|
GRAFT ZENITH AAA LEG EXTENSION
|
Facility
|
IP
|
$13,392.00
|
|
| Hospital Charge Code |
270636178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,008.80 |
| Max. Negotiated Rate |
$3,240.86 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,678.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,240.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,008.80
|
|
|
GRAFT ZENITH AAA LEG TFLE1654
|
Facility
|
OP
|
$14,980.00
|
|
| Hospital Charge Code |
270634660V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.00 |
| Max. Negotiated Rate |
$7,490.00 |
| Rate for Payer: Aetna Commercial |
$4,494.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,494.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,819.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,819.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,996.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,819.90
|
| Rate for Payer: Cigna Commercial |
$7,490.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,625.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,247.00
|
|
|
GRAFT ZENITH AAA LEG TFLE1654
|
Facility
|
IP
|
$14,980.00
|
|
| Hospital Charge Code |
270634660V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.00 |
| Max. Negotiated Rate |
$3,625.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,996.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,625.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,247.00
|
|
|
GRAFT ZENITH AAA LEG TFLE1654
|
Facility
|
OP
|
$13,392.00
|
|
| Hospital Charge Code |
270634660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,008.80 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Aetna Commercial |
$4,017.60
|
| Rate for Payer: Aetna Medicare Advantage |
$4,017.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,414.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,414.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,678.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,414.96
|
| Rate for Payer: Cigna Commercial |
$6,696.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,240.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,008.80
|
|
|
GRAFT ZENITH AAA LEG TFLE1654
|
Facility
|
IP
|
$13,392.00
|
|
| Hospital Charge Code |
270634660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,008.80 |
| Max. Negotiated Rate |
$3,240.86 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,678.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,240.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,008.80
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
IP
|
$39,255.00
|
|
| Hospital Charge Code |
270640599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,888.25 |
| Max. Negotiated Rate |
$9,499.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,851.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,499.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,888.25
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
OP
|
$39,255.00
|
|
| Hospital Charge Code |
270639808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,888.25 |
| Max. Negotiated Rate |
$19,627.50 |
| Rate for Payer: Aetna Commercial |
$11,776.50
|
| Rate for Payer: Aetna Medicare Advantage |
$11,776.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,010.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,010.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,851.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,010.02
|
| Rate for Payer: Cigna Commercial |
$19,627.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,499.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,888.25
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
IP
|
$41,060.00
|
|
| Hospital Charge Code |
270639242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,159.00 |
| Max. Negotiated Rate |
$9,936.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,212.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,936.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,159.00
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
IP
|
$38,110.00
|
|
| Hospital Charge Code |
270639317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,716.50 |
| Max. Negotiated Rate |
$9,222.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,622.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,222.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,716.50
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
OP
|
$38,110.00
|
|
| Hospital Charge Code |
270639317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,716.50 |
| Max. Negotiated Rate |
$19,055.00 |
| Rate for Payer: Aetna Commercial |
$11,433.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,433.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,718.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,718.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,622.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,718.05
|
| Rate for Payer: Cigna Commercial |
$19,055.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,222.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,716.50
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
IP
|
$41,060.00
|
|
| Hospital Charge Code |
270641632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,159.00 |
| Max. Negotiated Rate |
$9,936.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,212.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,936.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,159.00
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
OP
|
$39,255.00
|
|
| Hospital Charge Code |
270640605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,888.25 |
| Max. Negotiated Rate |
$19,627.50 |
| Rate for Payer: Aetna Commercial |
$11,776.50
|
| Rate for Payer: Aetna Medicare Advantage |
$11,776.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,010.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,010.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,851.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,010.02
|
| Rate for Payer: Cigna Commercial |
$19,627.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,499.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,888.25
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
OP
|
$41,060.00
|
|
| Hospital Charge Code |
270641632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,159.00 |
| Max. Negotiated Rate |
$20,530.00 |
| Rate for Payer: Aetna Commercial |
$12,318.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,318.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,470.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,470.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,470.30
|
| Rate for Payer: Cigna Commercial |
$20,530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,936.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,159.00
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
IP
|
$39,255.00
|
|
| Hospital Charge Code |
270639571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,888.25 |
| Max. Negotiated Rate |
$9,499.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,851.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,499.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,888.25
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
OP
|
$39,255.00
|
|
| Hospital Charge Code |
270639571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,888.25 |
| Max. Negotiated Rate |
$19,627.50 |
| Rate for Payer: Aetna Commercial |
$11,776.50
|
| Rate for Payer: Aetna Medicare Advantage |
$11,776.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,010.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,010.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,851.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,010.02
|
| Rate for Payer: Cigna Commercial |
$19,627.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,499.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,888.25
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
OP
|
$39,255.00
|
|
| Hospital Charge Code |
270640599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,888.25 |
| Max. Negotiated Rate |
$19,627.50 |
| Rate for Payer: Aetna Commercial |
$11,776.50
|
| Rate for Payer: Aetna Medicare Advantage |
$11,776.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,010.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,010.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,851.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,010.02
|
| Rate for Payer: Cigna Commercial |
$19,627.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,499.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,888.25
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
IP
|
$39,255.00
|
|
| Hospital Charge Code |
270640605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,888.25 |
| Max. Negotiated Rate |
$9,499.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,851.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,499.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,888.25
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
OP
|
$41,060.00
|
|
| Hospital Charge Code |
270639242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,159.00 |
| Max. Negotiated Rate |
$20,530.00 |
| Rate for Payer: Aetna Commercial |
$12,318.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,318.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,470.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,470.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,470.30
|
| Rate for Payer: Cigna Commercial |
$20,530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,936.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,159.00
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
OP
|
$41,060.00
|
|
| Hospital Charge Code |
270639572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,159.00 |
| Max. Negotiated Rate |
$20,530.00 |
| Rate for Payer: Aetna Commercial |
$12,318.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,318.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,470.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,470.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,470.30
|
| Rate for Payer: Cigna Commercial |
$20,530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,936.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,159.00
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
IP
|
$39,255.00
|
|
| Hospital Charge Code |
270639808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,888.25 |
| Max. Negotiated Rate |
$9,499.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,851.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,499.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,888.25
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
IP
|
$41,060.00
|
|
| Hospital Charge Code |
270640225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,159.00 |
| Max. Negotiated Rate |
$9,936.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,212.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,936.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,159.00
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
IP
|
$41,060.00
|
|
| Hospital Charge Code |
270639572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,159.00 |
| Max. Negotiated Rate |
$9,936.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,212.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,936.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,159.00
|
|
|
GRAFT ZENITH AAA MAIN BODY
|
Facility
|
OP
|
$41,060.00
|
|
| Hospital Charge Code |
270640225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,159.00 |
| Max. Negotiated Rate |
$20,530.00 |
| Rate for Payer: Aetna Commercial |
$12,318.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,318.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,470.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,470.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,470.30
|
| Rate for Payer: Cigna Commercial |
$20,530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,936.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,159.00
|
|
|
GRAFT ZENITH AAA MAINB TFB3088
|
Facility
|
IP
|
$36,704.00
|
|
| Hospital Charge Code |
270634659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,505.60 |
| Max. Negotiated Rate |
$8,882.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,340.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,882.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,505.60
|
|
|
GRAFT ZENITH AAA MAINB TFB3088
|
Facility
|
IP
|
$37,000.00
|
|
| Hospital Charge Code |
270634659V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,550.00 |
| Max. Negotiated Rate |
$8,954.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,954.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,550.00
|
|