|
HEDRON IA SPACER 26X34X15MM 15
|
Facility
|
IP
|
$30,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,500.00
|
|
|
HEEL 2 VIEWS-BILAT
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 7365050
|
| Hospital Charge Code |
94061255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
HEEL 2 VIEWS-BILAT
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 7365050
|
| Hospital Charge Code |
94061255
|
|
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
|
|
|
HEEL 2 VIEWS-LT
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 73650LT
|
| Hospital Charge Code |
94061405
|
|
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
|
|
|
HEEL 2 VIEWS-LT
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 73650LT
|
| Hospital Charge Code |
94061405
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
HEEL 2 VIEWS-RT
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 73650RT
|
| Hospital Charge Code |
94061407
|
|
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
|
|
|
HEEL 2 VIEWS-RT
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
HCPCS 73650RT
|
| Hospital Charge Code |
94061407
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$765.00
|
|
|
HEEL & ANKLE PROTECTORS PAIRS
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
270331532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.25
|
|
|
HEEL & ANKLE PROTECTORS PAIRS
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
270331532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$10.50
|
| Rate for Payer: Aetna Medicare Advantage |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.93
|
| Rate for Payer: Cigna Commercial |
$17.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.55
|
| Rate for Payer: Oxford Commercial |
$17.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.50
|
|
|
HEEL/ELBOW PROTECTORS UNI SIZE
|
Facility
|
IP
|
$6.42
|
|
| Hospital Charge Code |
270649752
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.96
|
|
|
HEEL/ELBOW PROTECTORS UNI SIZE
|
Facility
|
OP
|
$6.42
|
|
| Hospital Charge Code |
270649752
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$1.93
|
| Rate for Payer: Aetna Medicare Advantage |
$1.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.64
|
| Rate for Payer: Cigna Commercial |
$3.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.83
|
| Rate for Payer: Oxford Commercial |
$3.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.21
|
|
|
HEEL RELIEF SH
|
Facility
|
IP
|
$94.75
|
|
| Hospital Charge Code |
270629862
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$14.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.21
|
|
|
HEEL RELIEF SH
|
Facility
|
OP
|
$94.75
|
|
| Hospital Charge Code |
270629862
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$47.38 |
| Rate for Payer: Aetna Commercial |
$28.43
|
| Rate for Payer: Aetna Medicare Advantage |
$28.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.16
|
| Rate for Payer: Cigna Commercial |
$47.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.32
|
| Rate for Payer: Oxford Commercial |
$47.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$47.38
|
|
|
HEEL RUBBER
|
Facility
|
OP
|
$57.65
|
|
| Hospital Charge Code |
4000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$28.82 |
| Rate for Payer: Aetna Commercial |
$17.30
|
| Rate for Payer: Aetna Medicare Advantage |
$17.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.70
|
| Rate for Payer: Cigna Commercial |
$28.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.49
|
| Rate for Payer: Oxford Commercial |
$28.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.82
|
|
|
HEEL RUBBER
|
Facility
|
IP
|
$57.65
|
|
| Hospital Charge Code |
4000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$8.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.65
|
|
|
HEELSTICK/STATE TEST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
83091023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
HEELSTICK/STATE TEST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
83092033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEELSTICK/STATE TEST
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
83092033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
HEELSTICK/STATE TEST
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
83091023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
HEINZ BODIES;DIRECT
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 85441
|
| Hospital Charge Code |
38477025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$13.61
|
| Rate for Payer: Aetna Medicare Advantage |
$4.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.39
|
| Rate for Payer: Cigna Commercial |
$4.20
|
| Rate for Payer: Cigna Medicare Advantage |
$2.10
|
| Rate for Payer: Clover Medicare Advantage |
$3.99
|
| Rate for Payer: EmblemHealth Commercial |
$12.60
|
| Rate for Payer: Humana Medicare Advantage |
$4.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.20
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$4.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.20
|
|
|
HEINZ BODIES;DIRECT
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 85441
|
| Hospital Charge Code |
38477025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
|
|
HELICAL BLADE
|
Facility
|
OP
|
$3,290.85
|
|
| Hospital Charge Code |
270679032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.81 |
| Max. Negotiated Rate |
$1,645.42 |
| Rate for Payer: Aetna Commercial |
$987.25
|
| Rate for Payer: Aetna Medicare Advantage |
$987.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$839.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$839.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$839.17
|
| Rate for Payer: Cigna Commercial |
$1,645.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$427.81
|
| Rate for Payer: Oxford Commercial |
$1,645.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$493.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,645.42
|
|
|
HELICAL BLADE
|
Facility
|
IP
|
$3,290.85
|
|
| Hospital Charge Code |
270679032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.63 |
| Max. Negotiated Rate |
$493.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$493.63
|
|
|
HELICAL BLADE 11/X85
|
Facility
|
IP
|
$12,225.00
|
|
| Hospital Charge Code |
270681680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,833.75 |
| Max. Negotiated Rate |
$1,833.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,833.75
|
|
|
HELICAL BLADE 11/X85
|
Facility
|
OP
|
$12,225.00
|
|
| Hospital Charge Code |
270681680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,589.25 |
| Max. Negotiated Rate |
$6,112.50 |
| Rate for Payer: Aetna Commercial |
$3,667.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,667.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,117.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,117.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,117.38
|
| Rate for Payer: Cigna Commercial |
$6,112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,589.25
|
| Rate for Payer: Oxford Commercial |
$6,112.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,833.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,112.50
|
|