|
AEQUALIS REVERSED II PILOT FOR
|
Facility
|
OP
|
$787.50
|
|
| Hospital Charge Code |
270657909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: Aetna Medicare Advantage |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$157.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$393.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$190.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.12
|
|
|
AEQUALIS REV FRACTURE HUMERAL
|
Facility
|
OP
|
$34,875.00
|
|
| Hospital Charge Code |
270657920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,231.25 |
| Max. Negotiated Rate |
$17,437.50 |
| Rate for Payer: Aetna Commercial |
$10,462.50
|
| Rate for Payer: Aetna Medicare Advantage |
$10,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,893.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,893.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,893.12
|
| Rate for Payer: Cigna Commercial |
$17,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,439.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,231.25
|
|
|
AEQUALIS REV FRACTURE HUMERAL
|
Facility
|
IP
|
$34,875.00
|
|
| Hospital Charge Code |
270657920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,231.25 |
| Max. Negotiated Rate |
$8,439.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,439.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,231.25
|
|
|
AERO AIRWAY STENT SYSTEM 12 X
|
Facility
|
OP
|
$14,000.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
270678264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$7,000.00 |
| Rate for Payer: Aetna Commercial |
$4,200.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,570.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,570.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,570.00
|
| Rate for Payer: Cigna Commercial |
$7,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,388.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,100.00
|
|
|
AERO AIRWAY STENT SYSTEM 12 X
|
Facility
|
IP
|
$14,000.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
270678264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$3,388.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,388.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,100.00
|
|
|
AEROBIC ID
|
Facility
|
IP
|
$35.30
|
|
|
Service Code
|
HCPCS 87147
|
| Hospital Charge Code |
39900493
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.29
|
|
|
AEROBIC ID
|
Facility
|
OP
|
$35.30
|
|
|
Service Code
|
HCPCS 87147
|
| Hospital Charge Code |
39900493
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$16.78
|
| Rate for Payer: Aetna Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.98
|
| Rate for Payer: Cigna Commercial |
$5.18
|
| Rate for Payer: Cigna Medicare Advantage |
$2.59
|
| Rate for Payer: Clover Medicare Advantage |
$4.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.59
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$5.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.18
|
|
|
AEROCHAMBER FLOW
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
270600605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
|
|
AEROCHAMBER FLOW
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
270600605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Medicare Advantage |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.30
|
| Rate for Payer: Cigna Commercial |
$30.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.80
|
| Rate for Payer: Oxford Commercial |
$30.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.00
|
|
|
AEROCHAMBER PLUS W/MEDIUM MASK
|
Facility
|
OP
|
$62.38
|
|
| Hospital Charge Code |
270625710
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$31.19 |
| Rate for Payer: Aetna Commercial |
$18.71
|
| Rate for Payer: Aetna Medicare Advantage |
$18.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.91
|
| Rate for Payer: Cigna Commercial |
$31.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.11
|
| Rate for Payer: Oxford Commercial |
$31.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.19
|
|
|
AEROCHAMBER PLUS W/MEDIUM MASK
|
Facility
|
IP
|
$62.38
|
|
| Hospital Charge Code |
270625710
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.36
|
|
|
AEROCHAMBER Z-STAT PLUS
|
Facility
|
OP
|
$57.95
|
|
| Hospital Charge Code |
270626165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna Commercial |
$17.39
|
| Rate for Payer: Aetna Medicare Advantage |
$17.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.78
|
| Rate for Payer: Cigna Commercial |
$28.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.53
|
| Rate for Payer: Oxford Commercial |
$28.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.98
|
|
|
AEROCHAMBER Z-STAT PLUS
|
Facility
|
IP
|
$57.95
|
|
| Hospital Charge Code |
270626165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.69
|
|
|
AEROZOIN SPRAY
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
60634451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.45
|
|
|
AEROZOIN SPRAY
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
60634451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Aetna Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.87
|
| Rate for Payer: Cigna Commercial |
$11.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.99
|
| Rate for Payer: Oxford Commercial |
$11.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.50
|
|
|
AETOS GLENOSPHERE 34MM CONCENT
|
Facility
|
OP
|
$10,285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,542.75 |
| Max. Negotiated Rate |
$5,142.50 |
| Rate for Payer: Aetna Commercial |
$3,085.50
|
| 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: Qualcare PPO/HMO/WC |
$1,542.75
|
|
|
AETOS GLENOSPHERE 34MM CONCENT
|
Facility
|
IP
|
$10,285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704524
|
|
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: Qualcare PPO/HMO/WC |
$1,542.75
|
|
|
AETOS GLENOSPHERE 38MM CONCENT
|
Facility
|
IP
|
$10,285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704895
|
|
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: Qualcare PPO/HMO/WC |
$1,542.75
|
|
|
AETOS GLENOSPHERE 38MM CONCENT
|
Facility
|
OP
|
$10,285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,542.75 |
| Max. Negotiated Rate |
$5,142.50 |
| Rate for Payer: Aetna Commercial |
$3,085.50
|
| 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: Qualcare PPO/HMO/WC |
$1,542.75
|
|
|
AETOS HUMERAL HEAD CONCENTRIC
|
Facility
|
OP
|
$8,800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,320.00 |
| Max. Negotiated Rate |
$4,400.00 |
| Rate for Payer: Aetna Commercial |
$2,640.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,640.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,244.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,244.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,760.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,244.00
|
| Rate for Payer: Cigna Commercial |
$4,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,129.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,320.00
|
|
|
AETOS HUMERAL HEAD CONCENTRIC
|
Facility
|
IP
|
$8,800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,320.00 |
| Max. Negotiated Rate |
$2,129.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,760.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,129.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,320.00
|
|
|
AETOS META HUMERAL STEM SZ 1 S
|
Facility
|
OP
|
$15,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.25 |
| Max. Negotiated Rate |
$7,667.50 |
| Rate for Payer: Aetna Commercial |
$4,600.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,600.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,910.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,910.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,067.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,910.43
|
| Rate for Payer: Cigna Commercial |
$7,667.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,711.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,300.25
|
|
|
AETOS META HUMERAL STEM SZ 1 S
|
Facility
|
IP
|
$15,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.25 |
| Max. Negotiated Rate |
$3,711.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,067.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,711.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,300.25
|
|
|
AETOS META HUMERAL STEM SZ 3 L
|
Facility
|
IP
|
$15,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.25 |
| Max. Negotiated Rate |
$3,711.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,067.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,711.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,300.25
|
|
|
AETOS META HUMERAL STEM SZ 3 L
|
Facility
|
OP
|
$15,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.25 |
| Max. Negotiated Rate |
$7,667.50 |
| Rate for Payer: Aetna Commercial |
$4,600.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,600.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,910.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,910.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,067.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,910.43
|
| Rate for Payer: Cigna Commercial |
$7,667.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,711.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,300.25
|
|