|
TRIATHLON FEMUR CR SZ 2 LT
|
Facility
|
OP
|
$10,529.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$5,264.73 |
| Rate for Payer: Aetna Commercial |
$4,001.19
|
| Rate for Payer: Aetna Medicare Advantage |
$3,158.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,685.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,685.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,105.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,685.01
|
| Rate for Payer: Cigna Commercial |
$5,264.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,548.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,316.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,579.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$253.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$279.03
|
|
|
TRIATHLON FEMUR CR SZ 2 LT
|
Facility
|
IP
|
$10,529.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.42 |
| Max. Negotiated Rate |
$2,548.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,105.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,548.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,316.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,579.42
|
|
|
TRIATHLON FEMUR PS SZ 2 LT
|
Facility
|
OP
|
$6,531.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.42 |
| Max. Negotiated Rate |
$3,265.95 |
| Rate for Payer: Aetna Commercial |
$2,482.12
|
| Rate for Payer: Aetna Medicare Advantage |
$1,959.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,665.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,665.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,306.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,665.63
|
| Rate for Payer: Cigna Commercial |
$3,265.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,580.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,437.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$979.78
|
| Rate for Payer: UnitedHealthcare Community & State |
$157.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$173.10
|
|
|
TRIATHLON FEMUR PS SZ 2 LT
|
Facility
|
IP
|
$6,531.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.78 |
| Max. Negotiated Rate |
$1,580.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,306.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,580.72
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,437.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$979.78
|
|
|
TRIATHLON INSERT 11MM SZ3
|
Facility
|
OP
|
$23,925.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.59 |
| Max. Negotiated Rate |
$11,962.50 |
| Rate for Payer: Aetna Commercial |
$9,091.50
|
| Rate for Payer: Aetna Medicare Advantage |
$7,177.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,100.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,100.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,100.88
|
| Rate for Payer: Cigna Commercial |
$11,962.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,789.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,263.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,588.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$576.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$634.01
|
|
|
TRIATHLON INSERT 11MM SZ3
|
Facility
|
IP
|
$23,925.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,588.75 |
| Max. Negotiated Rate |
$5,789.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,785.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,789.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,263.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,588.75
|
|
|
TRIATHLON METAL PATELLA A38X11
|
Facility
|
OP
|
$2,550.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.47 |
| Max. Negotiated Rate |
$1,275.25 |
| Rate for Payer: Aetna Commercial |
$969.19
|
| Rate for Payer: Aetna Medicare Advantage |
$765.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$650.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$650.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$510.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$650.38
|
| Rate for Payer: Cigna Commercial |
$1,275.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$617.22
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$561.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$382.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$61.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$67.59
|
|
|
TRIATHLON METAL PATELLA A38X11
|
Facility
|
IP
|
$2,550.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$382.57 |
| Max. Negotiated Rate |
$617.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$510.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$617.22
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$561.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$382.57
|
|
|
TRIATHLON PATELLA SZ 3 PS LT
|
Facility
|
OP
|
$2,100.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.63 |
| Max. Negotiated Rate |
$1,050.33 |
| Rate for Payer: Aetna Commercial |
$798.25
|
| Rate for Payer: Aetna Medicare Advantage |
$630.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$535.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$535.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$420.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$535.67
|
| Rate for Payer: Cigna Commercial |
$1,050.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$508.36
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$462.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$315.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$50.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$55.67
|
|
|
TRIATHLON PATELLA SZ 3 PS LT
|
Facility
|
IP
|
$2,100.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.10 |
| Max. Negotiated Rate |
$508.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$420.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$508.36
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$462.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$315.10
|
|
|
TRIATHLON PS FEM COMP LT SZ3
|
Facility
|
IP
|
$10,774.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,616.15 |
| Max. Negotiated Rate |
$2,607.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,154.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,607.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,370.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,616.15
|
|
|
TRIATHLON PS FEM COMP LT SZ3
|
Facility
|
OP
|
$10,774.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.66 |
| Max. Negotiated Rate |
$5,387.18 |
| Rate for Payer: Aetna Commercial |
$4,094.25
|
| Rate for Payer: Aetna Medicare Advantage |
$3,232.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,747.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,747.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,154.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,747.46
|
| Rate for Payer: Cigna Commercial |
$5,387.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,607.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,370.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,616.15
|
| Rate for Payer: UnitedHealthcare Community & State |
$259.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$285.52
|
|
|
TRIATHLON PS FEM COMPON LT PS7
|
Facility
|
IP
|
$7,237.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.68 |
| Max. Negotiated Rate |
$1,751.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,447.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,751.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,592.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,085.68
|
|
|
TRIATHLON PS FEM COMPON LT PS7
|
Facility
|
OP
|
$7,237.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.43 |
| Max. Negotiated Rate |
$3,618.95 |
| Rate for Payer: Aetna Commercial |
$2,750.40
|
| Rate for Payer: Aetna Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,845.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,845.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,447.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,845.66
|
| Rate for Payer: Cigna Commercial |
$3,618.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,751.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,592.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,085.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$174.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$191.80
|
|
|
TRIATHLON PSF PS RT SZ7
|
Facility
|
OP
|
$10,774.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.66 |
| Max. Negotiated Rate |
$5,387.18 |
| Rate for Payer: Aetna Commercial |
$4,094.25
|
| Rate for Payer: Aetna Medicare Advantage |
$3,232.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,747.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,747.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,154.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,747.46
|
| Rate for Payer: Cigna Commercial |
$5,387.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,607.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,370.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,616.15
|
| Rate for Payer: UnitedHealthcare Community & State |
$259.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$285.52
|
|
|
TRIATHLON PSF PS RT SZ7
|
Facility
|
IP
|
$10,774.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,616.15 |
| Max. Negotiated Rate |
$2,607.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,154.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,607.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,370.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,616.15
|
|
|
TRIATHLON TBI CS SZ1 11MM
|
Facility
|
OP
|
$5,082.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270696480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$2,541.15 |
| Rate for Payer: Aetna Commercial |
$1,931.27
|
| Rate for Payer: Aetna Medicare Advantage |
$1,524.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,295.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,295.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,295.99
|
| Rate for Payer: Cigna Commercial |
$2,541.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,229.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,118.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$762.35
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$134.68
|
|
|
TRIATHLON TBI CS SZ1 11MM
|
Facility
|
IP
|
$5,082.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270696480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$762.35 |
| Max. Negotiated Rate |
$1,229.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,229.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,118.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$762.35
|
|
|
TRIATHLON TBI CS SZ3 12.0MM
|
Facility
|
OP
|
$5,082.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270698668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$2,541.10 |
| Rate for Payer: Aetna Commercial |
$1,931.24
|
| Rate for Payer: Aetna Medicare Advantage |
$1,524.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,295.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,295.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,295.96
|
| Rate for Payer: Cigna Commercial |
$2,541.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,229.89
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,118.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$762.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$122.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$134.68
|
|
|
TRIATHLON TBI CS SZ3 12.0MM
|
Facility
|
IP
|
$5,082.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270698668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$762.33 |
| Max. Negotiated Rate |
$1,229.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,229.89
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,118.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$762.33
|
|
|
TRIATHLON TBI CS X3 SZ6 10MM
|
Facility
|
OP
|
$10,529.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$5,264.73 |
| Rate for Payer: Aetna Commercial |
$4,001.19
|
| Rate for Payer: Aetna Medicare Advantage |
$3,158.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,685.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,685.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,105.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,685.01
|
| Rate for Payer: Cigna Commercial |
$5,264.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,548.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,316.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,579.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$253.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$279.03
|
|
|
TRIATHLON TBI CS X3 SZ6 10MM
|
Facility
|
IP
|
$10,529.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.42 |
| Max. Negotiated Rate |
$2,548.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,105.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,548.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,316.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,579.42
|
|
|
TRIATHLON TIBIA COMP SZ 1
|
Facility
|
IP
|
$6,924.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270696522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,038.69 |
| Max. Negotiated Rate |
$1,675.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,384.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,675.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,523.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,038.69
|
|
|
TRIATHLON TIBIA COMP SZ 1
|
Facility
|
OP
|
$6,924.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270696522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$3,462.30 |
| Rate for Payer: Aetna Commercial |
$2,631.35
|
| Rate for Payer: Aetna Medicare Advantage |
$2,077.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,765.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,765.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,384.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,765.77
|
| Rate for Payer: Cigna Commercial |
$3,462.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,675.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,523.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,038.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$166.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$183.50
|
|
|
TRIATHLON TIBIAL BEAR INSERT S
|
Facility
|
OP
|
$5,659.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$2,829.80 |
| Rate for Payer: Aetna Commercial |
$2,150.65
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,443.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,443.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,131.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,443.20
|
| Rate for Payer: Cigna Commercial |
$2,829.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,369.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,245.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$848.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$136.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$149.98
|
|