|
MAT CELL CONTAM STDY STR ANLYS
|
Facility
|
OP
|
$1,327.45
|
|
|
Service Code
|
HCPCS 81265
|
| Hospital Charge Code |
401381265
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.18 |
| Max. Negotiated Rate |
$841.31 |
| Rate for Payer: Aetna Commercial |
$633.95
|
| Rate for Payer: Aetna Medicare Advantage |
$755.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$841.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$841.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$233.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$841.31
|
| Rate for Payer: Cigna Commercial |
$663.73
|
| Rate for Payer: Cigna Medicare Advantage |
$233.07
|
| Rate for Payer: Clover Medicare Advantage |
$221.42
|
| Rate for Payer: EmblemHealth Commercial |
$699.21
|
| Rate for Payer: Humana Medicare Advantage |
$240.06
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$233.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$398.24
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$199.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$186.46
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$233.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$233.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.18
|
|
|
MATCH HEAD BUR 3.0MM 23.0M6ST
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
270335570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.55
|
|
|
MATCH HEAD BUR 3.0MM 23.0M6ST
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
270335570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$78.50 |
| Rate for Payer: Aetna Commercial |
$59.66
|
| Rate for Payer: Aetna Medicare Advantage |
$47.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.03
|
| Rate for Payer: Cigna Commercial |
$78.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.10
|
| Rate for Payer: Oxford Commercial |
$31.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.16
|
|
|
MATCH HEAD BUR 9CM 23.0M9ST
|
Facility
|
IP
|
$184.00
|
|
| Hospital Charge Code |
270335571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.60
|
|
|
MATCH HEAD BUR 9CM 23.0M9ST
|
Facility
|
OP
|
$184.00
|
|
| Hospital Charge Code |
270335571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$69.92
|
| Rate for Payer: Aetna Medicare Advantage |
$55.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.92
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.20
|
| Rate for Payer: Oxford Commercial |
$36.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.88
|
|
|
MAT ECOSUCTIONER
|
Facility
|
OP
|
$2,760.00
|
|
| Hospital Charge Code |
270675433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$1,048.80
|
| Rate for Payer: Aetna Medicare Advantage |
$828.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$703.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$703.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$703.80
|
| Rate for Payer: Cigna Commercial |
$1,380.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$828.00
|
| Rate for Payer: Oxford Commercial |
$552.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$414.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$552.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$66.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$73.14
|
|
|
MAT ECOSUCTIONER
|
Facility
|
IP
|
$2,760.00
|
|
| Hospital Charge Code |
270675433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$414.00
|
|
|
MATERNITY PROFILE***
|
Facility
|
OP
|
$276.00
|
|
| Hospital Charge Code |
3008034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$104.88
|
| Rate for Payer: Aetna Medicare Advantage |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.38
|
| Rate for Payer: Cigna Commercial |
$138.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.31
|
|
|
MATERNITY PROFILE***
|
Facility
|
IP
|
$276.00
|
|
| Hospital Charge Code |
3008034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.40
|
|
|
MATRISTEM MATRIX PLUS 7x10CM
|
Facility
|
IP
|
$9,870.00
|
|
|
Service Code
|
HCPCS Q4166
|
| Hospital Charge Code |
270677281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,480.50 |
| Max. Negotiated Rate |
$2,388.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,974.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,388.54
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,171.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,480.50
|
|
|
MATRISTEM MATRIX PLUS 7x10CM
|
Facility
|
OP
|
$9,870.00
|
|
|
Service Code
|
HCPCS Q4166
|
| Hospital Charge Code |
270677281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$2,388.54 |
| 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 |
$1,974.00
|
| 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 |
$2,388.54
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,171.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,480.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$237.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$261.56
|
|
|
MATRISTEM SURG MATRIX 10X15CM
|
Facility
|
IP
|
$15,750.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270651272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,362.50 |
| Max. Negotiated Rate |
$3,811.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,811.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,465.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,362.50
|
|
|
MATRISTEM SURG MATRIX 10X15CM
|
Facility
|
OP
|
$15,750.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270651272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$379.57 |
| Max. Negotiated Rate |
$7,875.00 |
| Rate for Payer: Aetna Commercial |
$5,985.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,016.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,016.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,016.25
|
| Rate for Payer: Cigna Commercial |
$7,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,811.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,465.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,362.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$379.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$417.38
|
|
|
MATRISTIM PSM 7X10 CM
|
Facility
|
IP
|
$9,967.50
|
|
|
Service Code
|
HCPCS Q4166
|
| Hospital Charge Code |
270662112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,495.12 |
| Max. Negotiated Rate |
$2,412.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,993.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,412.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,192.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,495.12
|
|
|
MATRISTIM PSM 7X10 CM
|
Facility
|
OP
|
$9,967.50
|
|
|
Service Code
|
HCPCS Q4166
|
| Hospital Charge Code |
270662112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$2,412.14 |
| 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 |
$1,993.50
|
| 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 |
$2,412.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,192.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,495.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$240.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$264.14
|
|
|
MATRIX 200mg MM0200
|
Facility
|
OP
|
$3,008.00
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
270644124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.49 |
| Max. Negotiated Rate |
$1,504.00 |
| Rate for Payer: Aetna Commercial |
$1,143.04
|
| Rate for Payer: Aetna Medicare Advantage |
$902.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$767.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$767.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$601.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$767.04
|
| Rate for Payer: Cigna Commercial |
$1,504.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$727.94
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$661.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$451.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$72.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.71
|
|
|
MATRIX 200mg MM0200
|
Facility
|
IP
|
$3,008.00
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
270644124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$727.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$601.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$727.94
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$661.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$451.20
|
|
|
MATRIX 200mg MM0200/1MGJW
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
270644124W
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Aetna Medicare Advantage |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.08
|
| Rate for Payer: Cigna Commercial |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.42
|
|
|
MATRIX 200mg MM0200/1MGJW
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
270644124W
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.40
|
|
|
MATRIX BILAYER MESHED 4x10
|
Facility
|
IP
|
$26,845.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270651359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,026.75 |
| Max. Negotiated Rate |
$6,496.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,369.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,496.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,905.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,026.75
|
|
|
MATRIX BILAYER MESHED 4x10
|
Facility
|
OP
|
$26,845.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270651359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.96 |
| Max. Negotiated Rate |
$13,422.50 |
| Rate for Payer: Aetna Commercial |
$10,201.10
|
| Rate for Payer: Aetna Medicare Advantage |
$8,053.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,845.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,845.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,369.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,845.48
|
| Rate for Payer: Cigna Commercial |
$13,422.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,496.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,905.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,026.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$646.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$711.39
|
|
|
MATRIX BN FIB AERIDYAN 12.5CC
|
Facility
|
OP
|
$27,169.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.78 |
| Max. Negotiated Rate |
$13,584.60 |
| Rate for Payer: Aetna Commercial |
$10,324.30
|
| Rate for Payer: Aetna Medicare Advantage |
$8,150.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,928.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,928.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,433.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,928.15
|
| Rate for Payer: Cigna Commercial |
$13,584.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,574.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,977.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,075.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$654.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$719.98
|
|
|
MATRIX BN FIB AERIDYAN 12.5CC
|
Facility
|
IP
|
$27,169.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,075.38 |
| Max. Negotiated Rate |
$6,574.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,433.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,574.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,977.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,075.38
|
|
|
MATRIX BURN 10CM X 15CM
|
Facility
|
IP
|
$10,575.00
|
|
|
Service Code
|
HCPCS Q4166
|
| Hospital Charge Code |
270662120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,586.25 |
| Max. Negotiated Rate |
$2,559.15 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,559.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,586.25
|
|
|
MATRIX BURN 10CM X 15CM
|
Facility
|
OP
|
$10,575.00
|
|
|
Service Code
|
HCPCS Q4166
|
| Hospital Charge Code |
270662120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$2,559.15 |
| 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 |
$156.71
|
| 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 |
$2,559.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,586.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$254.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$280.24
|
|
