|
CATH FOXCROSS PTA 5x40x80cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644501C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 5x40x80cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644501C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 5x60MMx135CM
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270648368C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 5x60MMx135CM
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270648368C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6*100*135cm
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270648356C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$487.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$325.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$393.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
CATH FOXCROSS PTA 6*100*135cm
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270648356C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$325.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$393.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
CATH FOXCROSS PTA 6x20MMx135CM
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270648369C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x20MMx135CM
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270648369C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x20x80cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644504C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x20x80cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644504C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x40x135cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644397C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x40x135cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644397C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x40x80cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644505C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x40x80cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644505C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x60MMx135CM
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270648371C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x60MMx135CM
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270648371C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x80MMx80CM
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270648377C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 6x80MMx80CM
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270648377C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 7x100x135MM
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270648375C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 7x100x135MM
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270648375C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 7x120x135MM
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270648376C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 7x120x135MM
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270648376C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 7x20x135cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644506C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 7x20x135cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644506C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
CATH FOXCROSS PTA 7x20x80cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270643928C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|