|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270CH0033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270CH0026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270CH0022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270CH0032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270CH0020
|
|
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
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270CH0028
|
|
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
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270CH0024
|
|
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
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270CH0013
|
|
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
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270CH0022
|
|
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
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270CH0023
|
|
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
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270658396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$277.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270CH0019
|
|
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
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270CH0032
|
|
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
|
|
|
CATHETER BALLOON HIGH PRESSURE
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270CH0024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
CATHETER BALLOON NC VOYAGER 3.
|
Facility
|
OP
|
$1,275.00
|
|
| Hospital Charge Code |
270643055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare Advantage |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$325.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$325.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$325.12
|
| Rate for Payer: Cigna Commercial |
$637.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$308.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$191.25
|
|
|
CATHETER BALLOON NC VOYAGER 3.
|
Facility
|
IP
|
$1,275.00
|
|
| Hospital Charge Code |
270643055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$308.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$255.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$308.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$191.25
|
|
|
CATHETER BALLOON SUBMARINE PLU
|
Facility
|
OP
|
$354.95
|
|
| Hospital Charge Code |
270654360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$177.47 |
| Rate for Payer: Aetna Commercial |
$106.48
|
| Rate for Payer: Aetna Medicare Advantage |
$106.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.51
|
| Rate for Payer: Cigna Commercial |
$177.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.24
|
|
|
CATHETER BALLOON SUBMARINE PLU
|
Facility
|
IP
|
$354.95
|
|
| Hospital Charge Code |
270654360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$85.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.24
|
|
|
CATHETER BALLOON UDT/4-4/5/75
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
270CH0135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATHETER BALLOON UDT/4-4/5/75
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
270CH0135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| 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) PPO |
$260.10
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.60
|
| Rate for Payer: Oxford Commercial |
$510.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$510.00
|
|
|
CATHETER BALLOON UT/SDS
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
270653607
|
|
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: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATHETER BALLOON UT/SDS
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
270653607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| 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: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
270653608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| 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: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
270653608
|
|
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: Qualcare PPO/HMO/WC |
$153.00
|
|
|
CATHETER BALLOON UT/SDS OTW
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
270653597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| 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: Qualcare PPO/HMO/WC |
$153.00
|
|