|
ACLOVATE 0.05%/15GM
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
60632390
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare Advantage |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.28
|
| Rate for Payer: Cigna Commercial |
$28.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.28
|
| Rate for Payer: Oxford Commercial |
$28.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.00
|
|
|
ACL TENDON-KNEE PER SQ. CM.
|
Facility
|
IP
|
$249.00
|
|
| Hospital Charge Code |
270332705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.35
|
|
|
ACL TENDON-KNEE PER SQ. CM.
|
Facility
|
OP
|
$249.00
|
|
| Hospital Charge Code |
270332705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Medicare Advantage |
$74.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.49
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.35
|
|
|
ACL TIGHT ROPE DRILL PIN
|
Facility
|
IP
|
$895.00
|
|
| Hospital Charge Code |
270656488
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.25 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$134.25
|
|
|
ACL TIGHT ROPE DRILL PIN
|
Facility
|
OP
|
$895.00
|
|
| Hospital Charge Code |
270656488
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$447.50 |
| Rate for Payer: Aetna Commercial |
$268.50
|
| Rate for Payer: Aetna Medicare Advantage |
$268.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$228.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$228.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$228.22
|
| Rate for Payer: Cigna Commercial |
$447.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$116.35
|
| Rate for Payer: Oxford Commercial |
$447.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$134.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$447.50
|
|
|
ACL TIGHTROPE II DOUBLE LOADED
|
Facility
|
IP
|
$2,394.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.21 |
| Max. Negotiated Rate |
$579.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$478.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$579.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$359.21
|
|
|
ACL TIGHTROPE II DOUBLE LOADED
|
Facility
|
OP
|
$2,394.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.21 |
| Max. Negotiated Rate |
$1,197.38 |
| Rate for Payer: Aetna Commercial |
$718.42
|
| Rate for Payer: Aetna Medicare Advantage |
$718.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$610.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$610.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$478.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$610.66
|
| Rate for Payer: Cigna Commercial |
$1,197.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$579.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$359.21
|
|
|
ACL TIGHTROPE RT
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
270663931
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$525.00
|
| 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) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$227.50
|
| Rate for Payer: Oxford Commercial |
$875.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$875.00
|
|
|
ACL TIGHTROPE RT
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
270663931
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
ACL TRAY FEE AR992
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270641554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
ACL TRAY FEE AR992
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270641554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.00
|
| Rate for Payer: Oxford Commercial |
$250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.00
|
|
|
ACL TR SUTURE CUTTER
|
Facility
|
OP
|
$1,130.00
|
|
| Hospital Charge Code |
270664910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: Aetna Commercial |
$339.00
|
| Rate for Payer: Aetna Medicare Advantage |
$339.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$288.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$288.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$288.15
|
| Rate for Payer: Cigna Commercial |
$565.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.90
|
| Rate for Payer: Oxford Commercial |
$565.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$169.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$565.00
|
|
|
ACL TR SUTURE CUTTER
|
Facility
|
IP
|
$1,130.00
|
|
| Hospital Charge Code |
270664910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$169.50
|
|
|
ACNE SURGERY
|
Facility
|
OP
|
$990.50
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
412310040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.76 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$297.15
|
| Rate for Payer: Aetna Medicare Advantage |
$297.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$252.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$252.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$252.58
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.76
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
ACNE SURGERY
|
Facility
|
IP
|
$990.50
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
412310040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.57 |
| Max. Negotiated Rate |
$148.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.57
|
|
|
ACORN BUR
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
270335567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Medicare Advantage |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.14
|
| Rate for Payer: Cigna Commercial |
$139.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.27
|
| Rate for Payer: Oxford Commercial |
$139.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.50
|
|
|
ACORN BUR
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
270335567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$41.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.85
|
|
|
ACP 2 LEVEL 40MM
|
Facility
|
IP
|
$5,500.00
|
|
| Hospital Charge Code |
270703572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
ACP 2 LEVEL 40MM
|
Facility
|
OP
|
$5,500.00
|
|
| Hospital Charge Code |
270703572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$1,650.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
ACP 3 LVL 51MM
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,800.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,530.00
|
| Rate for Payer: Cigna Commercial |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
ACP 3 LVL 51MM
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
ACP DOUBLE SYRINGE
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270339457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
ACP DOUBLE SYRINGE
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270339457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.25
|
| Rate for Payer: Oxford Commercial |
$112.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.50
|
|
|
ACPELLA ADULT GREEN
|
Facility
|
OP
|
$205.49
|
|
| Hospital Charge Code |
270664898
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.71 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$61.65
|
| Rate for Payer: Aetna Medicare Advantage |
$61.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.40
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.71
|
| Rate for Payer: Oxford Commercial |
$102.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$102.75
|
|
|
ACPELLA ADULT GREEN
|
Facility
|
IP
|
$205.49
|
|
| Hospital Charge Code |
270664898
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$30.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.82
|
|