|
VG LAMINOPLASTY
|
Facility
|
OP
|
$4,284.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.24 |
| Max. Negotiated Rate |
$2,142.00 |
| Rate for Payer: Aetna Commercial |
$1,627.92
|
| Rate for Payer: Aetna Medicare Advantage |
$1,285.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,092.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,092.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$856.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,092.42
|
| Rate for Payer: Cigna Commercial |
$2,142.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,036.73
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$942.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$642.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$103.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.53
|
|
|
VG LAMINOPLASTY
|
Facility
|
OP
|
$4,284.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.24 |
| Max. Negotiated Rate |
$2,142.00 |
| Rate for Payer: Aetna Commercial |
$1,627.92
|
| Rate for Payer: Aetna Medicare Advantage |
$1,285.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,092.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,092.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$856.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,092.42
|
| Rate for Payer: Cigna Commercial |
$2,142.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,036.73
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$942.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$642.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$103.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.53
|
|
|
VIA 17 MICROCATH 45D TIP
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270697115S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.68 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna Commercial |
$2,565.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,025.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,721.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,721.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,721.25
|
| Rate for Payer: Cigna Commercial |
$3,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,633.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,485.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,012.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$162.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$178.88
|
|
|
VIA 17 MICROCATH 45D TIP
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
270697115S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.50 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,633.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,485.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,012.50
|
|
|
VIABAHN ENDOPRIS 10 VB10101002
|
Facility
|
IP
|
$12,152.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270633881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,822.80 |
| Max. Negotiated Rate |
$2,940.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,430.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,940.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,673.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,822.80
|
|
|
VIABAHN ENDOPRIS 10 VB10101002
|
Facility
|
OP
|
$12,152.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270633881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.86 |
| Max. Negotiated Rate |
$6,076.00 |
| Rate for Payer: Aetna Commercial |
$4,617.76
|
| Rate for Payer: Aetna Medicare Advantage |
$3,645.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,098.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,098.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,430.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,098.76
|
| Rate for Payer: Cigna Commercial |
$6,076.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,940.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,673.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,822.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$292.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$322.03
|
|
|
VIABAHN VBX 11X79
|
Facility
|
IP
|
$17,095.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270683406N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.25 |
| Max. Negotiated Rate |
$4,136.99 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,419.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,136.99
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,760.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,564.25
|
|
|
VIABAHN VBX 11X79
|
Facility
|
IP
|
$17,095.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270683406S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.25 |
| Max. Negotiated Rate |
$4,136.99 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,419.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,136.99
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,760.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,564.25
|
|
|
VIABAHN VBX 11X79
|
Facility
|
OP
|
$17,095.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270683406S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.99 |
| Max. Negotiated Rate |
$8,547.50 |
| Rate for Payer: Aetna Commercial |
$6,496.10
|
| Rate for Payer: Aetna Medicare Advantage |
$5,128.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,359.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,359.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,419.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,359.23
|
| Rate for Payer: Cigna Commercial |
$8,547.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,136.99
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,760.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,564.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$411.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$453.02
|
|
|
VIABAHN VBX 11X79
|
Facility
|
OP
|
$17,095.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270683406N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.99 |
| Max. Negotiated Rate |
$8,547.50 |
| Rate for Payer: Aetna Commercial |
$6,496.10
|
| Rate for Payer: Aetna Medicare Advantage |
$5,128.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,359.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,359.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,419.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,359.23
|
| Rate for Payer: Cigna Commercial |
$8,547.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,136.99
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,760.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,564.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$411.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$453.02
|
|
|
VIABHN VBX/LT EXT ILIAC STNT
|
Facility
|
IP
|
$16,275.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680299N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.25 |
| Max. Negotiated Rate |
$3,938.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,255.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,938.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,580.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,441.25
|
|
|
VIABHN VBX/LT EXT ILIAC STNT
|
Facility
|
OP
|
$16,275.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680299N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.23 |
| Max. Negotiated Rate |
$8,137.50 |
| Rate for Payer: Aetna Commercial |
$6,184.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,882.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,150.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,150.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,150.12
|
| Rate for Payer: Cigna Commercial |
$8,137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,938.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,580.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,441.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$392.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$431.29
|
|
|
VIABHN VBX/LT EXT ILIAC STNT
|
Facility
|
IP
|
$16,680.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680299S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,502.00 |
| Max. Negotiated Rate |
$4,036.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,036.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,669.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,502.00
|
|
|
VIABHN VBX/LT EXT ILIAC STNT
|
Facility
|
IP
|
$16,680.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,502.00 |
| Max. Negotiated Rate |
$4,036.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,036.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,669.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,502.00
|
|
|
VIABHN VBX/LT EXT ILIAC STNT
|
Facility
|
OP
|
$16,680.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680299S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.99 |
| Max. Negotiated Rate |
$8,340.00 |
| Rate for Payer: Aetna Commercial |
$6,338.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5,004.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,253.40
|
| Rate for Payer: Cigna Commercial |
$8,340.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,036.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,669.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,502.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$401.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$442.02
|
|
|
VIABHN VBX/LT EXT ILIAC STNT
|
Facility
|
OP
|
$16,680.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.99 |
| Max. Negotiated Rate |
$8,340.00 |
| Rate for Payer: Aetna Commercial |
$6,338.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5,004.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,253.40
|
| Rate for Payer: Cigna Commercial |
$8,340.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,036.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,669.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,502.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$401.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$442.02
|
|
|
VIABHN VBX/RT EXT ILIAC STNT
|
Facility
|
IP
|
$16,680.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,502.00 |
| Max. Negotiated Rate |
$4,036.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,036.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,669.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,502.00
|
|
|
VIABHN VBX/RT EXT ILIAC STNT
|
Facility
|
OP
|
$16,275.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680298N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.23 |
| Max. Negotiated Rate |
$8,137.50 |
| Rate for Payer: Aetna Commercial |
$6,184.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,882.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,150.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,150.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,150.12
|
| Rate for Payer: Cigna Commercial |
$8,137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,938.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,580.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,441.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$392.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$431.29
|
|
|
VIABHN VBX/RT EXT ILIAC STNT
|
Facility
|
IP
|
$16,680.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680298S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,502.00 |
| Max. Negotiated Rate |
$4,036.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,036.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,669.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,502.00
|
|
|
VIABHN VBX/RT EXT ILIAC STNT
|
Facility
|
IP
|
$16,275.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680298N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.25 |
| Max. Negotiated Rate |
$3,938.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,255.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,938.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,580.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,441.25
|
|
|
VIABHN VBX/RT EXT ILIAC STNT
|
Facility
|
OP
|
$16,680.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680298S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.99 |
| Max. Negotiated Rate |
$8,340.00 |
| Rate for Payer: Aetna Commercial |
$6,338.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5,004.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,253.40
|
| Rate for Payer: Cigna Commercial |
$8,340.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,036.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,669.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,502.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$401.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$442.02
|
|
|
VIABHN VBX/RT EXT ILIAC STNT
|
Facility
|
OP
|
$16,680.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270680298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.99 |
| Max. Negotiated Rate |
$8,340.00 |
| Rate for Payer: Aetna Commercial |
$6,338.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5,004.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,253.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,253.40
|
| Rate for Payer: Cigna Commercial |
$8,340.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,036.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,669.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,502.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$401.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$442.02
|
|
|
VIABLE BONE MATRIX 1 CC BIO4
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
270692124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.75 |
| Max. Negotiated Rate |
$998.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$825.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$998.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$907.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$618.75
|
|
|
VIABLE BONE MATRIX 1 CC BIO4
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
270692124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.41 |
| Max. Negotiated Rate |
$2,062.50 |
| Rate for Payer: Aetna Commercial |
$1,567.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,237.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,051.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,051.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,051.88
|
| Rate for Payer: Cigna Commercial |
$2,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$998.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$907.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$618.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$99.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$109.31
|
|
|
VIAFILL DEMINE BONE FIBER 3CC
|
Facility
|
IP
|
$3,750.00
|
|
| Hospital Charge Code |
270702355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$907.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$825.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
|