|
ROD CONTOURED 6.0MM 65MM
|
Facility
|
OP
|
$1,680.00
|
|
| Hospital Charge Code |
270670387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.40
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 70MM
|
Facility
|
OP
|
$1,680.00
|
|
| Hospital Charge Code |
270670388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.40
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 70MM
|
Facility
|
IP
|
$1,680.00
|
|
| Hospital Charge Code |
270670388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$406.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 75MM
|
Facility
|
IP
|
$1,680.00
|
|
| Hospital Charge Code |
270670389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$406.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 75MM
|
Facility
|
OP
|
$1,680.00
|
|
| Hospital Charge Code |
270670389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.40
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 80MM
|
Facility
|
IP
|
$1,680.00
|
|
| Hospital Charge Code |
270670390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$406.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 80MM
|
Facility
|
OP
|
$1,680.00
|
|
| Hospital Charge Code |
270670390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.40
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 85MM
|
Facility
|
IP
|
$1,680.00
|
|
| Hospital Charge Code |
270670391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$406.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 85MM
|
Facility
|
OP
|
$1,680.00
|
|
| Hospital Charge Code |
270670391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.40
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 90MM
|
Facility
|
IP
|
$1,680.00
|
|
| Hospital Charge Code |
270670392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$406.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 90MM
|
Facility
|
OP
|
$1,680.00
|
|
| Hospital Charge Code |
270670392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.40
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 95MM
|
Facility
|
OP
|
$1,680.00
|
|
| Hospital Charge Code |
270670393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.40
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 95MM
|
Facility
|
IP
|
$1,680.00
|
|
| Hospital Charge Code |
270670393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$406.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CREO MIS CURVED 5.5X55MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS CURVED 5.5X55MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS CURVE TI 5.5X40MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS CURVE TI 5.5X40MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS CURVE TI 5.5X60MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS CURVE TI 5.5X60MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS TI CURVE 5.5X45MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS TI CURVE 5.5X45MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CRVD 5X5X50
|
Facility
|
OP
|
$2,900.00
|
|
| Hospital Charge Code |
270657954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$870.00
|
| Rate for Payer: Aetna Medicare Advantage |
$870.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$739.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$739.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$739.50
|
| Rate for Payer: Cigna Commercial |
$1,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$701.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.00
|
|
|
ROD CRVD 5X5X50
|
Facility
|
IP
|
$2,900.00
|
|
| Hospital Charge Code |
270657954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$701.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$701.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.00
|
|
|
ROD CURV BULLET NOSE 5.5X180MM
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: Cigna Commercial |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
ROD CURV BULLET NOSE 5.5X180MM
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|