|
GRAFT PRIMATRIX 5x5CM/SQ CM JW
|
Facility
|
IP
|
$319.20
|
|
| Hospital Charge Code |
270673686W
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.88 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.88
|
|
|
GRAFT PRIMATRIX 5x5CM/SQ CM JW
|
Facility
|
OP
|
$319.20
|
|
| Hospital Charge Code |
270673686W
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial |
$121.30
|
| Rate for Payer: Aetna Medicare Advantage |
$95.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.46
|
|
|
GRAFT PRIMATRIX 6 X 6 CM
|
Facility
|
OP
|
$6,560.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270682617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$1,587.52 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,312.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,587.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,443.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$984.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$158.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$173.84
|
|
|
GRAFT PRIMATRIX 6 X 6 CM
|
Facility
|
IP
|
$6,560.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270682617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.00 |
| Max. Negotiated Rate |
$1,587.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,587.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,443.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$984.00
|
|
|
GRAFT PRIMATRIX 6X6CM
|
Facility
|
IP
|
$7,695.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270675446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,154.25 |
| Max. Negotiated Rate |
$1,862.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,539.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,862.19
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,692.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,154.25
|
|
|
GRAFT PRIMATRIX 6X6CM
|
Facility
|
OP
|
$7,695.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270675446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$1,862.19 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,539.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,862.19
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,692.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,154.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$203.92
|
|
|
GRAFT PRIMATRIX 8x12CM
|
Facility
|
IP
|
$17,200.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270677842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,580.00 |
| Max. Negotiated Rate |
$4,162.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,440.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,162.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,784.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
|
|
GRAFT PRIMATRIX 8x12CM
|
Facility
|
OP
|
$17,200.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270677842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$4,162.40 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,440.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,162.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,784.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,580.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$414.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.80
|
|
|
GRAFT PRIMATRIX AG 10X25CM
|
Facility
|
OP
|
$32,071.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270692965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$7,761.18 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,414.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,761.18
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,055.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,810.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$772.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$849.88
|
|
|
GRAFT PRIMATRIX AG 10X25CM
|
Facility
|
IP
|
$32,071.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270692965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,810.65 |
| Max. Negotiated Rate |
$7,761.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,414.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,761.18
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,055.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,810.65
|
|
|
GRAFT PRIMATRIX AG 4X4CM
|
Facility
|
OP
|
$3,865.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270678340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$935.33 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$773.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$935.33
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$579.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$93.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$102.42
|
|
|
GRAFT PRIMATRIX AG 4X4CM
|
Facility
|
OP
|
$3,865.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270673840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$935.33 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$773.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$935.33
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$579.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$93.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$102.42
|
|
|
GRAFT PRIMATRIX AG 4X4CM
|
Facility
|
IP
|
$3,865.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270673840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.75 |
| Max. Negotiated Rate |
$935.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$773.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$935.33
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$579.75
|
|
|
GRAFT PRIMATRIX AG 4X4CM
|
Facility
|
IP
|
$3,865.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270678340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.75 |
| Max. Negotiated Rate |
$935.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$773.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$935.33
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$579.75
|
|
|
GRAFT PRIMATRIX MESH 20X25CM
|
Facility
|
IP
|
$44,740.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270683923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,711.00 |
| Max. Negotiated Rate |
$10,827.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,948.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,827.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,842.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,711.00
|
|
|
GRAFT PRIMATRIX MESH 20X25CM
|
Facility
|
OP
|
$44,740.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270683923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$10,827.08 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,948.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,827.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,842.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,711.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,078.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,185.61
|
|
|
GRAFT PRIMATRIX MESH 8X8CM
|
Facility
|
OP
|
$11,120.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270696529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$2,691.04 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,691.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,446.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,668.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$267.99
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$294.68
|
|
|
GRAFT PRIMATRIX MESH 8X8CM
|
Facility
|
IP
|
$11,120.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270696529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.00 |
| Max. Negotiated Rate |
$2,691.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,691.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,446.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,668.00
|
|
|
GRAFT PRIMATRIX MESH AG 6X6CM
|
Facility
|
OP
|
$18,295.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270698688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$4,427.39 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,659.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,427.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,024.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,744.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$440.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$484.82
|
|
|
GRAFT PRIMATRIX MESH AG 6X6CM
|
Facility
|
IP
|
$18,295.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270698688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,744.25 |
| Max. Negotiated Rate |
$4,427.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,659.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,427.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,024.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,744.25
|
|
|
GRAFT PRIMATRIX MESHED 6X6 CM
|
Facility
|
OP
|
$7,700.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270684047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$1,863.40 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$533.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,540.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$533.66
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,863.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,155.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$204.05
|
|
|
GRAFT PRIMATRIX MESHED 6X6 CM
|
Facility
|
IP
|
$7,700.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
270684047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$1,863.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,540.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,863.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,155.00
|
|
|
GRAFT PRODENSE 7CC
|
Facility
|
OP
|
$22,369.00
|
|
| Hospital Charge Code |
270703288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.09 |
| Max. Negotiated Rate |
$11,184.50 |
| Rate for Payer: Aetna Commercial |
$8,500.22
|
| Rate for Payer: Aetna Medicare Advantage |
$6,710.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,704.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,704.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,473.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,704.10
|
| Rate for Payer: Cigna Commercial |
$11,184.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,413.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,921.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,355.35
|
| Rate for Payer: UnitedHealthcare Community & State |
$539.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$592.78
|
|
|
GRAFT PRODENSE 7CC
|
Facility
|
IP
|
$22,369.00
|
|
| Hospital Charge Code |
270703288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,355.35 |
| Max. Negotiated Rate |
$5,413.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,473.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,413.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,921.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,355.35
|
|
|
GRAFT PROPATEN 7MM DIA 60x80CM
|
Facility
|
IP
|
$13,635.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
270673929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,045.25 |
| Max. Negotiated Rate |
$3,299.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,727.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,299.67
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,999.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,045.25
|
|
