|
BALLOON VOYAGER NC 2.0x6mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270643175C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER NC 2.5x15mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270643186C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER NC 2.5x15mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270643186C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
BALLOON VOYAGER NC 2.5x6mm
|
Facility
|
IP
|
$850.00
|
|
| Hospital Charge Code |
270645527C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$187.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
|
|
BALLOON VOYAGER NC 2.5x6mm
|
Facility
|
OP
|
$850.00
|
|
| Hospital Charge Code |
270645527C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Medicare Advantage |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$216.75
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$187.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.52
|
|
|
BALLOON VOYAGER NC 3.75x12mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270643182C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER NC 3.75x12mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270643182C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
BALLOON VOYAGER NC 4.0x15mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270643191C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER NC 4.0x15mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270643191C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
BALLOON VOYAGER NC 4.0x20mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270643194C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER NC 4.0x20mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270643194C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
BALLOON VOYAGER NC 4.5x12mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270643184C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
BALLOON VOYAGER NC 4.5x12mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270643184C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER NC 4.5x8mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270643177C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER NC 4.5x8mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270643177C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
BALLOON VOYAGER OTW 1.5x12mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270644663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER OTW 1.5x12mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270644663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
BALLOON VOYAGER OTW 2.0x12mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270642994C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
BALLOON VOYAGER OTW 2.0x12mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270642994C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER OTW 2.0x20mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270644232C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
BALLOON VOYAGER OTW 2.0x20mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270644232C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER OTW 2.5x12mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270643888C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER OTW 2.5x12mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270643888C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
BALLOON VOYAGER OTW 2.5x20mm
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270643807C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
BALLOON VOYAGER OTW 2.5x20mm
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270643807C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|