|
1STDAYHOSP CARE LOW SEV
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
83246195
|
|
Hospital Revenue Code
|
919
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$80.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
1STDAYHOSP CARE LOW SEV
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
83246195
|
|
Hospital Revenue Code
|
919
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
1STDAYHOSP CARE MED SEV
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
83246200
|
|
Hospital Revenue Code
|
919
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$126.48 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$126.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
1STDAYHOSP CARE MED SEV
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
83246200
|
|
Hospital Revenue Code
|
919
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
1 STRATAFIX 1
|
Facility
|
IP
|
$141.70
|
|
| Hospital Charge Code |
270686133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.25
|
|
|
1 STRATAFIX 1
|
Facility
|
OP
|
$141.70
|
|
| Hospital Charge Code |
270686133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.42 |
| Max. Negotiated Rate |
$70.85 |
| Rate for Payer: Aetna Commercial |
$42.51
|
| Rate for Payer: Aetna Medicare Advantage |
$42.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.13
|
| Rate for Payer: Cigna Commercial |
$70.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.42
|
| Rate for Payer: Oxford Commercial |
$70.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.85
|
|
|
1' SUTR BTH RPTR ANKLE CRL LIG
|
Facility
|
IP
|
$30,651.00
|
|
|
Service Code
|
HCPCS 27696
|
| Hospital Charge Code |
16000626
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,597.65 |
| Max. Negotiated Rate |
$4,597.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,597.65
|
|
|
1' SUTR BTH RPTR ANKLE CRL LIG
|
Facility
|
OP
|
$30,651.00
|
|
|
Service Code
|
HCPCS 27696
|
| Hospital Charge Code |
16000626
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$17,279.91 |
| Rate for Payer: Aetna Better Health Medicaid |
$15,569.19
|
| Rate for Payer: Aetna Commercial |
$9,195.30
|
| Rate for Payer: Aetna Medicare Advantage |
$9,195.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,816.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,816.01
|
| 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 |
$7,816.01
|
| Rate for Payer: Cigna Commercial |
$17,279.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,984.63
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,597.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$15,880.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15,569.19
|
|
|
200MM CARBON ROD
|
Facility
|
OP
|
$775.00
|
|
| Hospital Charge Code |
270339507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$232.50
|
| Rate for Payer: Aetna Medicare Advantage |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.62
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
200MM CARBON ROD
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270339507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
200MM RODS
|
Facility
|
IP
|
$5,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$793.05 |
| Max. Negotiated Rate |
$1,279.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,057.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,279.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$793.05
|
|
|
200MM RODS
|
Facility
|
OP
|
$5,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$793.05 |
| Max. Negotiated Rate |
$2,643.50 |
| Rate for Payer: Aetna Commercial |
$1,586.10
|
| Rate for Payer: Aetna Medicare Advantage |
$1,586.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,348.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,348.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,057.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,348.18
|
| Rate for Payer: Cigna Commercial |
$2,643.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,279.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$793.05
|
|
|
2019-COVID19 (LABCORP)
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS U0002
|
| Hospital Charge Code |
4013U0002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.05
|
|
|
2019-COVID19 (LABCORP)
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS U0002
|
| Hospital Charge Code |
4013U0002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$166.24
|
| Rate for Payer: Aetna Medicare Advantage |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$188.00
|
| Rate for Payer: Cigna Commercial |
$51.31
|
| Rate for Payer: Cigna Medicare Advantage |
$25.66
|
| Rate for Payer: Clover Medicare Advantage |
$48.74
|
| Rate for Payer: EmblemHealth Commercial |
$153.93
|
| Rate for Payer: Humana Medicare Advantage |
$52.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.31
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$51.31
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$54.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$51.31
|
|
|
-20. 22MM FEMORAL HEAD
|
Facility
|
IP
|
$2,721.90
|
|
| Hospital Charge Code |
270656853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.29 |
| Max. Negotiated Rate |
$658.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$544.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$658.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$408.29
|
|
|
-20. 22MM FEMORAL HEAD
|
Facility
|
OP
|
$2,721.90
|
|
| Hospital Charge Code |
270656853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.29 |
| Max. Negotiated Rate |
$1,360.95 |
| Rate for Payer: Aetna Commercial |
$816.57
|
| Rate for Payer: Aetna Medicare Advantage |
$816.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$694.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$694.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$544.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$694.08
|
| Rate for Payer: Cigna Commercial |
$1,360.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$658.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$408.29
|
|
|
20.427
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 7363050
|
| Hospital Charge Code |
94270109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$75.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.50
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
20.427
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 7363050
|
| Hospital Charge Code |
94270109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
2.0 ASNIS MICRO CANN SCREW 18/
|
Facility
|
OP
|
$1,421.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.27 |
| Max. Negotiated Rate |
$710.90 |
| Rate for Payer: Aetna Commercial |
$426.54
|
| Rate for Payer: Aetna Medicare Advantage |
$426.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$362.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$362.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$284.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$362.56
|
| Rate for Payer: Cigna Commercial |
$710.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.27
|
|
|
2.0 ASNIS MICRO CANN SCREW 18/
|
Facility
|
IP
|
$1,421.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.27 |
| Max. Negotiated Rate |
$344.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$284.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.27
|
|
|
2.0 ASNIS MICRO CANN SCREW 19/
|
Facility
|
IP
|
$1,421.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.27 |
| Max. Negotiated Rate |
$344.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$284.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.27
|
|
|
2.0 ASNIS MICRO CANN SCREW 19/
|
Facility
|
OP
|
$1,421.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.27 |
| Max. Negotiated Rate |
$710.90 |
| Rate for Payer: Aetna Commercial |
$426.54
|
| Rate for Payer: Aetna Medicare Advantage |
$426.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$362.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$362.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$284.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$362.56
|
| Rate for Payer: Cigna Commercial |
$710.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.27
|
|
|
2.0 ASNIS MICRO CANN SCREW 20/
|
Facility
|
IP
|
$1,421.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.27 |
| Max. Negotiated Rate |
$344.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$284.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.27
|
|
|
2.0 ASNIS MICRO CANN SCREW 20/
|
Facility
|
OP
|
$1,421.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.27 |
| Max. Negotiated Rate |
$710.90 |
| Rate for Payer: Aetna Commercial |
$426.54
|
| Rate for Payer: Aetna Medicare Advantage |
$426.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$362.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$362.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$284.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$362.56
|
| Rate for Payer: Cigna Commercial |
$710.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.27
|
|
|
20 CM RAIL
|
Facility
|
IP
|
$4,345.00
|
|
| Hospital Charge Code |
270656619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.75 |
| Max. Negotiated Rate |
$1,051.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$869.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,051.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$651.75
|
|