|
CORONARY SVG ANGIO ONLY
|
Facility
|
OP
|
$12,026.00
|
|
|
Service Code
|
HCPCS 93455
|
| Hospital Charge Code |
7411225
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,563.38 |
| Max. Negotiated Rate |
$8,580.00 |
| Rate for Payer: Aetna Commercial |
$3,607.80
|
| Rate for Payer: Aetna Medicare Advantage |
$3,607.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,066.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,066.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,066.63
|
| Rate for Payer: Cigna Commercial |
$7,720.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,563.38
|
| Rate for Payer: Oxford Commercial |
$7,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,803.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,580.00
|
|
|
CORPECTOMY CAGE 12X14X28MM 6D
|
Facility
|
IP
|
$39,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270695757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,996.25 |
| Max. Negotiated Rate |
$9,673.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,673.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,996.25
|
|
|
CORPECTOMY CAGE 12X14X28MM 6D
|
Facility
|
OP
|
$39,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270695757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,996.25 |
| Max. Negotiated Rate |
$19,987.50 |
| Rate for Payer: Aetna Commercial |
$11,992.50
|
| Rate for Payer: Aetna Medicare Advantage |
$11,992.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,193.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,193.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,193.62
|
| Rate for Payer: Cigna Commercial |
$19,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,673.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,996.25
|
|
|
CORPECTOMY MATRIXX 15X23MM 12D
|
Facility
|
IP
|
$39,975.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,996.25 |
| Max. Negotiated Rate |
$9,673.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,673.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,996.25
|
|
|
CORPECTOMY MATRIXX 15X23MM 12D
|
Facility
|
OP
|
$39,975.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,996.25 |
| Max. Negotiated Rate |
$19,987.50 |
| Rate for Payer: Aetna Commercial |
$11,992.50
|
| Rate for Payer: Aetna Medicare Advantage |
$11,992.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,193.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,193.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,193.62
|
| Rate for Payer: Cigna Commercial |
$19,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,673.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,996.25
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$12,289.64
|
|
|
Service Code
|
HCPCS 28295
|
| Hospital Charge Code |
16000482
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,843.45 |
| Max. Negotiated Rate |
$1,843.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,843.45
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$12,289.64
|
|
|
Service Code
|
HCPCS 28295
|
| Hospital Charge Code |
16000482
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,597.65 |
| Max. Negotiated Rate |
$7,791.93 |
| Rate for Payer: Aetna Commercial |
$3,686.89
|
| Rate for Payer: Aetna Medicare Advantage |
$3,686.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,133.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,133.86
|
| 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 |
$3,133.86
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,597.65
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,843.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
CORRECTION OF BUNION-LT
|
Facility
|
IP
|
$46,489.60
|
|
|
Service Code
|
HCPCS 28298
|
| Hospital Charge Code |
16000365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,973.44 |
| Max. Negotiated Rate |
$6,973.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,973.44
|
|
|
CORRECTION OF BUNION-LT
|
Facility
|
OP
|
$46,489.60
|
|
|
Service Code
|
HCPCS 28298
|
| Hospital Charge Code |
16000365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$17,279.91 |
| Rate for Payer: Aetna Commercial |
$13,946.88
|
| Rate for Payer: Aetna Medicare Advantage |
$13,946.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,854.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,854.85
|
| 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 |
$11,854.85
|
| Rate for Payer: Cigna Commercial |
$17,279.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,043.65
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,973.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
CORRECTION OF BUNION RT
|
Facility
|
OP
|
$46,489.60
|
|
|
Service Code
|
HCPCS 28297
|
| Hospital Charge Code |
16000244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$30,573.98 |
| Rate for Payer: Aetna Commercial |
$13,946.88
|
| Rate for Payer: Aetna Medicare Advantage |
$13,946.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,854.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,854.85
|
| 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 |
$11,854.85
|
| Rate for Payer: Cigna Commercial |
$30,573.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,043.65
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,973.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
CORRECTION OF BUNION RT
|
Facility
|
IP
|
$46,489.60
|
|
|
Service Code
|
HCPCS 28297
|
| Hospital Charge Code |
16000244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,973.44 |
| Max. Negotiated Rate |
$6,973.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,973.44
|
|
|
CORSET LUMBAR
|
Facility
|
IP
|
$224.95
|
|
| Hospital Charge Code |
270647303
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.74
|
|
|
CORSET LUMBAR
|
Facility
|
OP
|
$224.95
|
|
| Hospital Charge Code |
270647303
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$112.47 |
| Rate for Payer: Aetna Commercial |
$67.48
|
| Rate for Payer: Aetna Medicare Advantage |
$67.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.36
|
| Rate for Payer: Cigna Commercial |
$112.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.24
|
| Rate for Payer: Oxford Commercial |
$112.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.47
|
|
|
CORSET LUMBAR CUSTOM
|
Facility
|
IP
|
$550.45
|
|
| Hospital Charge Code |
270612782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.57 |
| Max. Negotiated Rate |
$133.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.57
|
|
|
CORSET LUMBAR CUSTOM
|
Facility
|
OP
|
$550.45
|
|
| Hospital Charge Code |
270612782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.57 |
| Max. Negotiated Rate |
$275.23 |
| Rate for Payer: Aetna Commercial |
$165.13
|
| Rate for Payer: Aetna Medicare Advantage |
$165.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.36
|
| Rate for Payer: Cigna Commercial |
$275.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.57
|
|
|
CORSET STEEL
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
270645189
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$147.00
|
| Rate for Payer: Aetna Medicare Advantage |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.95
|
| Rate for Payer: Cigna Commercial |
$245.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.70
|
| Rate for Payer: Oxford Commercial |
$245.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$245.00
|
|
|
CORSET STEEL
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
270645189
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
|
|
CORSET XL 4S
|
Facility
|
IP
|
$199.95
|
|
| Hospital Charge Code |
270648112
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$29.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.99
|
|
|
CORSET XL 4S
|
Facility
|
OP
|
$199.95
|
|
| Hospital Charge Code |
270648112
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$99.97 |
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Aetna Medicare Advantage |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.99
|
| Rate for Payer: Cigna Commercial |
$99.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.99
|
| Rate for Payer: Oxford Commercial |
$99.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$99.97
|
|
|
CORT ALLOGRAFT 2 PK FC-0100-2
|
Facility
|
IP
|
$19,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,962.50 |
| Max. Negotiated Rate |
$4,779.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,779.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,962.50
|
|
|
CORT ALLOGRAFT 2 PK FC-0100-2
|
Facility
|
OP
|
$19,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,962.50 |
| Max. Negotiated Rate |
$9,875.00 |
| Rate for Payer: Aetna Commercial |
$5,925.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,036.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,036.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,036.25
|
| Rate for Payer: Cigna Commercial |
$9,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,779.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,962.50
|
|
|
CORT ALLOGRAFT EA FC-0100-1
|
Facility
|
OP
|
$9,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.25 |
| Max. Negotiated Rate |
$4,937.50 |
| Rate for Payer: Aetna Commercial |
$2,962.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,962.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,518.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,518.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,518.12
|
| Rate for Payer: Cigna Commercial |
$4,937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,389.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,481.25
|
|
|
CORT ALLOGRAFT EA FC-0100-1
|
Facility
|
IP
|
$9,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.25 |
| Max. Negotiated Rate |
$2,389.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,389.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,481.25
|
|
|
CORTEX SCREW 2.4X18MM
|
Facility
|
OP
|
$568.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.26 |
| Max. Negotiated Rate |
$284.20 |
| Rate for Payer: Aetna Commercial |
$170.52
|
| Rate for Payer: Aetna Medicare Advantage |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$144.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$144.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$144.94
|
| Rate for Payer: Cigna Commercial |
$284.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.26
|
|
|
CORTEX SCREW 2.4X18MM
|
Facility
|
IP
|
$568.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.26 |
| Max. Negotiated Rate |
$137.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$113.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.26
|
|