|
GM-1 ANTIBODY VI
|
Facility
|
OP
|
$187.25
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
3038090F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$31.36
|
| Rate for Payer: Aetna Medicare Advantage |
$37.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.62
|
| Rate for Payer: Cigna Commercial |
$93.62
|
| Rate for Payer: Cigna Medicare Advantage |
$11.53
|
| Rate for Payer: Clover Medicare Advantage |
$10.95
|
| Rate for Payer: EmblemHealth Commercial |
$34.59
|
| Rate for Payer: Humana Medicare Advantage |
$11.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$11.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.17
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.96
|
|
|
GMI ELISA - MAG ANTIBODY PANEL
|
Facility
|
OP
|
$448.00
|
|
| Hospital Charge Code |
3031598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: Aetna Commercial |
$170.24
|
| Rate for Payer: Aetna Medicare Advantage |
$134.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.24
|
| Rate for Payer: Cigna Commercial |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.87
|
|
|
GMI ELISA - MAG ANTIBODY PANEL
|
Facility
|
IP
|
$448.00
|
|
| Hospital Charge Code |
3031598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.20
|
|
|
GMI ELISA PANEL A
|
Facility
|
IP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3031598A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.02 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
|
|
GMI ELISA PANEL A
|
Facility
|
OP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3031598A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$126.72
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.03
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.72
|
|
|
GMI ELISA PANEL B
|
Facility
|
OP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3031598B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$126.72
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.03
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.72
|
|
|
GMI ELISA PANEL B
|
Facility
|
IP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3031598B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.02 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
|
|
GMI ELISA PANEL C
|
Facility
|
IP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3031598C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.02 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
|
|
GMI ELISA PANEL C
|
Facility
|
OP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3031598C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$126.72
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.03
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.72
|
|
|
GMI ELISA PANEL D
|
Facility
|
OP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3031598D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare Advantage |
$55.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.34
|
| Rate for Payer: Cigna Commercial |
$126.72
|
| Rate for Payer: Cigna Medicare Advantage |
$17.27
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$76.03
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.72
|
|
|
GMI ELISA PANEL D
|
Facility
|
IP
|
$253.45
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3031598D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.02 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.02
|
|
|
GMK FEMUR HINGE CEMENTED LEFT
|
Facility
|
IP
|
$46,510.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,976.50 |
| Max. Negotiated Rate |
$11,255.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9,302.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,255.42
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$10,232.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,976.50
|
|
|
GMK FEMUR HINGE CEMENTED LEFT
|
Facility
|
OP
|
$46,510.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.89 |
| Max. Negotiated Rate |
$23,255.00 |
| Rate for Payer: Aetna Commercial |
$17,673.80
|
| Rate for Payer: Aetna Medicare Advantage |
$13,953.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,860.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,860.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9,302.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11,860.05
|
| Rate for Payer: Cigna Commercial |
$23,255.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,255.42
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$10,232.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,976.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,120.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,232.52
|
|
|
GMK FEMUR HINGE CEMENTED RIGHT
|
Facility
|
OP
|
$46,510.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.89 |
| Max. Negotiated Rate |
$23,255.00 |
| Rate for Payer: Aetna Commercial |
$17,673.80
|
| Rate for Payer: Aetna Medicare Advantage |
$13,953.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,860.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,860.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9,302.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11,860.05
|
| Rate for Payer: Cigna Commercial |
$23,255.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,255.42
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$10,232.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,976.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,120.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,232.52
|
|
|
GMK FEMUR HINGE CEMENTED RIGHT
|
Facility
|
IP
|
$46,510.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,976.50 |
| Max. Negotiated Rate |
$11,255.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9,302.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,255.42
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$10,232.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,976.50
|
|
|
GMK HINGE INSERT 20MM S4
|
Facility
|
IP
|
$14,905.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.75 |
| Max. Negotiated Rate |
$3,607.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,981.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,607.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,279.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.75
|
|
|
GMK HINGE INSERT 20MM S4
|
Facility
|
OP
|
$14,905.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.21 |
| Max. Negotiated Rate |
$7,452.50 |
| Rate for Payer: Aetna Commercial |
$5,663.90
|
| Rate for Payer: Aetna Medicare Advantage |
$4,471.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,800.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,800.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,981.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,800.78
|
| Rate for Payer: Cigna Commercial |
$7,452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,607.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,279.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$359.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$394.98
|
|
|
GMK-HINGE INSERT 20MM S4
|
Facility
|
IP
|
$14,905.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.75 |
| Max. Negotiated Rate |
$3,607.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,981.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,607.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,279.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.75
|
|
|
GMK-HINGE INSERT 20MM S4
|
Facility
|
OP
|
$14,905.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.21 |
| Max. Negotiated Rate |
$7,452.50 |
| Rate for Payer: Aetna Commercial |
$5,663.90
|
| Rate for Payer: Aetna Medicare Advantage |
$4,471.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,800.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,800.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,981.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,800.78
|
| Rate for Payer: Cigna Commercial |
$7,452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,607.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,279.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$359.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$394.98
|
|
|
GMK STEM EXTEN 11mmx30mm
|
Facility
|
IP
|
$2,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$665.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$665.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$605.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
|
|
GMK STEM EXTEN 11mmx30mm
|
Facility
|
OP
|
$2,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.28 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$1,045.00
|
| Rate for Payer: Aetna Medicare Advantage |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$701.25
|
| Rate for Payer: Cigna Commercial |
$1,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$665.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$605.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$66.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$72.88
|
|
|
GMK TIBIAL TRAY HINGE LEFT S2
|
Facility
|
IP
|
$24,345.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,651.75 |
| Max. Negotiated Rate |
$5,891.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,869.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,891.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,355.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,651.75
|
|
|
GMK TIBIAL TRAY HINGE LEFT S2
|
Facility
|
OP
|
$24,345.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.71 |
| Max. Negotiated Rate |
$12,172.50 |
| Rate for Payer: Aetna Commercial |
$9,251.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,303.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,207.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,207.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,869.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,207.98
|
| Rate for Payer: Cigna Commercial |
$12,172.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,891.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,355.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,651.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$586.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$645.14
|
|
|
GNS II CMT TIB SIZE 3 RIGHT
|
Facility
|
OP
|
$15,872.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270686902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$382.53 |
| Max. Negotiated Rate |
$7,936.25 |
| Rate for Payer: Aetna Commercial |
$6,031.55
|
| Rate for Payer: Aetna Medicare Advantage |
$4,761.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,047.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,047.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,174.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,047.49
|
| Rate for Payer: Cigna Commercial |
$7,936.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,841.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,491.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,380.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$382.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$420.62
|
|
|
GNS II CMT TIB SIZE 3 RIGHT
|
Facility
|
IP
|
$15,872.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270686902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.88 |
| Max. Negotiated Rate |
$3,841.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,174.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,841.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,491.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,380.88
|
|
