|
ROD CONTOURED 5.5MM 30MM
|
Facility
|
IP
|
$1,430.00
|
|
| Hospital Charge Code |
270670363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 35MM
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
270670364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 35MM
|
Facility
|
IP
|
$1,430.00
|
|
| Hospital Charge Code |
270670364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 40MM
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 40MM
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 45MM
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 45MM
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 50MM
|
Facility
|
IP
|
$1,430.00
|
|
| Hospital Charge Code |
270670368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 50MM
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
270670368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 55MM
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
270670370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 55MM
|
Facility
|
IP
|
$1,430.00
|
|
| Hospital Charge Code |
270670370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 60MM
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
270670371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 60MM
|
Facility
|
IP
|
$1,430.00
|
|
| Hospital Charge Code |
270670371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 65MM
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 65MM
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 70MM
|
Facility
|
IP
|
$1,430.00
|
|
| Hospital Charge Code |
270670373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 70MM
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
270670373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 75MM
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 75MM
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 80MM
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 80MM
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 85MM
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
270670377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 85MM
|
Facility
|
IP
|
$1,430.00
|
|
| Hospital Charge Code |
270670377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 90MM
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$346.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|
|
ROD CONTOURED 5.5MM 90MM
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$429.00
|
| Rate for Payer: Aetna Medicare Advantage |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.65
|
| Rate for Payer: Cigna Commercial |
$715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.50
|
|