|
CATH FOXCROSS PTA 7x20x80cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270643928C
|
|
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 7x40x135cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644507C
|
|
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 7x40x135cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644507C
|
|
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 7x40x80cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644534C
|
|
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 7x40x80cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644534C
|
|
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 7x60CMx135MM
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270648373C
|
|
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 7x60CMx135MM
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270648373C
|
|
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 8x20x135cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644508C
|
|
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 8x20x135cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644508C
|
|
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 8x20x80cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270643976C
|
|
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 8x20x80cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270643976C
|
|
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 8x40x135cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644509C
|
|
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 8x40x135cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644509C
|
|
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 8x40x80cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644454C
|
|
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 8x40x80cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644454C
|
|
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 8x60x80cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270644553C
|
|
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 8x60x80cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270644553C
|
|
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 8x80x80cm
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270644580C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$312.50 |
| Rate for Payer: Aetna Commercial |
$187.50
|
| Rate for Payer: Aetna Medicare Advantage |
$187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$159.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$159.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$159.38
|
| Rate for Payer: Cigna Commercial |
$312.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.75
|
|
|
CATH FOXCROSS PTA 8x80x80cm
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270644580C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$151.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.75
|
|
|
CATH FOXCROSS PTA 9x40x80cm
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
27064440
|
|
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 9x40x80cm
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
27064440
|
|
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 FOXCRS PTA 5x100 10335100
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270642703V
|
|
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 FOXCRS PTA 5x100 10335100
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270642703V
|
|
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 FOX PTA 4x12x150 8397502
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270643927C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$352.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
CATH FOX PTA 4x12x150 8397502
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270643927C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|