|
CATH BALLOON ADM.035/4/120/130
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
2709000453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
CATH BALLOON ADM.035/4/120/130
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
2709000453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$450.00
|
|
|
CATH BALLOON ADM .035/4/20/130
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CATH BALLOON ADM .035/4/20/130
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$500.00
|
|
|
CATH BALLOON ADM .035/4/60/130
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$500.00
|
|
|
CATH BALLOON ADM .035/4/60/130
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CATH BALLOON ADM .035/4/80/130
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
2709000452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
CATH BALLOON ADM .035/4/80/130
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
2709000452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$450.00
|
|
|
CATH BALLOON ADM.035/5/120/130
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
2709000410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
CATH BALLOON ADM.035/5/120/130
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
2709000410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$450.00
|
|
|
CATH BALLOON ADM .035/5/20/130
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CATH BALLOON ADM .035/5/20/130
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$500.00
|
|
|
CATH BALLOON ADM .035/5/60/130
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$500.00
|
|
|
CATH BALLOON ADM .035/5/60/130
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CATH BALLOON ADM .035/5/80/130
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
2709000454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$450.00
|
|
|
CATH BALLOON ADM .035/5/80/130
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
2709000454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
CATH BALLOON ADM.035/6/120/130
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CATH BALLOON ADM.035/6/120/130
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$500.00
|
|
|
CATH BALLOON ADM .035/6/20/130
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
2709000766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$450.00
|
|
|
CATH BALLOON ADM .035/6/20/130
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
2709000766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
CATH BALLOON ADM .035/6/60/130
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
270900411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$500.00
|
|
|
CATH BALLOON ADM .035/6/60/130
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
270900411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CATH BALLOON ADM.035/6/60/130
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$500.00
|
|
|
CATH BALLOON ADM.035/6/60/130
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
2709000411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CATH BALLOON ADM .035/6/80/130
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
2709000455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$450.00
|
|