|
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: 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 |
$242.82 |
| 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: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.82
|
|
|
BALLOON ADMIRAL INPC 5x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.82 |
| 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: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.82
|
|
|
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: 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 |
$242.82 |
| 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: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.82
|
|
|
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: 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 |
$242.82 |
| 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: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.82
|
|
|
BALLOON ADMIRAL INPC 6x150x130
|
Facility
|
IP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678123S
|
|
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: 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 |
$248.50 |
| 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: Qualcare PPO/HMO/WC |
$1,312.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$276.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$248.50
|
|
|
BALLOON ADMIRAL INPC 6x150x130
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678123N
|
|
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: Qualcare PPO/HMO/WC |
$1,312.50
|
|
|
BALLOON ADMIRAL INPC 6x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678123S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.82 |
| 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: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.82
|
|
|
BALLOON ADMIRAL INPC 6x150x130
|
Facility
|
IP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678123A
|
|
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: Qualcare PPO/HMO/WC |
$1,282.50
|
|
|
BALLOON ADMIRAL INPC 6x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.82 |
| 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: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.82
|
|
|
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: Qualcare PPO/HMO/WC |
$1,282.50
|
|
|
BALLOON ADMIRAL INPC 6x150x130
|
Facility
|
OP
|
$8,550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270678123A
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.82 |
| 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: Qualcare PPO/HMO/WC |
$1,282.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.82
|
|
|
BALLOON ADMIRAL INPCT 5x60x130
|
Facility
|
IP
|
$7,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270689917
|
|
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: Qualcare PPO/HMO/WC |
$1,057.50
|
|
|
BALLOON ADMIRAL INPCT 5x60x130
|
Facility
|
OP
|
$7,050.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270689917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.22 |
| 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: Qualcare PPO/HMO/WC |
$1,057.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$222.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$200.22
|
|
|
BALLOON ADMIRAL XTREME 10x40
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270639026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$304.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.72
|
|
|
BALLOON ADMIRAL XTREME 10x40
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270639026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$193.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
BALLOON ADMIRAL XTREME 12x40
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270642306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
BALLOON ADMIRAL XTREME 12x40
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270642306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
BALLOON ADMIRAL XTREME 4x20x80
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270661119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
BALLOON ADMIRAL XTREME 4x20x80
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270661119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
BALLOON ADMIRAL XTREME 4x40
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270639669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$193.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
BALLOON ADMIRAL XTREME 4x40
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270639669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$304.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.72
|
|
