|
INSERT P.S. 20MM S3
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$990.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
INSERT PSN RVCK ART SUR VE18MM
|
Facility
|
IP
|
$12,905.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270700044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,935.75 |
| Max. Negotiated Rate |
$3,123.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,581.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,123.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,839.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,935.75
|
|
|
INSERT PSN RVCK ART SUR VE18MM
|
Facility
|
OP
|
$12,905.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270700044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$311.01 |
| Max. Negotiated Rate |
$6,452.50 |
| Rate for Payer: Aetna Commercial |
$4,903.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3,871.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,290.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,290.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,581.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,290.78
|
| Rate for Payer: Cigna Commercial |
$6,452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,123.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,839.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,935.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$311.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$341.98
|
|
|
INSERT PST POLY 20mm 183770
|
Facility
|
IP
|
$5,875.00
|
|
| Hospital Charge Code |
270639357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$881.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$881.25
|
|
|
INSERT PST POLY 20mm 183770
|
Facility
|
OP
|
$5,875.00
|
|
| Hospital Charge Code |
270639357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.59 |
| Max. Negotiated Rate |
$2,937.50 |
| Rate for Payer: Aetna Commercial |
$2,232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,762.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,498.12
|
| Rate for Payer: Cigna Commercial |
$2,937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,762.50
|
| Rate for Payer: Oxford Commercial |
$1,175.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$881.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$141.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$155.69
|
|
|
INSERT/REPLACE PG DU
|
Facility
|
OP
|
$31,274.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
366833228
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$376.15 |
| Max. Negotiated Rate |
$44,822.55 |
| Rate for Payer: Aetna Commercial |
$33,774.92
|
| Rate for Payer: Aetna Medicare Advantage |
$40,231.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44,822.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44,822.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,417.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$376.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44,822.55
|
| Rate for Payer: Cigna Commercial |
$24,890.32
|
| Rate for Payer: Cigna Medicare Advantage |
$12,417.25
|
| Rate for Payer: Clover Medicare Advantage |
$11,796.39
|
| Rate for Payer: EmblemHealth Commercial |
$37,251.75
|
| Rate for Payer: Humana Medicare Advantage |
$12,789.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12,417.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,382.20
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,691.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$753.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,417.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,417.25
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$17,126.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$828.76
|
|
|
INSERT/REPLACE PG DU
|
Facility
|
OP
|
$31,274.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
7411019
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$376.15 |
| Max. Negotiated Rate |
$44,822.55 |
| Rate for Payer: Aetna Commercial |
$33,774.92
|
| Rate for Payer: Aetna Medicare Advantage |
$40,231.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44,822.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44,822.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,417.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$376.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44,822.55
|
| Rate for Payer: Cigna Commercial |
$24,890.32
|
| Rate for Payer: Cigna Medicare Advantage |
$12,417.25
|
| Rate for Payer: Clover Medicare Advantage |
$11,796.39
|
| Rate for Payer: EmblemHealth Commercial |
$37,251.75
|
| Rate for Payer: Humana Medicare Advantage |
$12,789.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12,417.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,382.20
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,691.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$753.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,417.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,417.25
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$17,126.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$828.76
|
|
|
INSERT/REPLACE PG DU
|
Facility
|
IP
|
$31,274.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
7411019
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,691.10 |
| Max. Negotiated Rate |
$4,691.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,691.10
|
|
|
INSERT/REPLACE PG DU
|
Facility
|
IP
|
$31,274.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
366833228
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,691.10 |
| Max. Negotiated Rate |
$4,691.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,691.10
|
|
|
INSERT/REPLACE PG SN
|
Facility
|
IP
|
$27,653.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
366833212
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,147.95 |
| Max. Negotiated Rate |
$4,147.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,147.95
|
|
|
INSERT/REPLACE PG SN
|
Facility
|
OP
|
$27,653.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
7411017
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$384.39 |
| Max. Negotiated Rate |
$35,488.33 |
| Rate for Payer: Aetna Commercial |
$26,741.35
|
| Rate for Payer: Aetna Medicare Advantage |
$31,853.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9,831.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$384.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35,488.33
|
| Rate for Payer: Cigna Commercial |
$19,706.96
|
| Rate for Payer: Cigna Medicare Advantage |
$9,831.38
|
| Rate for Payer: Clover Medicare Advantage |
$9,339.81
|
| Rate for Payer: EmblemHealth Commercial |
$29,494.14
|
| Rate for Payer: Humana Medicare Advantage |
$10,126.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9,831.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,295.90
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,147.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$666.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$732.80
|
|
|
INSERT/REPLACE PG SN
|
Facility
|
IP
|
$27,653.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
7411017
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,147.95 |
| Max. Negotiated Rate |
$4,147.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,147.95
|
|
|
INSERT/REPLACE PG SN
|
Facility
|
OP
|
$27,653.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
366833212
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$384.39 |
| Max. Negotiated Rate |
$35,488.33 |
| Rate for Payer: Aetna Commercial |
$26,741.35
|
| Rate for Payer: Aetna Medicare Advantage |
$31,853.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9,831.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$384.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35,488.33
|
| Rate for Payer: Cigna Commercial |
$19,706.96
|
| Rate for Payer: Cigna Medicare Advantage |
$9,831.38
|
| Rate for Payer: Clover Medicare Advantage |
$9,339.81
|
| Rate for Payer: EmblemHealth Commercial |
$29,494.14
|
| Rate for Payer: Humana Medicare Advantage |
$10,126.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9,831.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,295.90
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,147.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$666.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$732.80
|
|
|
INSERT SELF CONTD PROSTHESIS
|
Facility
|
OP
|
$94,818.00
|
|
|
Service Code
|
HCPCS 54401
|
| Hospital Charge Code |
1600000543
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,355.00 |
| Max. Negotiated Rate |
$88,882.29 |
| Rate for Payer: Aetna Commercial |
$66,975.05
|
| Rate for Payer: Aetna Medicare Advantage |
$79,779.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$88,882.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$88,882.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24,623.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$88,882.29
|
| Rate for Payer: Cigna Commercial |
$49,357.08
|
| Rate for Payer: Cigna Medicare Advantage |
$24,623.18
|
| Rate for Payer: Clover Medicare Advantage |
$23,392.02
|
| Rate for Payer: EmblemHealth Commercial |
$73,869.54
|
| Rate for Payer: Humana Medicare Advantage |
$25,361.88
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24,623.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28,445.40
|
| Rate for Payer: Oxford Commercial |
$10,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,222.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$17,313.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,285.11
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24,623.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$24,623.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,512.68
|
|
|
INSERT SELF CONTD PROSTHESIS
|
Facility
|
IP
|
$94,818.00
|
|
|
Service Code
|
HCPCS 54401
|
| Hospital Charge Code |
1600000543
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,222.70 |
| Max. Negotiated Rate |
$14,222.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,222.70
|
|
|
INSERT SHOULDER RET
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270689836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$772.50 |
| Max. Negotiated Rate |
$1,246.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,030.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,246.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,133.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$772.50
|
|
|
INSERT SHOULDER RET
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270689836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.11 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,957.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,545.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,313.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,313.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,030.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,313.25
|
| Rate for Payer: Cigna Commercial |
$2,575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,246.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,133.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$772.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$124.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$136.47
|
|
|
INSERT SHOULDER RET 3 MM
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$772.50 |
| Max. Negotiated Rate |
$1,246.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,030.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,246.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,133.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$772.50
|
|
|
INSERT SHOULDER RET 3 MM
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.11 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,957.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,545.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,313.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,313.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,030.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,313.25
|
| Rate for Payer: Cigna Commercial |
$2,575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,246.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,133.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$772.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$124.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$136.47
|
|
|
INSERT SHOULDER RET. +5MM
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270684267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$772.50 |
| Max. Negotiated Rate |
$1,246.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,030.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,246.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,133.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$772.50
|
|
|
INSERT SHOULDER RET. +5MM
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270684267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.11 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,957.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,545.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,313.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,313.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,030.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,313.25
|
| Rate for Payer: Cigna Commercial |
$2,575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,246.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,133.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$772.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$124.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$136.47
|
|
|
INSERT SHPERE FLEX LEFT 10MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270684049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$120.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$132.50
|
|
|
INSERT SHPERE FLEX LEFT 10MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270684049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
INSERT SINGLE PM LEAD
|
Facility
|
OP
|
$15,108.00
|
|
|
Service Code
|
HCPCS 33216
|
| Hospital Charge Code |
7411027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$364.10 |
| Max. Negotiated Rate |
$35,488.33 |
| Rate for Payer: Aetna Commercial |
$26,741.35
|
| Rate for Payer: Aetna Medicare Advantage |
$31,853.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9,831.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$476.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35,488.33
|
| Rate for Payer: Cigna Commercial |
$19,706.96
|
| Rate for Payer: Cigna Medicare Advantage |
$9,831.38
|
| Rate for Payer: Clover Medicare Advantage |
$9,339.81
|
| Rate for Payer: EmblemHealth Commercial |
$29,494.14
|
| Rate for Payer: Humana Medicare Advantage |
$10,126.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9,831.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,532.40
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,266.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$364.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$981.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$400.36
|
|
|
INSERT SINGLE PM LEAD
|
Facility
|
OP
|
$15,108.00
|
|
|
Service Code
|
HCPCS 33216
|
| Hospital Charge Code |
366833216
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$364.10 |
| Max. Negotiated Rate |
$35,488.33 |
| Rate for Payer: Aetna Commercial |
$26,741.35
|
| Rate for Payer: Aetna Medicare Advantage |
$31,853.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9,831.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$476.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35,488.33
|
| Rate for Payer: Cigna Commercial |
$19,706.96
|
| Rate for Payer: Cigna Medicare Advantage |
$9,831.38
|
| Rate for Payer: Clover Medicare Advantage |
$9,339.81
|
| Rate for Payer: EmblemHealth Commercial |
$29,494.14
|
| Rate for Payer: Humana Medicare Advantage |
$10,126.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9,831.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,532.40
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,266.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$364.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$981.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$400.36
|
|
