|
CATH BALLOON AGILTRAC 9x60 55
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
270653194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$525.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
CATH BALLOON AMPH 4.0/40/152
|
Facility
|
OP
|
$1,825.00
|
|
| Hospital Charge Code |
2709003382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$912.50 |
| Rate for Payer: Aetna Commercial |
$547.50
|
| Rate for Payer: Aetna Medicare Advantage |
$547.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$465.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$465.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$465.38
|
| Rate for Payer: Cigna Commercial |
$912.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.25
|
| Rate for Payer: Oxford Commercial |
$912.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$912.50
|
|
|
CATH BALLOON AMPH 4.0/40/152
|
Facility
|
IP
|
$1,825.00
|
|
| Hospital Charge Code |
2709003382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$273.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.75
|
|
|
CATH BALLOON AMPHIRON 2/40/150
|
Facility
|
OP
|
$1,825.00
|
|
| Hospital Charge Code |
2709003602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$912.50 |
| Rate for Payer: Aetna Commercial |
$547.50
|
| Rate for Payer: Aetna Medicare Advantage |
$547.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$465.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$465.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$465.38
|
| Rate for Payer: Cigna Commercial |
$912.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.25
|
| Rate for Payer: Oxford Commercial |
$912.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$912.50
|
|
|
CATH BALLOON AMPHIRON 2/40/150
|
Facility
|
IP
|
$1,825.00
|
|
| Hospital Charge Code |
2709003602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$273.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.75
|
|
|
CATH BALLOON AMPHIRON 3/80/150
|
Facility
|
OP
|
$1,825.00
|
|
| Hospital Charge Code |
2709003604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$912.50 |
| Rate for Payer: Aetna Commercial |
$547.50
|
| Rate for Payer: Aetna Medicare Advantage |
$547.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$465.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$465.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$465.38
|
| Rate for Payer: Cigna Commercial |
$912.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.25
|
| Rate for Payer: Oxford Commercial |
$912.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$912.50
|
|
|
CATH BALLOON AMPHIRON 3/80/150
|
Facility
|
IP
|
$1,825.00
|
|
| Hospital Charge Code |
2709003604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$273.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$273.75
|
|
|
CATH BALLOON ANGIOPL 20640293
|
Facility
|
IP
|
$1,495.00
|
|
| Hospital Charge Code |
270640293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$361.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$299.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.25
|
|
|
CATH BALLOON ANGIOPL 20640293
|
Facility
|
OP
|
$1,495.00
|
|
| Hospital Charge Code |
270640293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$747.50 |
| Rate for Payer: Aetna Commercial |
$448.50
|
| Rate for Payer: Aetna Medicare Advantage |
$448.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$381.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$381.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$299.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$381.23
|
| Rate for Payer: Cigna Commercial |
$747.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.25
|
|
|
CATH BALLOONHIGHPRESS 4X20X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATH BALLOONHIGHPRESS 4X20X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| 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 |
$126.75
|
| Rate for Payer: Oxford Commercial |
$487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$487.50
|
|
|
CATHBALLOONHIGHPRESS 4X20X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| 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 |
$126.75
|
| Rate for Payer: Oxford Commercial |
$487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$487.50
|
|
|
CATHBALLOONHIGHPRESS 4X20X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 4X20X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 4X20X120
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
2709006495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHBALLOONHIGHPRESS 4X20X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| 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 |
$126.75
|
| Rate for Payer: Oxford Commercial |
$487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$487.50
|
|
|
CATHBALLOONHIGHPRESS 4X20X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| 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 |
$126.75
|
| Rate for Payer: Oxford Commercial |
$487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$487.50
|
|
|
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 4X60X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| 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 |
$126.75
|
| Rate for Payer: Oxford Commercial |
$487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$487.50
|
|
|
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 4X80X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| 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 |
$126.75
|
| Rate for Payer: Oxford Commercial |
$487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$487.50
|
|
|
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 |
$126.75 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| 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 |
$126.75
|
| Rate for Payer: Oxford Commercial |
$487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$487.50
|
|
|
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 5X40X120
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
2709006503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| 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 |
$126.75
|
| Rate for Payer: Oxford Commercial |
$487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$487.50
|
|