|
MINI C-ARM
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
270339107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.70
|
|
|
MINI FRAGMENT PLATES
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
270335004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$29.40
|
| Rate for Payer: Aetna Medicare Advantage |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.99
|
| Rate for Payer: Cigna Commercial |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.70
|
|
|
MINI FRAGMENT PLATES
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
270335004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$23.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.70
|
|
|
MINI FRAGMENT SCREWS
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
270335002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$41.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.50
|
|
|
MINI FRAGMENT SCREWS
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
270335002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare Advantage |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.35
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.50
|
|
|
MINIHIP HIP STEM SZ 5 STD NECK
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270706201
|
|
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
|
|
|
MINIHIP HIP STEM SZ 5 STD NECK
|
Facility
|
IP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270706201
|
|
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
|
|
|
MINI LARYGH ********
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
8001166
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.25
|
|
|
MINI LARYGH ********
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
8001166
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna Commercial |
$16.50
|
| Rate for Payer: Aetna Medicare Advantage |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.03
|
| Rate for Payer: Cigna Commercial |
$27.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.15
|
| Rate for Payer: Oxford Commercial |
$27.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.50
|
|
|
MINILOK ANCHORS
|
Facility
|
IP
|
$2,175.00
|
|
| Hospital Charge Code |
270657371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.25 |
| Max. Negotiated Rate |
$526.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$435.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$526.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$326.25
|
|
|
MINILOK ANCHORS
|
Facility
|
OP
|
$2,175.00
|
|
| Hospital Charge Code |
270657371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.25 |
| Max. Negotiated Rate |
$1,087.50 |
| Rate for Payer: Aetna Commercial |
$652.50
|
| Rate for Payer: Aetna Medicare Advantage |
$652.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$554.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$554.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$554.62
|
| Rate for Payer: Cigna Commercial |
$1,087.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$526.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$326.25
|
|
|
MINI MONOKA TUBE
|
Facility
|
OP
|
$183.00
|
|
| Hospital Charge Code |
270335549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Medicare Advantage |
$54.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.66
|
| Rate for Payer: Cigna Commercial |
$91.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.45
|
|
|
MINI MONOKA TUBE
|
Facility
|
IP
|
$183.00
|
|
| Hospital Charge Code |
270335549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$44.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.45
|
|
|
MINIPRESS/1MG/CAP
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60633435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
MINIPRESS/1MG/CAP
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60633435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
MINIPRESS/2MG/CAP
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
60633434
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
|
|
MINIPRESS/2MG/CAP
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
60633434
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.53
|
| Rate for Payer: Cigna Commercial |
$3.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.78
|
| Rate for Payer: Oxford Commercial |
$3.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.00
|
|
|
MINIPRESS/5MG/CAP
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
60634327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
|
|
MINIPRESS/5MG/CAP
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
60634327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.53
|
| Rate for Payer: Cigna Commercial |
$3.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.78
|
| Rate for Payer: Oxford Commercial |
$3.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.00
|
|
|
MINIPRESS/5MG/UD
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
60634645
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.27
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.65
|
| Rate for Payer: Oxford Commercial |
$2.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.50
|
|
|
MINIPRESS/5MG/UD
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
60634645
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
|
|
MINI STICK MAX 4FX10 CM STD NI
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
270652561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
MINI STICK MAX 4FX10 CM STD NI
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
270652561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$240.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.00
|
| Rate for Payer: Oxford Commercial |
$400.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$400.00
|
|
|
MINI STICK MAX 4FX10 CM STD NI
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
270652561N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
MINI STICK MAX 4FX10 CM STD NI
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
270652561N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$240.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.00
|
| Rate for Payer: Oxford Commercial |
$400.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$400.00
|
|