|
ARTHRD PST DFRM 7-12 VRT SGM
|
Facility
|
IP
|
$14,810.75
|
|
|
Service Code
|
HCPCS 22802
|
| Hospital Charge Code |
16000805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,221.61 |
| Max. Negotiated Rate |
$2,221.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,221.61
|
|
|
ARTHRD PST DFRM 7-12 VRT SGM
|
Facility
|
OP
|
$14,810.75
|
|
|
Service Code
|
HCPCS 22802
|
| Hospital Charge Code |
16000805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$356.94 |
| Max. Negotiated Rate |
$75,192.36 |
| Rate for Payer: Aetna Commercial |
$56,659.34
|
| Rate for Payer: Aetna Medicare Advantage |
$67,491.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75,192.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75,192.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20,830.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75,192.36
|
| Rate for Payer: Cigna Commercial |
$41,754.94
|
| Rate for Payer: Cigna Medicare Advantage |
$20,830.64
|
| Rate for Payer: Clover Medicare Advantage |
$19,789.11
|
| Rate for Payer: EmblemHealth Commercial |
$62,491.92
|
| Rate for Payer: Humana Medicare Advantage |
$21,455.56
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20,830.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,443.23
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,221.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$356.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20,830.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$20,830.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$392.48
|
|
|
ARTHRD SI JT PRQ WO TFXJ DEV
|
Facility
|
IP
|
$84,204.60
|
|
|
Service Code
|
HCPCS 27278
|
| Hospital Charge Code |
16001048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,630.69 |
| Max. Negotiated Rate |
$12,630.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12,630.69
|
|
|
ARTHRD SI JT PRQ WO TFXJ DEV
|
Facility
|
OP
|
$84,204.60
|
|
|
Service Code
|
HCPCS 27278
|
| Hospital Charge Code |
16001048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,626.00 |
| Max. Negotiated Rate |
$75,192.36 |
| Rate for Payer: Aetna Commercial |
$56,659.34
|
| Rate for Payer: Aetna Medicare Advantage |
$67,491.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75,192.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75,192.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20,830.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75,192.36
|
| Rate for Payer: Cigna Commercial |
$41,754.94
|
| Rate for Payer: Cigna Medicare Advantage |
$20,830.64
|
| Rate for Payer: Clover Medicare Advantage |
$19,789.11
|
| Rate for Payer: EmblemHealth Commercial |
$62,491.92
|
| Rate for Payer: Humana Medicare Advantage |
$21,455.56
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20,830.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25,261.38
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12,630.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,029.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20,830.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$20,830.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,231.42
|
|
|
ARTHREX 10MM RETRO CUTTER CAT
|
Facility
|
IP
|
$1,395.00
|
|
| Hospital Charge Code |
270656418
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$209.25 |
| Max. Negotiated Rate |
$209.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$209.25
|
|
|
ARTHREX 10MM RETRO CUTTER CAT
|
Facility
|
OP
|
$1,395.00
|
|
| Hospital Charge Code |
270656418
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.62 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Medicare Advantage |
$418.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$355.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$355.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$355.73
|
| Rate for Payer: Cigna Commercial |
$697.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$418.50
|
| Rate for Payer: Oxford Commercial |
$279.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$209.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$279.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.97
|
|
|
ARTHREX 10MM RETRO CUTTER CAT
|
Facility
|
OP
|
$1,395.00
|
|
| Hospital Charge Code |
656418
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.62 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Medicare Advantage |
$418.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$355.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$355.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$355.73
|
| Rate for Payer: Cigna Commercial |
$697.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$418.50
|
| Rate for Payer: Oxford Commercial |
$279.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$209.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$279.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.97
|
|
|
ARTHREX 10MM RETRO CUTTER CAT
|
Facility
|
IP
|
$1,395.00
|
|
| Hospital Charge Code |
656418
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$209.25 |
| Max. Negotiated Rate |
$209.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$209.25
|
|
|
ARTHREX ACP KIT SERIES WITH AC
|
Facility
|
OP
|
$1,075.00
|
|
| Hospital Charge Code |
270703393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$537.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Medicare Advantage |
$322.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$215.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$274.12
|
| Rate for Payer: Cigna Commercial |
$537.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$236.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.49
|
|
|
ARTHREX ACP KIT SERIES WITH AC
|
Facility
|
IP
|
$1,075.00
|
|
| Hospital Charge Code |
270703393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.25 |
| Max. Negotiated Rate |
$260.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$215.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.15
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$236.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.25
|
|
|
ARTHREX DISSECTOR 3.5MM X 13CM
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
270704728
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.00
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.00
|
| Rate for Payer: Oxford Commercial |
$40.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.30
|
|
|
ARTHREX DISSECTOR 3.5MM X 13CM
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
270704728
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
ARTHREX FIBERTAK
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270704953
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
ARTHREX FIBERTAK
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270704953
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$262.50
|
| Rate for Payer: Oxford Commercial |
$175.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.19
|
|
|
ARTHREX LASSO
|
Facility
|
OP
|
$901.25
|
|
| Hospital Charge Code |
270704952
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$450.62 |
| Rate for Payer: Aetna Commercial |
$342.48
|
| Rate for Payer: Aetna Medicare Advantage |
$270.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.82
|
| Rate for Payer: Cigna Commercial |
$450.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$270.38
|
| Rate for Payer: Oxford Commercial |
$180.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$180.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.88
|
|
|
ARTHREX LASSO
|
Facility
|
IP
|
$901.25
|
|
| Hospital Charge Code |
270704952
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$135.19 |
| Max. Negotiated Rate |
$135.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.19
|
|
|
ARTHRO BIOINDUCTIVE 1 MED
|
Facility
|
IP
|
$14,000.00
|
|
| Hospital Charge Code |
270687117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$3,388.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,388.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,080.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,100.00
|
|
|
ARTHRO BIOINDUCTIVE 1 MED
|
Facility
|
OP
|
$14,000.00
|
|
| Hospital Charge Code |
270687117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$7,000.00 |
| Rate for Payer: Aetna Commercial |
$5,320.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,570.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,570.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,570.00
|
| Rate for Payer: Cigna Commercial |
$7,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,388.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,080.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,100.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$337.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$371.00
|
|
|
ARTHROCELL
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,299.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,090.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|
|
ARTHROCELL
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.95 |
| Max. Negotiated Rate |
$4,750.00 |
| Rate for Payer: Aetna Commercial |
$3,610.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,422.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,422.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,422.50
|
| Rate for Payer: Cigna Commercial |
$4,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,299.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,090.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$228.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$251.75
|
|
|
ARTHROCELL 10CC
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270706087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,250.00 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,630.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,250.00
|
|
|
ARTHROCELL 10CC
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270706087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$5,700.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,825.00
|
| Rate for Payer: Cigna Commercial |
$7,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,630.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,250.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$361.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$397.50
|
|
|
ARTHRODESIS ANT SP4-7 VERTEB
|
Facility
|
OP
|
$9,300.00
|
|
|
Service Code
|
HCPCS 22810
|
| Hospital Charge Code |
1600000872
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$224.13 |
| Max. Negotiated Rate |
$75,192.36 |
| Rate for Payer: Aetna Commercial |
$56,659.34
|
| Rate for Payer: Aetna Medicare Advantage |
$67,491.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75,192.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75,192.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20,830.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75,192.36
|
| Rate for Payer: Cigna Commercial |
$41,754.94
|
| Rate for Payer: Cigna Medicare Advantage |
$20,830.64
|
| Rate for Payer: Clover Medicare Advantage |
$19,789.11
|
| Rate for Payer: EmblemHealth Commercial |
$62,491.92
|
| Rate for Payer: Humana Medicare Advantage |
$21,455.56
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20,830.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,790.00
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,395.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$224.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20,830.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$20,830.64
|
|
|
ARTHRODESIS ANT SP4-7 VERTEB
|
Facility
|
IP
|
$9,300.00
|
|
|
Service Code
|
HCPCS 22810
|
| Hospital Charge Code |
1600000872
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,395.00 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,395.00
|
|
|
ARTHRODESIS GREAT TOE,IP JOINT
|
Facility
|
IP
|
$19,998.60
|
|
|
Service Code
|
HCPCS 28755
|
| Hospital Charge Code |
16000726
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,999.79 |
| Max. Negotiated Rate |
$2,999.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,999.79
|
|