BALLOON STERLING 5x20mm 80cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270637556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$448.05
|
| 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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5x20mm 80cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270637556
|
|
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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5x40mm 135cm
|
Facility
|
OP
|
$1,493.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270641917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$448.05
|
| 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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5x40mm 135cm
|
Facility
|
IP
|
$1,493.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270641917
|
|
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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5x60mm 135cm
|
Facility
|
IP
|
$1,493.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270641373
|
|
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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 5x60mm 135cm
|
Facility
|
OP
|
$1,493.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270641373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$448.05
|
| 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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 6.5x20 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270644096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$448.05
|
| 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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 6.5x20 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270644096
|
|
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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 6x100mm 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270638408
|
|
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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 6x100mm 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270638408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$448.05
|
| 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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 6x20mm 135cm
|
Facility
|
IP
|
$1,906.50
|
|
| Hospital Charge Code |
270637715C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.98 |
| Max. Negotiated Rate |
$461.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$381.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$461.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.98
|
|
|
BALLOON STERLING 6x20mm 135cm
|
Facility
|
OP
|
$1,493.50
|
|
| Hospital Charge Code |
270637715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Aetna Commercial |
$448.05
|
| 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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 6x20mm 135cm
|
Facility
|
OP
|
$1,906.50
|
|
| Hospital Charge Code |
270637715C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.98 |
| Max. Negotiated Rate |
$953.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.98
|
| Rate for Payer: Aetna Commercial |
$571.95
|
| Rate for Payer: Aetna Medicare Advantage |
$571.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$486.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$486.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$381.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$486.16
|
| Rate for Payer: Cigna Commercial |
$953.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$461.37
|
|
|
BALLOON STERLING 6x20mm 135cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270637715
|
|
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: Qualcare PPO/HMO/WC |
$224.03
|
|
|
BALLOON STERLING 6x20mm 80cm
|
Facility
|
IP
|
$1,493.50
|
|
| Hospital Charge Code |
270637627
|
|
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: Qualcare PPO/HMO/WC |
$224.03
|
|