|
BALLOON JADEOTW014150x3.5x80
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705223
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x3.5x80
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705223
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x4.0x100
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705224
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x4.0x100
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705224
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x4.0x120
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705225
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x4.0x120
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705225
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x4.0x150
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705226
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x4.0x150
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705226
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x4.0x240
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705227
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x4.0x240
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705227
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x4.0x40
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705228
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x4.0x40
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705228
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x4.0x60
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705229
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x4.0x60
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705229
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x4.0x80
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705230
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x4.0x80
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705230
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x5.0x100
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705231
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x5.0x100
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705231
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x5.0x150
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705232
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x5.0x150
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705232
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x5.0x240
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705234
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x5.0x240
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705234
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x5.0x40
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705235
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|
|
BALLOON JADEOTW014150x5.0x40
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270705235
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
BALLOON JADEOTW014150x5.0x60
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270705236
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.75
|
| Rate for Payer: Oxford Commercial |
$387.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.50
|
|