|
BALLOON JADEOTW018150x3.0x150
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705257
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x3.0x150
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705257
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x3.0x240
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705258
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x3.0x240
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705258
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x3.0x40
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705259
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x3.0x40
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705259
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x3.0x60
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705260
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x3.0x60
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705260
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x3.0x80
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705261
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x3.0x80
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705261
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x3.5x150
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705578
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x3.5x150
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705578
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x3.5x40
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705573
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x3.5x40
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705573
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x3.5x60
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705574
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x3.5x60
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705574
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x3.5x80
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705575
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x3.5x80
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705575
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x4.0x100
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705262
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x4.0x100
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705262
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x4.0x120
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705263
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x4.0x120
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705263
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x4.0x150
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270705264
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
BALLOON JADEOTW018150x4.0x150
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705264
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|
|
BALLOON JADEOTW018150x4.0x240
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270705265
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.50
|
| Rate for Payer: Oxford Commercial |
$145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.21
|
|