|
GRAFT BIFURC TH/WALL 18/9 40cm
|
Facility
|
OP
|
$4,565.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270637984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,282.50 |
| Rate for Payer: Aetna Commercial |
$1,734.70
|
| Rate for Payer: Aetna Medicare Advantage |
$1,369.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,164.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,164.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$913.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,164.08
|
| Rate for Payer: Cigna Commercial |
$2,282.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,104.73
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,004.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$684.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$110.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$120.97
|
|
|
GRAFT BIFURC TH/WALL 18/9 40cm
|
Facility
|
IP
|
$4,565.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270637984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.75 |
| Max. Negotiated Rate |
$1,104.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$913.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,104.73
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,004.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$684.75
|
|
|
GRAFT BIOBRACE 23MM
|
Facility
|
IP
|
$19,250.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270697767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,887.50 |
| Max. Negotiated Rate |
$4,658.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,658.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,235.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,887.50
|
|
|
GRAFT BIOBRACE 23MM
|
Facility
|
OP
|
$19,250.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270697767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$463.93 |
| Max. Negotiated Rate |
$9,625.00 |
| Rate for Payer: Aetna Commercial |
$7,315.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,775.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,908.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,908.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,908.75
|
| Rate for Payer: Cigna Commercial |
$9,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,658.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,235.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,887.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$463.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$510.12
|
|
|
GRAFT BIOBRACE 5X25MM
|
Facility
|
OP
|
$12,875.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270699462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.29 |
| Max. Negotiated Rate |
$6,437.50 |
| Rate for Payer: Aetna Commercial |
$4,892.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,862.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,283.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,283.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,283.12
|
| Rate for Payer: Cigna Commercial |
$6,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,115.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,832.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,931.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$310.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$341.19
|
|
|
GRAFT BIOBRACE 5X25MM
|
Facility
|
IP
|
$12,875.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270699462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,931.25 |
| Max. Negotiated Rate |
$3,115.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,115.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,832.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,931.25
|
|
|
GRAFT BIOCORE MOLDABLE100X20MM
|
Facility
|
OP
|
$23,079.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.20 |
| Max. Negotiated Rate |
$11,539.50 |
| Rate for Payer: Aetna Commercial |
$8,770.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,923.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,885.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,885.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,615.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,885.15
|
| Rate for Payer: Cigna Commercial |
$11,539.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,585.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,077.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,461.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$556.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$611.59
|
|
|
GRAFT BIOCORE MOLDABLE100X20MM
|
Facility
|
IP
|
$23,079.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,461.85 |
| Max. Negotiated Rate |
$5,585.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,615.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,585.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,077.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,461.85
|
|
|
GRAFT BIO DBM PUTTY PLUS 5CC
|
Facility
|
OP
|
$11,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.35 |
| Max. Negotiated Rate |
$5,567.50 |
| Rate for Payer: Aetna Commercial |
$4,231.30
|
| Rate for Payer: Aetna Medicare Advantage |
$3,340.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,839.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,839.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,227.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,839.43
|
| Rate for Payer: Cigna Commercial |
$5,567.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,694.67
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,449.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,670.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$268.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$295.08
|
|
|
GRAFT BIO DBM PUTTY PLUS 5CC
|
Facility
|
IP
|
$11,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.25 |
| Max. Negotiated Rate |
$2,694.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,227.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,694.67
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,449.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,670.25
|
|
|
GRAFT BIOD RESTORE S
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
270684070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$852.50 |
| Rate for Payer: Aetna Commercial |
$647.90
|
| Rate for Payer: Aetna Medicare Advantage |
$511.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$434.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$434.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$341.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$434.77
|
| Rate for Payer: Cigna Commercial |
$852.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$412.61
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$375.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$41.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.18
|
|
|
GRAFT BIOD RESTORE S
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
270684070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$412.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$341.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$412.61
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$375.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.75
|
|
|
GRAFT BOLT 8.5X30MM
|
Facility
|
IP
|
$5,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.75 |
| Max. Negotiated Rate |
$1,240.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,025.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,240.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,127.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$768.75
|
|
|
GRAFT BOLT 8.5X30MM
|
Facility
|
OP
|
$5,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.51 |
| Max. Negotiated Rate |
$2,562.50 |
| Rate for Payer: Aetna Commercial |
$1,947.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,537.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,306.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,306.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,025.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,306.88
|
| Rate for Payer: Cigna Commercial |
$2,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,240.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,127.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$768.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$123.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.81
|
|
|
GRAFT BONE AUGMENT REG 1.5CC
|
Facility
|
IP
|
$12,350.00
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
270697750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,852.50 |
| Max. Negotiated Rate |
$2,988.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,470.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,988.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,717.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,852.50
|
|
|
GRAFT BONE AUGMENT REG 1.5CC
|
Facility
|
OP
|
$12,350.00
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
270697750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.63 |
| Max. Negotiated Rate |
$6,175.00 |
| Rate for Payer: Aetna Commercial |
$4,693.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,705.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,149.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,149.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,470.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,149.25
|
| Rate for Payer: Cigna Commercial |
$6,175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,988.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,717.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,852.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$297.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$327.27
|
|
|
GRAFT BONE BIOCORE 50X20MM
|
Facility
|
OP
|
$16,578.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.53 |
| Max. Negotiated Rate |
$8,289.00 |
| Rate for Payer: Aetna Commercial |
$6,299.64
|
| Rate for Payer: Aetna Medicare Advantage |
$4,973.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,227.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,227.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,315.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,227.39
|
| Rate for Payer: Cigna Commercial |
$8,289.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,011.88
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,647.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,486.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$399.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$439.32
|
|
|
GRAFT BONE BIOCORE 50X20MM
|
Facility
|
IP
|
$16,578.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,486.70 |
| Max. Negotiated Rate |
$4,011.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,315.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,011.88
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,647.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,486.70
|
|
|
GRAFT BONE GENEX 10CC
|
Facility
|
OP
|
$13,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.80 |
| Max. Negotiated Rate |
$6,987.50 |
| Rate for Payer: Aetna Commercial |
$5,310.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,192.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,563.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,563.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,795.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,563.62
|
| Rate for Payer: Cigna Commercial |
$6,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,381.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,074.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,096.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$336.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$370.34
|
|
|
GRAFT BONE GENEX 10CC
|
Facility
|
IP
|
$13,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.25 |
| Max. Negotiated Rate |
$3,381.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,795.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,381.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,074.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,096.25
|
|
|
GRAFT BONE MAGNETOS 10CC 1-2MM
|
Facility
|
OP
|
$16,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.62 |
| Max. Negotiated Rate |
$8,125.00 |
| Rate for Payer: Aetna Commercial |
$6,175.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,875.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,143.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,143.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,143.75
|
| Rate for Payer: Cigna Commercial |
$8,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,932.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,575.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,437.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$391.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$430.62
|
|
|
GRAFT BONE MAGNETOS 10CC 1-2MM
|
Facility
|
IP
|
$16,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,437.50 |
| Max. Negotiated Rate |
$3,932.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,932.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,575.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,437.50
|
|
|
GRAFT BONE MAGNETOS 5CC 1-2MM
|
Facility
|
IP
|
$8,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$1,966.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,966.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,787.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,218.75
|
|
|
GRAFT BONE MAGNETOS 5CC 1-2MM
|
Facility
|
OP
|
$8,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.81 |
| Max. Negotiated Rate |
$4,062.50 |
| Rate for Payer: Aetna Commercial |
$3,087.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,437.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,071.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,071.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,625.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,071.88
|
| Rate for Payer: Cigna Commercial |
$4,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,966.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,787.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,218.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$195.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$215.31
|
|
|
GRAFT BONE MATRIX COLLAGRAFT
|
Facility
|
OP
|
$3,501.85
|
|
| Hospital Charge Code |
270610062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$1,750.92 |
| Rate for Payer: Aetna Commercial |
$1,330.70
|
| Rate for Payer: Aetna Medicare Advantage |
$1,050.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$892.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$892.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$700.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$892.97
|
| Rate for Payer: Cigna Commercial |
$1,750.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$847.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$770.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$525.28
|
| Rate for Payer: UnitedHealthcare Community & State |
$84.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$92.80
|
|