|
FEMUR LEFT 65mm 145172
|
Facility
|
IP
|
$13,312.70
|
|
| Hospital Charge Code |
270635345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.90 |
| Max. Negotiated Rate |
$3,221.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,662.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,221.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,996.90
|
|
|
FEMUR LEFT 65mm 145172
|
Facility
|
OP
|
$13,312.70
|
|
| Hospital Charge Code |
270635345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.90 |
| Max. Negotiated Rate |
$6,656.35 |
| Rate for Payer: Aetna Commercial |
$3,993.81
|
| Rate for Payer: Aetna Medicare Advantage |
$3,993.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,394.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,394.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,662.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,394.74
|
| Rate for Payer: Cigna Commercial |
$6,656.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,221.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,996.90
|
|
|
FEMUR LEFT 75mm 145174
|
Facility
|
OP
|
$13,420.00
|
|
| Hospital Charge Code |
270637545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,013.00 |
| Max. Negotiated Rate |
$6,710.00 |
| Rate for Payer: Aetna Commercial |
$4,026.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,026.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,422.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,422.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,684.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,422.10
|
| Rate for Payer: Cigna Commercial |
$6,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,247.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,013.00
|
|
|
FEMUR LEFT 75mm 145174
|
Facility
|
IP
|
$13,420.00
|
|
| Hospital Charge Code |
270637545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,013.00 |
| Max. Negotiated Rate |
$3,247.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,684.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,247.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,013.00
|
|
|
FEMUR LINER G7 VITE FREE 36MM
|
Facility
|
OP
|
$24,995.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270698165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.30 |
| Max. Negotiated Rate |
$12,497.67 |
| Rate for Payer: Aetna Commercial |
$7,498.60
|
| Rate for Payer: Aetna Medicare Advantage |
$7,498.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,373.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,373.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,999.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,373.81
|
| Rate for Payer: Cigna Commercial |
$12,497.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,048.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,749.30
|
|
|
FEMUR LINER G7 VITE FREE 36MM
|
Facility
|
IP
|
$24,995.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270698165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.30 |
| Max. Negotiated Rate |
$6,048.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,999.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,048.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,749.30
|
|
|
FEMUR LPS NEXGEN KNEE
|
Facility
|
IP
|
$12,047.30
|
|
| Hospital Charge Code |
270639146
|
|
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
|
|
|
FEMUR LPS NEXGEN KNEE
|
Facility
|
OP
|
$12,047.30
|
|
| Hospital Charge Code |
270639146
|
|
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
|
|
|
FEMUR LPS RIGHT D
|
Facility
|
OP
|
$11,583.95
|
|
| Hospital Charge Code |
270637618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.59 |
| Max. Negotiated Rate |
$5,791.98 |
| Rate for Payer: Aetna Commercial |
$3,475.18
|
| Rate for Payer: Aetna Medicare Advantage |
$3,475.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,953.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,953.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,316.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,953.91
|
| Rate for Payer: Cigna Commercial |
$5,791.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,803.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,737.59
|
|
|
FEMUR LPS RIGHT D
|
Facility
|
IP
|
$11,583.95
|
|
| Hospital Charge Code |
270637618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.59 |
| Max. Negotiated Rate |
$2,803.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,316.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,803.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,737.59
|
|
|
FEMUR MIN 2 VIEWS BILAT
|
Facility
|
OP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 7355250
|
| Hospital Charge Code |
94061484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$858.15 |
| Max. Negotiated Rate |
$3,300.59 |
| Rate for Payer: Aetna Commercial |
$1,980.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,980.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,683.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,683.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,683.30
|
| Rate for Payer: Cigna Commercial |
$3,300.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$858.15
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR MIN 2 VIEWS BILAT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 7355250
|
| Hospital Charge Code |
94270263
|
|
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 MIN 2 VIEWS BILAT
|
Facility
|
OP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 7355250
|
| Hospital Charge Code |
2011594
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$858.15 |
| Max. Negotiated Rate |
$3,300.59 |
| Rate for Payer: Aetna Commercial |
$1,980.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,980.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,683.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,683.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,683.30
|
| Rate for Payer: Cigna Commercial |
$3,300.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$858.15
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR MIN 2 VIEWS BILAT
|
Facility
|
IP
|
$358.23
|
|
|
Service Code
|
HCPCS 7355250
|
| Hospital Charge Code |
75190638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
|
|
FEMUR MIN 2 VIEWS BILAT
|
Facility
|
IP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 7355250
|
| Hospital Charge Code |
94061484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$990.18 |
| Max. Negotiated Rate |
$990.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
|
|
FEMUR MIN 2 VIEWS BILAT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 7355250
|
| Hospital Charge Code |
75190638
|
|
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 MIN 2 VIEWS BILAT
|
Facility
|
IP
|
$358.23
|
|
|
Service Code
|
HCPCS 7355250
|
| Hospital Charge Code |
94270263
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
|
|
FEMUR MIN 2 VIEWS BILAT
|
Facility
|
IP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 7355250
|
| Hospital Charge Code |
2011594
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$990.18 |
| Max. Negotiated Rate |
$990.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
|
|
FEMUR MIN 2 VIEWS LT
|
Facility
|
IP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 73552LT
|
| Hospital Charge Code |
2011552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$990.18 |
| Max. Negotiated Rate |
$990.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
|
|
FEMUR MIN 2 VIEWS LT
|
Facility
|
IP
|
$358.23
|
|
|
Service Code
|
HCPCS 73552LT
|
| Hospital Charge Code |
94270271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.73
|
|
|
FEMUR MIN 2 VIEWS LT
|
Facility
|
IP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 73552LT
|
| Hospital Charge Code |
94061491
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$990.18 |
| Max. Negotiated Rate |
$990.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
|
|
FEMUR MIN 2 VIEWS LT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 73552LT
|
| Hospital Charge Code |
94270271
|
|
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 MIN 2 VIEWS LT
|
Facility
|
OP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 73552LT
|
| Hospital Charge Code |
2011552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$858.15 |
| Max. Negotiated Rate |
$3,300.59 |
| Rate for Payer: Aetna Commercial |
$1,980.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,980.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,683.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,683.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,683.30
|
| Rate for Payer: Cigna Commercial |
$3,300.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$858.15
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
FEMUR MIN 2 VIEWS LT
|
Facility
|
OP
|
$358.23
|
|
|
Service Code
|
HCPCS 73552LT
|
| Hospital Charge Code |
75190644
|
|
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 MIN 2 VIEWS LT
|
Facility
|
OP
|
$6,601.19
|
|
|
Service Code
|
HCPCS 73552LT
|
| Hospital Charge Code |
94061491
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$858.15 |
| Max. Negotiated Rate |
$3,300.59 |
| Rate for Payer: Aetna Commercial |
$1,980.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,980.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,683.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,683.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,683.30
|
| Rate for Payer: Cigna Commercial |
$3,300.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$858.15
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$990.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|