|
TARGET 360 SOFT 12MM X 30CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689849S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 12MM X 30CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689849S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 12MM X 30CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 14MM X 30CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 14MM X 30CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 2MM X 4CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 2MM X 4CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 3MM X 10CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 3MM X 10CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 3MM X 6CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 3MM X 6CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 3MM X 8CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 3MM X 8CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 4MM X 10CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 4MM X 10CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 4MM X 15CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 4MM X 15CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 4MM X 6CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 4MM X 6CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 5 MM X 10 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 5 MM X 10 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 5MM X 15CM
|
Facility
|
OP
|
$10,426.25
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270689859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|
|
TARGET 360 SOFT 5MM X 15CM
|
Facility
|
IP
|
$10,426.25
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270689859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 5MMX15CM
|
Facility
|
IP
|
$10,426.25
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270689859S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$2,523.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 SOFT 5MMX15CM
|
Facility
|
OP
|
$10,426.25
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270689859S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,961.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3,127.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,085.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,658.69
|
| Rate for Payer: Cigna Commercial |
$5,213.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,523.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,293.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,563.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$251.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.30
|
|