|
PRDI THERAPEUTIC PHR SET****
|
Facility
|
OP
|
$213.00
|
|
| Hospital Charge Code |
8002529
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$106.50 |
| Rate for Payer: Aetna Commercial |
$80.94
|
| Rate for Payer: Aetna Medicare Advantage |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.31
|
| Rate for Payer: Cigna Commercial |
$106.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.90
|
| Rate for Payer: Oxford Commercial |
$42.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.64
|
|
|
Pre-albumin
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
39888031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: Aetna Medicare Advantage |
$47.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.67
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.59
|
| Rate for Payer: Clover Medicare Advantage |
$13.86
|
| Rate for Payer: EmblemHealth Commercial |
$43.77
|
| Rate for Payer: Humana Medicare Advantage |
$15.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
Pre-albumin
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
39888031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
PREALBUMIN
|
Facility
|
IP
|
$96.25
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
3002842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.44
|
|
|
PREALBUMIN
|
Facility
|
OP
|
$96.25
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
3002842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: Aetna Medicare Advantage |
$47.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.67
|
| Rate for Payer: Cigna Commercial |
$48.12
|
| Rate for Payer: Cigna Medicare Advantage |
$14.59
|
| Rate for Payer: Clover Medicare Advantage |
$13.86
|
| Rate for Payer: EmblemHealth Commercial |
$43.77
|
| Rate for Payer: Humana Medicare Advantage |
$15.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.88
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.55
|
|
|
PREALBUMIN
|
Facility
|
IP
|
$100.25
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
39900428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$15.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.04
|
|
|
PREALBUMIN
|
Facility
|
OP
|
$100.25
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
39900428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: Aetna Medicare Advantage |
$47.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.67
|
| Rate for Payer: Cigna Commercial |
$50.12
|
| Rate for Payer: Cigna Medicare Advantage |
$14.59
|
| Rate for Payer: Clover Medicare Advantage |
$13.86
|
| Rate for Payer: EmblemHealth Commercial |
$43.77
|
| Rate for Payer: Humana Medicare Advantage |
$15.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.07
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.66
|
|
|
PREALBUMIN SERUM
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
38478093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$15.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.45
|
|
|
PREALBUMIN SERUM
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
38478093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: Aetna Medicare Advantage |
$47.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.67
|
| Rate for Payer: Cigna Commercial |
$51.50
|
| Rate for Payer: Cigna Medicare Advantage |
$14.59
|
| Rate for Payer: Clover Medicare Advantage |
$13.86
|
| Rate for Payer: EmblemHealth Commercial |
$43.77
|
| Rate for Payer: Humana Medicare Advantage |
$15.03
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.73
|
|
|
PRE-BENT ROD 5.5X45MM
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$380.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$220.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
PRE-BENT ROD 5.5X45MM
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$220.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
PRE-BENT ROD 5.5X60MM
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270702847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$665.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$385.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.38
|
|
|
PRE-BENT ROD 5.5X60MM
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270702847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$423.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$385.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
PREBENT ROD 5.5X60MM
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$220.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
PREBENT ROD 5.5X60MM
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$380.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$220.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
PRE-BENT ROD 5.5X70MM
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$665.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$385.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.38
|
|
|
PRE-BENT ROD 5.5X70MM
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$423.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$385.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
PRECEPT SCREW 6.5x40MM POLYAXI
|
Facility
|
IP
|
$10,285.00
|
|
| Hospital Charge Code |
270665929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,542.75 |
| Max. Negotiated Rate |
$2,488.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,057.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,488.97
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,262.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,542.75
|
|
|
PRECEPT SCREW 6.5x40MM POLYAXI
|
Facility
|
OP
|
$10,285.00
|
|
| Hospital Charge Code |
270665929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.87 |
| Max. Negotiated Rate |
$5,142.50 |
| Rate for Payer: Aetna Commercial |
$3,908.30
|
| Rate for Payer: Aetna Medicare Advantage |
$3,085.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,622.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,622.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,057.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,622.68
|
| Rate for Payer: Cigna Commercial |
$5,142.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,488.97
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,262.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,542.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$247.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$272.55
|
|
|
PRECEPT SCREW 6.5x50MM POLYAXI
|
Facility
|
IP
|
$10,285.00
|
|
| Hospital Charge Code |
270665928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,542.75 |
| Max. Negotiated Rate |
$2,488.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,057.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,488.97
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,262.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,542.75
|
|
|
PRECEPT SCREW 6.5x50MM POLYAXI
|
Facility
|
OP
|
$10,285.00
|
|
| Hospital Charge Code |
270665928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.87 |
| Max. Negotiated Rate |
$5,142.50 |
| Rate for Payer: Aetna Commercial |
$3,908.30
|
| Rate for Payer: Aetna Medicare Advantage |
$3,085.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,622.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,622.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,057.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,622.68
|
| Rate for Payer: Cigna Commercial |
$5,142.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,488.97
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,262.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,542.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$247.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$272.55
|
|
|
PRECEPT SCREW SHANK, 6.5x50MM
|
Facility
|
IP
|
$4,865.00
|
|
| Hospital Charge Code |
270665930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.75 |
| Max. Negotiated Rate |
$1,177.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$973.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,177.33
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,070.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$729.75
|
|
|
PRECEPT SCREW SHANK, 6.5x50MM
|
Facility
|
OP
|
$4,865.00
|
|
| Hospital Charge Code |
270665930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$2,432.50 |
| Rate for Payer: Aetna Commercial |
$1,848.70
|
| Rate for Payer: Aetna Medicare Advantage |
$1,459.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,240.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,240.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$973.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,240.58
|
| Rate for Payer: Cigna Commercial |
$2,432.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,177.33
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,070.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$729.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$117.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$128.92
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$49,604.88
|
|
|
Service Code
|
MSDRG 067
|
| Min. Negotiated Rate |
$15,104.05 |
| Max. Negotiated Rate |
$49,604.88 |
| Rate for Payer: Aetna Medicare Advantage |
$49,604.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15,899.00
|
| Rate for Payer: Cigna Commercial |
$27,485.25
|
| Rate for Payer: Cigna Medicare Advantage |
$15,899.00
|
| Rate for Payer: Clover Medicare Advantage |
$15,104.05
|
| Rate for Payer: EmblemHealth Commercial |
$47,697.00
|
| Rate for Payer: Humana Medicare Advantage |
$16,375.97
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15,899.00
|
| Rate for Payer: Oxford Commercial |
$19,754.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$34,639.29
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15,899.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$15,899.00
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$30,072.87
|
|
|
Service Code
|
MSDRG 068
|
| Min. Negotiated Rate |
$9,156.80 |
| Max. Negotiated Rate |
$30,072.87 |
| Rate for Payer: Aetna Medicare Advantage |
$30,072.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9,638.74
|
| Rate for Payer: Cigna Commercial |
$16,176.38
|
| Rate for Payer: Cigna Medicare Advantage |
$9,638.74
|
| Rate for Payer: Clover Medicare Advantage |
$9,156.80
|
| Rate for Payer: EmblemHealth Commercial |
$28,916.22
|
| Rate for Payer: Humana Medicare Advantage |
$9,927.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9,638.74
|
| Rate for Payer: Oxford Commercial |
$11,626.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$20,386.87
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9,638.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$9,638.74
|
|
