|
TAP SYN CORT 3.5 311.33
|
Facility
|
OP
|
$682.45
|
|
| Hospital Charge Code |
270604142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.37 |
| Max. Negotiated Rate |
$341.23 |
| Rate for Payer: Aetna Commercial |
$204.74
|
| Rate for Payer: Aetna Medicare Advantage |
$204.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$174.02
|
| Rate for Payer: Cigna Commercial |
$341.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.37
|
|
|
TAP SYN CORT 4.5 130 311.46
|
Facility
|
OP
|
$446.45
|
|
| Hospital Charge Code |
270619720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$223.22 |
| Rate for Payer: Aetna Commercial |
$133.94
|
| Rate for Payer: Aetna Medicare Advantage |
$133.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$113.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$113.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$89.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$113.84
|
| Rate for Payer: Cigna Commercial |
$223.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.97
|
|
|
TAP SYN CORT 4.5 130 311.46
|
Facility
|
IP
|
$446.45
|
|
| Hospital Charge Code |
270619720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$108.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$89.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.97
|
|
|
TAP WLZ ADJ BONE 1.5 915-2080
|
Facility
|
OP
|
$944.85
|
|
| Hospital Charge Code |
270621794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.73 |
| Max. Negotiated Rate |
$472.43 |
| Rate for Payer: Aetna Commercial |
$283.45
|
| Rate for Payer: Aetna Medicare Advantage |
$283.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$240.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$240.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$188.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$240.94
|
| Rate for Payer: Cigna Commercial |
$472.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$228.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.73
|
|
|
TAP WLZ ADJ BONE 1.5 915-2080
|
Facility
|
IP
|
$944.85
|
|
| Hospital Charge Code |
270621794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.73 |
| Max. Negotiated Rate |
$228.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$188.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$228.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.73
|
|
|
TAP ZIM QC 3.5MM 234637
|
Facility
|
OP
|
$506.45
|
|
| Hospital Charge Code |
270607933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.97 |
| Max. Negotiated Rate |
$253.22 |
| Rate for Payer: Aetna Commercial |
$151.94
|
| Rate for Payer: Aetna Medicare Advantage |
$151.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$129.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$129.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$129.14
|
| Rate for Payer: Cigna Commercial |
$253.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.97
|
|
|
TAP ZIM QC 3.5MM 234637
|
Facility
|
IP
|
$506.45
|
|
| Hospital Charge Code |
270607933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.97 |
| Max. Negotiated Rate |
$122.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.97
|
|
|
TAP ZIM QC 4.5MM 234647
|
Facility
|
IP
|
$315.25
|
|
| Hospital Charge Code |
270610455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$76.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$63.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.29
|
|
|
TAP ZIM QC 4.5MM 234647
|
Facility
|
OP
|
$315.25
|
|
| Hospital Charge Code |
270610455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$157.62 |
| Rate for Payer: Aetna Commercial |
$94.58
|
| Rate for Payer: Aetna Medicare Advantage |
$94.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$80.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$80.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$63.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$80.39
|
| Rate for Payer: Cigna Commercial |
$157.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.29
|
|
|
TAP ZIM QC 4.5MM SHORT 234646
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
270610454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Medicare Advantage |
$25.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.42
|
| Rate for Payer: Cigna Commercial |
$42.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.60
|
|
|
TAP ZIM QC 4.5MM SHORT 234646
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
270610454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.60
|
|
|
TARGET 360 NANO 1.5 MM X 3 CM
|
Facility
|
IP
|
$10,516.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697788S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,577.40 |
| Max. Negotiated Rate |
$2,544.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,103.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,544.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,577.40
|
|
|
TARGET 360 NANO 1.5 MM X 3 CM
|
Facility
|
OP
|
$10,516.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697788S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,577.40 |
| Max. Negotiated Rate |
$5,258.00 |
| Rate for Payer: Aetna Commercial |
$3,154.80
|
| Rate for Payer: Aetna Medicare Advantage |
$3,154.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,681.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,681.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,103.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,681.58
|
| Rate for Payer: Cigna Commercial |
$5,258.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,544.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,577.40
|
|
|
TARGET 360 NANO 2.5 MM X 4 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689844
|
|
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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 2.5 MM X 4 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,127.88
|
| 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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 2 MM X 3 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689842S
|
|
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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 2 MM X 3 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689842
|
|
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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 2 MM X 3 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,127.88
|
| 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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 2 MM X 3 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689842S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,127.88
|
| 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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 2 MM X 4 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689843
|
|
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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 2 MM X 4 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689843S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,127.88
|
| 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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 2 MM X 4 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,127.88
|
| 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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 2 MM X 4 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689843S
|
|
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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 3.5 MM X 6 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.94 |
| Max. Negotiated Rate |
$5,213.12 |
| Rate for Payer: Aetna Commercial |
$3,127.88
|
| 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: Qualcare PPO/HMO/WC |
$1,563.94
|
|
|
TARGET 360 NANO 3.5 MM X 6 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689847
|
|
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: Qualcare PPO/HMO/WC |
$1,563.94
|
|