|
ENDCAP T25 STAR DRIVE
|
Facility
|
OP
|
$828.00
|
|
| Hospital Charge Code |
270662829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare Advantage |
$248.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$211.14
|
| Rate for Payer: Cigna Commercial |
$414.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.20
|
|
|
ENDCAP T25 STAR DRIVE
|
Facility
|
IP
|
$828.00
|
|
| Hospital Charge Code |
270662829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$200.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.20
|
|
|
END CAP T2 PROX, 6MM
|
Facility
|
IP
|
$1,460.00
|
|
| Hospital Charge Code |
270671183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$353.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$292.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$353.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$219.00
|
|
|
END CAP T2 PROX, 6MM
|
Facility
|
OP
|
$1,460.00
|
|
| Hospital Charge Code |
270671183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna Commercial |
$438.00
|
| Rate for Payer: Aetna Medicare Advantage |
$438.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$292.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$372.30
|
| Rate for Payer: Cigna Commercial |
$730.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$353.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$219.00
|
|
|
ENDCAP T40 STRDRV 0MM GRAY ST
|
Facility
|
OP
|
$905.35
|
|
| Hospital Charge Code |
270677570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$452.68 |
| Rate for Payer: Aetna Commercial |
$271.61
|
| Rate for Payer: Aetna Medicare Advantage |
$271.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$230.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$230.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$230.86
|
| Rate for Payer: Cigna Commercial |
$452.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.80
|
|
|
ENDCAP T40 STRDRV 0MM GRAY ST
|
Facility
|
IP
|
$905.35
|
|
| Hospital Charge Code |
270677570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$219.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.80
|
|
|
ENDCAP T40 STRDRV 0MM TIBIA ST
|
Facility
|
OP
|
$905.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$452.68 |
| Rate for Payer: Aetna Commercial |
$271.61
|
| Rate for Payer: Aetna Medicare Advantage |
$271.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$230.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$230.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$230.86
|
| Rate for Payer: Cigna Commercial |
$452.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.80
|
|
|
ENDCAP T40 STRDRV 0MM TIBIA ST
|
Facility
|
IP
|
$905.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$219.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.80
|
|
|
ENDCAP TI MULTILOC 0MM
|
Facility
|
OP
|
$911.55
|
|
| Hospital Charge Code |
270650156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$455.77 |
| Rate for Payer: Aetna Commercial |
$273.46
|
| Rate for Payer: Aetna Medicare Advantage |
$273.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$232.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$232.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$232.45
|
| Rate for Payer: Cigna Commercial |
$455.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.50
|
| Rate for Payer: Oxford Commercial |
$455.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$455.77
|
|
|
ENDCAP TI MULTILOC 0MM
|
Facility
|
IP
|
$911.55
|
|
| Hospital Charge Code |
270650156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.73 |
| Max. Negotiated Rate |
$136.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.73
|
|
|
END CAP TI T40
|
Facility
|
IP
|
$1,212.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.90 |
| Max. Negotiated Rate |
$293.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$242.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$293.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$181.90
|
|
|
END CAP TI T40
|
Facility
|
OP
|
$1,212.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.90 |
| Max. Negotiated Rate |
$606.33 |
| Rate for Payer: Aetna Commercial |
$363.80
|
| Rate for Payer: Aetna Medicare Advantage |
$363.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$309.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$309.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$242.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$309.23
|
| Rate for Payer: Cigna Commercial |
$606.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$293.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$181.90
|
|
|
END CAP TI T40 STARDRIVE
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.85 |
| Max. Negotiated Rate |
$439.50 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Aetna Medicare Advantage |
$263.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.15
|
| Rate for Payer: Cigna Commercial |
$439.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$212.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.85
|
|
|
END CAP TI T40 STARDRIVE
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.85 |
| Max. Negotiated Rate |
$212.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$212.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.85
|
|
|
END CAP TI W T25 SD FOR NAIL
|
Facility
|
IP
|
$1,106.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.92 |
| Max. Negotiated Rate |
$267.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$221.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$267.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.92
|
|
|
END CAP TI W T25 SD FOR NAIL
|
Facility
|
OP
|
$1,106.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.92 |
| Max. Negotiated Rate |
$553.08 |
| Rate for Payer: Aetna Commercial |
$331.85
|
| Rate for Payer: Aetna Medicare Advantage |
$331.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$282.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$282.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$221.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$282.07
|
| Rate for Payer: Cigna Commercial |
$553.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$267.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.92
|
|
|
END CAP VALOR
|
Facility
|
IP
|
$1,060.00
|
|
| Hospital Charge Code |
270677452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.00
|
|
|
END CAP VALOR
|
Facility
|
OP
|
$1,060.00
|
|
| Hospital Charge Code |
270677452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna Commercial |
$318.00
|
| Rate for Payer: Aetna Medicare Advantage |
$318.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$270.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$270.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$270.30
|
| Rate for Payer: Cigna Commercial |
$530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.80
|
| Rate for Payer: Oxford Commercial |
$530.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$530.00
|
|
|
ENDCAP ZIM FOR NAIL 2252-01
|
Facility
|
OP
|
$1,035.25
|
|
| Hospital Charge Code |
270619866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.29 |
| Max. Negotiated Rate |
$517.62 |
| Rate for Payer: Aetna Commercial |
$310.57
|
| Rate for Payer: Aetna Medicare Advantage |
$310.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$263.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$263.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$207.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$263.99
|
| Rate for Payer: Cigna Commercial |
$517.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$250.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.29
|
|
|
ENDCAP ZIM FOR NAIL 2252-01
|
Facility
|
IP
|
$1,035.25
|
|
| Hospital Charge Code |
270619866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.29 |
| Max. Negotiated Rate |
$250.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$207.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$250.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.29
|
|
|
ENDO 5 ML APPLIER
|
Facility
|
OP
|
$8,900.00
|
|
| Hospital Charge Code |
270665369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,157.00 |
| Max. Negotiated Rate |
$4,450.00 |
| Rate for Payer: Aetna Commercial |
$2,670.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,670.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,269.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,269.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,269.50
|
| Rate for Payer: Cigna Commercial |
$4,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,157.00
|
| Rate for Payer: Oxford Commercial |
$4,450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,335.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,450.00
|
|
|
ENDO 5 ML APPLIER
|
Facility
|
IP
|
$8,900.00
|
|
| Hospital Charge Code |
270665369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,335.00 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,335.00
|
|
|
ENDOBABCOCK 10mm
|
Facility
|
IP
|
$349.65
|
|
| Hospital Charge Code |
270655928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$52.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.45
|
|
|
ENDOBABCOCK 10mm
|
Facility
|
OP
|
$349.65
|
|
| Hospital Charge Code |
270655928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna Commercial |
$104.89
|
| Rate for Payer: Aetna Medicare Advantage |
$104.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.16
|
| Rate for Payer: Cigna Commercial |
$174.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.45
|
| Rate for Payer: Oxford Commercial |
$174.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$174.82
|
|
|
ENDO BABCOCK 10 MM ****
|
Facility
|
OP
|
$519.00
|
|
| Hospital Charge Code |
1603380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Medicare Advantage |
$155.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.34
|
| Rate for Payer: Cigna Commercial |
$259.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.47
|
| Rate for Payer: Oxford Commercial |
$259.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$259.50
|
|