|
HMMF LOCKSCREW AXS SD 2.0X6MM
|
Facility
|
OP
|
$978.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$489.10 |
| Rate for Payer: Aetna Commercial |
$371.72
|
| Rate for Payer: Aetna Medicare Advantage |
$293.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$249.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$249.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$249.44
|
| Rate for Payer: Cigna Commercial |
$489.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$215.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.92
|
|
|
HMMF LOCKSCREW AXS SD 2.0X6MM
|
Facility
|
IP
|
$978.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.73 |
| Max. Negotiated Rate |
$236.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$215.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.73
|
|
|
HMMF LOCKSCREW AXS SD 2.0X8MM
|
Facility
|
OP
|
$978.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$489.10 |
| Rate for Payer: Aetna Commercial |
$371.72
|
| Rate for Payer: Aetna Medicare Advantage |
$293.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$249.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$249.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$249.44
|
| Rate for Payer: Cigna Commercial |
$489.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$215.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.92
|
|
|
HMMF LOCKSCREW AXS SD 2.0X8MM
|
Facility
|
IP
|
$978.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.73 |
| Max. Negotiated Rate |
$236.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$215.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.73
|
|
|
HMRL BEARING 36MM STD VITE
|
Facility
|
IP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270688615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,783.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,783.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,530.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,725.00
|
|
|
HMRL BEARING 36MM STD VITE
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270688615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.15 |
| Max. Negotiated Rate |
$5,750.00 |
| Rate for Payer: Aetna Commercial |
$4,370.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,932.50
|
| Rate for Payer: Cigna Commercial |
$5,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,783.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,530.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,725.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$277.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$304.75
|
|
|
HMRL TRAY STD STD
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270688614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.60 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,280.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,530.00
|
| Rate for Payer: Cigna Commercial |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,320.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$144.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$159.00
|
|
|
HMRL TRAY STD STD
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270688614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,320.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
HMRL TRAYT STD +5 MM
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270690728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.60 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,280.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,530.00
|
| Rate for Payer: Cigna Commercial |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,320.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$144.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$159.00
|
|
|
HMRL TRAYT STD +5 MM
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270690728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,320.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
HMS/5ML
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
60634566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Aetna Commercial |
$23.18
|
| Rate for Payer: Aetna Medicare Advantage |
$18.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.55
|
| Rate for Payer: Cigna Commercial |
$30.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.30
|
| Rate for Payer: Oxford Commercial |
$12.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.62
|
|
|
HMS/5ML
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
60634566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$9.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.15
|
|
|
HNK1 (CD57) I
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
3038511A
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$72.84
|
| Rate for Payer: Aetna Medicare Advantage |
$86.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$96.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$96.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$96.67
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Cigna Medicare Advantage |
$26.78
|
| Rate for Payer: Clover Medicare Advantage |
$25.44
|
| Rate for Payer: EmblemHealth Commercial |
$80.34
|
| Rate for Payer: Humana Medicare Advantage |
$27.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$26.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$26.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.88
|
|
|
HNK1 (CD57) I
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
3038511A
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.60
|
|
|
HNK1 (CD57) II
|
Facility
|
IP
|
$259.25
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
3038511B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.89 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.89
|
|
|
HNK1 (CD57) II
|
Facility
|
OP
|
$259.25
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
3038511B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$136.19 |
| Rate for Payer: Aetna Commercial |
$102.63
|
| Rate for Payer: Aetna Medicare Advantage |
$122.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$81.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.19
|
| Rate for Payer: Cigna Commercial |
$129.62
|
| Rate for Payer: Cigna Medicare Advantage |
$37.73
|
| Rate for Payer: Clover Medicare Advantage |
$35.84
|
| Rate for Payer: EmblemHealth Commercial |
$113.19
|
| Rate for Payer: Humana Medicare Advantage |
$38.86
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$37.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.78
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.18
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$37.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.87
|
|
|
HOFFMAN FOOT ARCH LRF 180MM
|
Facility
|
OP
|
$11,332.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.11 |
| Max. Negotiated Rate |
$5,666.10 |
| Rate for Payer: Aetna Commercial |
$4,306.24
|
| Rate for Payer: Aetna Medicare Advantage |
$3,399.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,889.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,889.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,266.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,889.71
|
| Rate for Payer: Cigna Commercial |
$5,666.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,742.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,493.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,699.83
|
| Rate for Payer: UnitedHealthcare Community & State |
$273.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$300.30
|
|
|
HOFFMAN FOOT ARCH LRF 180MM
|
Facility
|
IP
|
$11,332.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.83 |
| Max. Negotiated Rate |
$2,742.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,266.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,742.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,493.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,699.83
|
|
|
HOFFMAN FOOT RING LNG LRF180MM
|
Facility
|
IP
|
$13,034.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,955.11 |
| Max. Negotiated Rate |
$3,154.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,606.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,154.24
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,867.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,955.11
|
|
|
HOFFMAN FOOT RING LNG LRF180MM
|
Facility
|
OP
|
$13,034.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$314.12 |
| Max. Negotiated Rate |
$6,517.02 |
| Rate for Payer: Aetna Commercial |
$4,952.94
|
| Rate for Payer: Aetna Medicare Advantage |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,323.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,323.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,606.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,323.68
|
| Rate for Payer: Cigna Commercial |
$6,517.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,154.24
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,867.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,955.11
|
| Rate for Payer: UnitedHealthcare Community & State |
$314.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$345.40
|
|
|
HOFFMAN FOOT RING SH LRF 180MM
|
Facility
|
OP
|
$13,427.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$323.61 |
| Max. Negotiated Rate |
$6,713.90 |
| Rate for Payer: Aetna Commercial |
$5,102.56
|
| Rate for Payer: Aetna Medicare Advantage |
$4,028.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,424.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,424.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,685.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,424.09
|
| Rate for Payer: Cigna Commercial |
$6,713.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,249.53
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,954.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,014.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$323.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$355.84
|
|
|
HOFFMAN FOOT RING SH LRF 180MM
|
Facility
|
IP
|
$13,427.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,014.17 |
| Max. Negotiated Rate |
$3,249.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,685.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,249.53
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,954.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,014.17
|
|
|
HOFFMAN FULL RING LRF 180MM
|
Facility
|
IP
|
$10,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.15 |
| Max. Negotiated Rate |
$2,468.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,040.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,468.64
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,244.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,530.15
|
|
|
HOFFMAN FULL RING LRF 180MM
|
Facility
|
OP
|
$10,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.84 |
| Max. Negotiated Rate |
$5,100.50 |
| Rate for Payer: Aetna Commercial |
$3,876.38
|
| Rate for Payer: Aetna Medicare Advantage |
$3,060.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,601.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,601.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,040.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,601.26
|
| Rate for Payer: Cigna Commercial |
$5,100.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,468.64
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,244.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,530.15
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$270.33
|
|
|
HOFFMAN HEXAPO STRUTXS89-109MM
|
Facility
|
OP
|
$15,730.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$379.11 |
| Max. Negotiated Rate |
$7,865.38 |
| Rate for Payer: Aetna Commercial |
$5,977.69
|
| Rate for Payer: Aetna Medicare Advantage |
$4,719.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,011.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,011.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,146.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,011.34
|
| Rate for Payer: Cigna Commercial |
$7,865.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,806.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,460.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,359.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$379.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$416.86
|
|