|
BALLOON ADMIRAL INP 7x80x130
|
Facility
|
OP
|
$7,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270673871S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.91 |
| Max. Negotiated Rate |
$3,525.00 |
| Rate for Payer: Aetna Commercial |
$2,679.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,797.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,797.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,410.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,797.75
|
| Rate for Payer: Cigna Commercial |
$3,525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,706.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,551.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,057.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$169.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$186.82
|
|
|
BALLOON ADMIRAL INP 7x80x130
|
Facility
|
IP
|
$7,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270673871S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.50 |
| Max. Negotiated Rate |
$1,706.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,410.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,706.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,551.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,057.50
|
|
|
BALLOON ADMIRAL INP 7x80x130
|
Facility
|
IP
|
$7,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270673871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.50 |
| Max. Negotiated Rate |
$1,706.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,410.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,706.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,551.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,057.50
|
|
|
BALLOON ADMIRAL INP 7x80x130
|
Facility
|
OP
|
$7,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270673871N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.91 |
| Max. Negotiated Rate |
$3,525.00 |
| Rate for Payer: Aetna Commercial |
$2,679.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,797.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,797.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,410.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,797.75
|
| Rate for Payer: Cigna Commercial |
$3,525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,706.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,551.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,057.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$169.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$186.82
|
|
|
BALLOON ADMIRAL INP 7x80x130
|
Facility
|
OP
|
$7,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270673871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.91 |
| Max. Negotiated Rate |
$3,525.00 |
| Rate for Payer: Aetna Commercial |
$2,679.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,797.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,797.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,410.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,797.75
|
| Rate for Payer: Cigna Commercial |
$3,525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,706.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,551.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,057.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$169.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$186.82
|
|
|
BALLOON ADMIRAL INP 7x80x130
|
Facility
|
IP
|
$7,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270673871N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.50 |
| Max. Negotiated Rate |
$1,706.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,410.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,706.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,551.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,057.50
|
|
|
BALLOON ADMIRAL INPC 4x150x130
|
Facility
|
IP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678121S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,282.50 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
|
|
BALLOON ADMIRAL INPC 4x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678121S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Aetna Commercial |
$3,249.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,565.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,180.25
|
| Rate for Payer: Cigna Commercial |
$4,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.57
|
|
|
BALLOON ADMIRAL INPC 4x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Aetna Commercial |
$3,249.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,565.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,180.25
|
| Rate for Payer: Cigna Commercial |
$4,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.57
|
|
|
BALLOON ADMIRAL INPC 4x150x130
|
Facility
|
IP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,282.50 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
|
|
BALLOON ADMIRAL INPC 4x150x130
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678121N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.88 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Aetna Commercial |
$3,325.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,625.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,231.25
|
| Rate for Payer: Cigna Commercial |
$4,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,925.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$210.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$231.88
|
|
|
BALLOON ADMIRAL INPC 4x150x130
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678121N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$2,117.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,925.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
|
|
BALLOON ADMIRAL INPC 5x120x130
|
Facility
|
IP
|
$7,800.00
|
|
| Hospital Charge Code |
270705331
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,170.00 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,170.00
|
|
|
BALLOON ADMIRAL INPC 5x120x130
|
Facility
|
OP
|
$7,800.00
|
|
| Hospital Charge Code |
270705331
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$187.98 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$2,964.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,340.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,989.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,989.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,989.00
|
| Rate for Payer: Cigna Commercial |
$3,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,340.00
|
| Rate for Payer: Oxford Commercial |
$1,560.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,170.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,560.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$187.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$206.70
|
|
|
BALLOON ADMIRAL INPC 5x150x130
|
Facility
|
IP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678122S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,282.50 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
|
|
BALLOON ADMIRAL INPC 5x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678122C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Aetna Commercial |
$3,249.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,565.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,180.25
|
| Rate for Payer: Cigna Commercial |
$4,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.57
|
|
|
BALLOON ADMIRAL INPC 5x150x130
|
Facility
|
IP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678122C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,282.50 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
|
|
BALLOON ADMIRAL INPC 5x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Aetna Commercial |
$3,249.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,565.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,180.25
|
| Rate for Payer: Cigna Commercial |
$4,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.57
|
|
|
BALLOON ADMIRAL INPC 5x150x130
|
Facility
|
IP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,282.50 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
|
|
BALLOON ADMIRAL INPC 5x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678122N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Aetna Commercial |
$3,249.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,565.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,180.25
|
| Rate for Payer: Cigna Commercial |
$4,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.57
|
|
|
BALLOON ADMIRAL INPC 5x150x130
|
Facility
|
IP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678122N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,282.50 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
|
|
BALLOON ADMIRAL INPC 5x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678122S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Aetna Commercial |
$3,249.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,565.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,180.25
|
| Rate for Payer: Cigna Commercial |
$4,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.57
|
|
|
BALLOON ADMIRAL INPC 6x150x130
|
Facility
|
IP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,282.50 |
| Max. Negotiated Rate |
$2,069.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
|
|
BALLOON ADMIRAL INPC 6x150x130
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678123N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.88 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Aetna Commercial |
$3,325.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,625.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,231.25
|
| Rate for Payer: Cigna Commercial |
$4,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,925.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$210.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$231.88
|
|
|
BALLOON ADMIRAL INPC 6x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678123S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$4,275.00 |
| Rate for Payer: Aetna Commercial |
$3,249.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,565.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,180.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,710.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,180.25
|
| Rate for Payer: Cigna Commercial |
$4,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,069.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,881.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$206.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.57
|
|
