|
FEMUR 1 VIEW BILAT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 7355150
|
| Hospital Charge Code |
94270264
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$107.47
|
| Rate for Payer: Aetna Medicare Advantage |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.35
|
| Rate for Payer: Cigna Commercial |
$179.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.57
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 1 VIEW BILAT
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 7355150
|
| Hospital Charge Code |
2011595
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
FEMUR 1 VIEW BILAT
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 7355150
|
| Hospital Charge Code |
2011595
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,530.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$663.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 1 VIEW BILAT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 7355150
|
| Hospital Charge Code |
94061483
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$107.47
|
| Rate for Payer: Aetna Medicare Advantage |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.35
|
| Rate for Payer: Cigna Commercial |
$179.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.57
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 1 VIEW LT
|
Facility
|
IP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551LT
|
| Hospital Charge Code |
94061492
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
|
|
FEMUR 1 VIEW LT
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 73551RT
|
| Hospital Charge Code |
2011553
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
FEMUR 1 VIEW LT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551LT
|
| Hospital Charge Code |
94270272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$107.47
|
| Rate for Payer: Aetna Medicare Advantage |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.35
|
| Rate for Payer: Cigna Commercial |
$179.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.57
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 1 VIEW LT
|
Facility
|
IP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551LT
|
| Hospital Charge Code |
94270272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
|
|
FEMUR 1 VIEW LT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551LT
|
| Hospital Charge Code |
75190645
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$107.47
|
| Rate for Payer: Aetna Medicare Advantage |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.35
|
| Rate for Payer: Cigna Commercial |
$179.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.57
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 1 VIEW LT
|
Facility
|
IP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551LT
|
| Hospital Charge Code |
75190645
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
|
|
FEMUR 1 VIEW LT
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 73551RT
|
| Hospital Charge Code |
2011553
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,530.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$663.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 1 VIEW LT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551LT
|
| Hospital Charge Code |
94061492
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$107.47
|
| Rate for Payer: Aetna Medicare Advantage |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.35
|
| Rate for Payer: Cigna Commercial |
$179.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.57
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 1 VIEW RT
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 73551RT
|
| Hospital Charge Code |
2011555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,530.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$663.00
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 1 VIEW RT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551RT
|
| Hospital Charge Code |
94270274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$107.47
|
| Rate for Payer: Aetna Medicare Advantage |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.35
|
| Rate for Payer: Cigna Commercial |
$179.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.57
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 1 VIEW RT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551RT
|
| Hospital Charge Code |
94061494
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$107.47
|
| Rate for Payer: Aetna Medicare Advantage |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.35
|
| Rate for Payer: Cigna Commercial |
$179.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.57
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 1 VIEW RT
|
Facility
|
IP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551RT
|
| Hospital Charge Code |
94270274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
|
|
FEMUR 1 VIEW RT
|
Facility
|
IP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551RT
|
| Hospital Charge Code |
94061494
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
|
|
FEMUR 1 VIEW RT
|
Facility
|
IP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551RT
|
| Hospital Charge Code |
75190647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
|
|
FEMUR 1 VIEW RT
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 73551RT
|
| Hospital Charge Code |
2011555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
FEMUR 1 VIEW RT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 73551RT
|
| Hospital Charge Code |
75190647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$107.47
|
| Rate for Payer: Aetna Medicare Advantage |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.35
|
| Rate for Payer: Cigna Commercial |
$179.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.57
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR 70R CR POROUS 183052
|
Facility
|
OP
|
$17,420.00
|
|
| Hospital Charge Code |
270639970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,613.00 |
| Max. Negotiated Rate |
$8,710.00 |
| Rate for Payer: Aetna Commercial |
$5,226.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,226.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,442.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,442.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,484.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,442.10
|
| Rate for Payer: Cigna Commercial |
$8,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,215.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,613.00
|
|
|
FEMUR 70R CR POROUS 183052
|
Facility
|
IP
|
$17,420.00
|
|
| Hospital Charge Code |
270639970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,613.00 |
| Max. Negotiated Rate |
$4,215.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,484.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,215.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,613.00
|
|
|
FEMUR ADVANCE PRIM POR LT SZ4
|
Facility
|
IP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697443
|
|
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
|
|
|
FEMUR ADVANCE PRIM POR LT SZ4
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697443
|
|
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
|
|
|
FEMUR ADVANCE PRI NONPOR LTSZ4
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697442
|
|
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
|
|