|
ANCEF/500MG
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
60632465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Medicare Advantage |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.29
|
| Rate for Payer: Cigna Commercial |
$4.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.17
|
| Rate for Payer: Oxford Commercial |
$4.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.50
|
|
|
ANCEF 500MG/50ML
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
60635022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.88
|
| Rate for Payer: Cigna Commercial |
$13.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.51
|
| Rate for Payer: Oxford Commercial |
$13.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.50
|
|
|
ANCEF 500MG/50ML
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
60635022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.05
|
|
|
ANCHOR 2 MM ALL SUTRE
|
Facility
|
OP
|
$2,323.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.56 |
| Max. Negotiated Rate |
$1,161.88 |
| Rate for Payer: Aetna Commercial |
$697.12
|
| Rate for Payer: Aetna Medicare Advantage |
$697.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$592.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$592.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$464.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$592.56
|
| Rate for Payer: Cigna Commercial |
$1,161.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.56
|
|
|
ANCHOR 2 MM ALL SUTRE
|
Facility
|
IP
|
$2,323.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.56 |
| Max. Negotiated Rate |
$562.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$464.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.56
|
|
|
ANCHOR 4.5 MM KNOTLESS
|
Facility
|
OP
|
$1,928.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.31 |
| Max. Negotiated Rate |
$964.38 |
| Rate for Payer: Aetna Commercial |
$578.62
|
| Rate for Payer: Aetna Medicare Advantage |
$578.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$491.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$491.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$385.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$491.83
|
| Rate for Payer: Cigna Commercial |
$964.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$466.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.31
|
|
|
ANCHOR 4.5 MM KNOTLESS
|
Facility
|
IP
|
$1,928.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.31 |
| Max. Negotiated Rate |
$466.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$385.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$466.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.31
|
|
|
ANCHOR 4.5 MM KNOTLESS KIT
|
Facility
|
OP
|
$2,323.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.56 |
| Max. Negotiated Rate |
$1,161.88 |
| Rate for Payer: Aetna Commercial |
$697.12
|
| Rate for Payer: Aetna Medicare Advantage |
$697.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$592.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$592.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$464.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$592.56
|
| Rate for Payer: Cigna Commercial |
$1,161.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.56
|
|
|
ANCHOR 4.5 MM KNOTLESS KIT
|
Facility
|
IP
|
$2,323.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.56 |
| Max. Negotiated Rate |
$562.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$464.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.56
|
|
|
ANCHOR 5.5 HEALIX PEEK
|
Facility
|
OP
|
$2,220.00
|
|
| Hospital Charge Code |
270667452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.00 |
| Max. Negotiated Rate |
$1,110.00 |
| Rate for Payer: Aetna Commercial |
$666.00
|
| Rate for Payer: Aetna Medicare Advantage |
$666.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$566.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$566.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$444.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$566.10
|
| Rate for Payer: Cigna Commercial |
$1,110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$537.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$333.00
|
|
|
ANCHOR 5.5 HEALIX PEEK
|
Facility
|
IP
|
$2,220.00
|
|
| Hospital Charge Code |
270667452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.00 |
| Max. Negotiated Rate |
$537.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$444.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$537.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$333.00
|
|
|
ANCHOR 5.5 MM SWIVELOCK
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
ANCHOR 5.5 MM SWIVELOCK
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Aetna Commercial |
$562.50
|
| Rate for Payer: Aetna Medicare Advantage |
$562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$478.12
|
| Rate for Payer: Cigna Commercial |
$937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
ANCHOR 5.5 TIT W/NE 3910400055
|
Facility
|
OP
|
$1,365.00
|
|
| Hospital Charge Code |
270643475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare Advantage |
$409.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$348.07
|
| Rate for Payer: Cigna Commercial |
$682.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
ANCHOR 5.5 TIT W/NE 3910400055
|
Facility
|
IP
|
$1,365.00
|
|
| Hospital Charge Code |
270643475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$330.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
ANCHOR 6.5 W/ORTHOCORD
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$1,015.00 |
| Rate for Payer: Aetna Commercial |
$609.00
|
| Rate for Payer: Aetna Medicare Advantage |
$609.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$517.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$517.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$406.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$517.65
|
| Rate for Payer: Cigna Commercial |
$1,015.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$491.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$304.50
|
|
|
ANCHOR 6.5 W/ORTHOCORD
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$491.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$406.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$491.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$304.50
|
|
|
ANCHOR ADVANCE HEALIX
|
Facility
|
OP
|
$2,425.00
|
|
| Hospital Charge Code |
270659928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.75 |
| Max. Negotiated Rate |
$1,212.50 |
| Rate for Payer: Aetna Commercial |
$727.50
|
| Rate for Payer: Aetna Medicare Advantage |
$727.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$618.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$618.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$485.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$618.38
|
| Rate for Payer: Cigna Commercial |
$1,212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$586.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$363.75
|
|
|
ANCHOR ADVANCE HEALIX
|
Facility
|
IP
|
$2,425.00
|
|
| Hospital Charge Code |
270659928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.75 |
| Max. Negotiated Rate |
$586.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$485.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$586.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$363.75
|
|
|
ANCHOR AIR+MENISCAL SYST CRVD
|
Facility
|
OP
|
$2,446.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.94 |
| Max. Negotiated Rate |
$1,223.12 |
| Rate for Payer: Aetna Commercial |
$733.88
|
| Rate for Payer: Aetna Medicare Advantage |
$733.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$623.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$623.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$489.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$623.79
|
| Rate for Payer: Cigna Commercial |
$1,223.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$591.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$366.94
|
|
|
ANCHOR AIR+MENISCAL SYST CRVD
|
Facility
|
IP
|
$2,446.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.94 |
| Max. Negotiated Rate |
$591.99 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$489.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$591.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$366.94
|
|
|
ANCHOR ALPHAVENT 4.75 MM BIOCO
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270701806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
ANCHOR ALPHAVENT 4.75 MM BIOCO
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270701806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
ANCHOR ALPHAVENT 4.75 MM PEEK
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$975.00
|
| Rate for Payer: Aetna Medicare Advantage |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$828.75
|
| Rate for Payer: Cigna Commercial |
$1,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
|
|
ANCHOR ALPHAVENT 4.75 MM PEEK
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$786.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
|