|
FEM HEAD CER BIOLOX S TAP 28MM
|
Facility
|
IP
|
$9,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.50 |
| Max. Negotiated Rate |
$2,417.58 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,998.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,417.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,498.50
|
|
|
FEM NAIL RETRO 10.5MM X 300MM
|
Facility
|
OP
|
$7,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.00 |
| Max. Negotiated Rate |
$3,780.00 |
| Rate for Payer: Aetna Commercial |
$2,268.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,268.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,927.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,927.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,512.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,927.80
|
| Rate for Payer: Cigna Commercial |
$3,780.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,829.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,134.00
|
|
|
FEM NAIL RETRO 10.5MM X 300MM
|
Facility
|
IP
|
$7,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.00 |
| Max. Negotiated Rate |
$1,829.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,512.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,829.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,134.00
|
|
|
FEM NAIL RETRO 13.5MMX380MM
|
Facility
|
OP
|
$8,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.25 |
| Max. Negotiated Rate |
$4,087.50 |
| Rate for Payer: Aetna Commercial |
$2,452.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,452.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,084.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,084.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,635.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,084.62
|
| Rate for Payer: Cigna Commercial |
$4,087.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,978.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,226.25
|
|
|
FEM NAIL RETRO 13.5MMX380MM
|
Facility
|
IP
|
$8,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.25 |
| Max. Negotiated Rate |
$1,978.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,635.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,978.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,226.25
|
|
|
FEM NEXG KNEE LPS OPT 59961551
|
Facility
|
OP
|
$12,529.20
|
|
| Hospital Charge Code |
270642103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,879.38 |
| Max. Negotiated Rate |
$6,264.60 |
| Rate for Payer: Aetna Commercial |
$3,758.76
|
| Rate for Payer: Aetna Medicare Advantage |
$3,758.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,505.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,194.95
|
| Rate for Payer: Cigna Commercial |
$6,264.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,032.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,879.38
|
|
|
FEM NEXG KNEE LPS OPT 59961551
|
Facility
|
IP
|
$12,529.20
|
|
| Hospital Charge Code |
270642103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,879.38 |
| Max. Negotiated Rate |
$3,032.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,505.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,032.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,879.38
|
|
|
FEM NEX KNE CR SZ C LT59721301
|
Facility
|
OP
|
$13,667.00
|
|
| Hospital Charge Code |
270634980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,050.05 |
| Max. Negotiated Rate |
$6,833.50 |
| Rate for Payer: Aetna Commercial |
$4,100.10
|
| Rate for Payer: Aetna Medicare Advantage |
$4,100.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,485.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,485.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,733.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,485.09
|
| Rate for Payer: Cigna Commercial |
$6,833.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,307.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,050.05
|
|
|
FEM NEX KNE CR SZ C LT59721301
|
Facility
|
IP
|
$13,667.00
|
|
| Hospital Charge Code |
270634980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,050.05 |
| Max. Negotiated Rate |
$3,307.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,733.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,307.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,050.05
|
|
|
FEM NEX KNE CR SZ C RT59721302
|
Facility
|
OP
|
$13,667.00
|
|
| Hospital Charge Code |
270634981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,050.05 |
| Max. Negotiated Rate |
$6,833.50 |
| Rate for Payer: Aetna Commercial |
$4,100.10
|
| Rate for Payer: Aetna Medicare Advantage |
$4,100.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,485.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,485.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,733.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,485.09
|
| Rate for Payer: Cigna Commercial |
$6,833.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,307.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,050.05
|
|
|
FEM NEX KNE CR SZ C RT59721302
|
Facility
|
IP
|
$13,667.00
|
|
| Hospital Charge Code |
270634981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,050.05 |
| Max. Negotiated Rate |
$3,307.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,733.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,307.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,050.05
|
|
|
FEM NEX KNEE LPS OPT 59961552
|
Facility
|
OP
|
$12,047.30
|
|
| Hospital Charge Code |
270639170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.10 |
| Max. Negotiated Rate |
$6,023.65 |
| Rate for Payer: Aetna Commercial |
$3,614.19
|
| Rate for Payer: Aetna Medicare Advantage |
$3,614.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,072.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,072.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,409.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,072.06
|
| Rate for Payer: Cigna Commercial |
$6,023.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,915.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,807.10
|
|
|
FEM NEX KNEE LPS OPT 59961552
|
Facility
|
IP
|
$12,047.30
|
|
| Hospital Charge Code |
270639170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.10 |
| Max. Negotiated Rate |
$2,915.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,409.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,915.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,807.10
|
|
|
FEMORAL ANGIOGRAM
|
Facility
|
IP
|
$6,122.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
7411147
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$918.30 |
| Max. Negotiated Rate |
$918.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$918.30
|
|
|
FEMORAL ANGIOGRAM
|
Facility
|
OP
|
$6,122.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
7411147
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$141.37 |
| Max. Negotiated Rate |
$7,519.21 |
| Rate for Payer: Aetna Commercial |
$1,836.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,836.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,561.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,561.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$141.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,561.11
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$795.86
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$918.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMORAL ASYM POST STAB SZ 3 LF
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270670657
|
|
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
|
|
|
FEMORAL ASYM POST STAB SZ 3 LF
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270670657
|
|
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
|
|
|
FEMORAL ASYM POST STAB SZ5 LF
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270672125
|
|
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
|
|
|
FEMORAL ASYM POST STAB SZ5 LF
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270672125
|
|
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
|
|
|
FEMORAL ASYM POST SZ2 RIGHT
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270669782
|
|
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
|
|
|
FEMORAL ASYM POST SZ2 RIGHT
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270669782
|
|
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
|
|
|
FEMORAL ATTUNE POST STAB SZ 4
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270685505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$5,750.00 |
| Rate for Payer: Aetna Commercial |
$3,450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,932.50
|
| Rate for Payer: Cigna Commercial |
$5,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,783.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,725.00
|
|
|
FEMORAL ATTUNE POST STAB SZ 4
|
Facility
|
IP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270685505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,783.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,783.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,725.00
|
|
|
FEMORAL ATTUNE POST SZ3 RT
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270685554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$5,750.00 |
| Rate for Payer: Aetna Commercial |
$3,450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,932.50
|
| Rate for Payer: Cigna Commercial |
$5,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,783.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,725.00
|
|
|
FEMORAL ATTUNE POST SZ3 RT
|
Facility
|
IP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270685554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,783.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,783.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,725.00
|
|