|
TARGET 360 SOFT 7MM X 20CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689866S
|
|
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 SOFT 7MM X 20CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689866
|
|
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 SOFT 7MM X 30CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689867
|
|
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 SOFT 7MM X 30CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689867
|
|
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 SOFT 7MM X 30CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689867S
|
|
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 SOFT 7MM X 30CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689867S
|
|
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 SOFT 8MM X 20CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689868
|
|
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 SOFT 8MM X 20CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689868
|
|
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 SOFT 8MM X 30CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689869
|
|
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 SOFT 8MM X 30CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689869
|
|
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 SOFT 9MM X 20CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689870
|
|
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 SOFT 9MM X 20CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689870
|
|
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 SOFT 9MM X 30CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689871
|
|
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 SOFT 9MM X 30CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689871S
|
|
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 SOFT 9MM X 30CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689871S
|
|
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 SOFT 9MM X 30CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689871
|
|
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 ULTRA 1.5 MM X 2 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689874S
|
|
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 ULTRA 1.5 MM X 2 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689874S
|
|
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 ULTRA 1.5 MM X 2 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689874
|
|
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 ULTRA 1.5 MM X 2 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689874
|
|
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 ULTRA 1.5 MM X 4 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689875
|
|
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 ULTRA 1.5 MM X 4 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689875
|
|
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 ULTRA 1 MM X 2 CM
|
Facility
|
OP
|
$10,426.25
|
|
| Hospital Charge Code |
270689872
|
|
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 ULTRA 1 MM X 2 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689872
|
|
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 ULTRA 1 MM X 3 CM
|
Facility
|
IP
|
$10,426.25
|
|
| Hospital Charge Code |
270689873
|
|
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
|
|