|
NEXGEN LPS FLEX FIXED 17MM
|
Facility
|
OP
|
$5,860.00
|
|
| Hospital Charge Code |
270667443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.00 |
| Max. Negotiated Rate |
$2,930.00 |
| Rate for Payer: Aetna Commercial |
$1,758.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.30
|
| Rate for Payer: Cigna Commercial |
$2,930.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.00
|
|
|
NEXGEN LPS FLEX FIXED 17MM
|
Facility
|
IP
|
$5,860.00
|
|
| Hospital Charge Code |
270667443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.00 |
| Max. Negotiated Rate |
$1,418.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.00
|
|
|
NEXGEN LPS-FLEX FIXED CD 17
|
Facility
|
OP
|
$5,860.00
|
|
| Hospital Charge Code |
270667170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.00 |
| Max. Negotiated Rate |
$2,930.00 |
| Rate for Payer: Aetna Commercial |
$1,758.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.30
|
| Rate for Payer: Cigna Commercial |
$2,930.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.00
|
|
|
NEXGEN LPS-FLEX FIXED CD 17
|
Facility
|
IP
|
$5,860.00
|
|
| Hospital Charge Code |
270667170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.00 |
| Max. Negotiated Rate |
$1,418.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.00
|
|
|
NEXGEN LPS FLEX FIXED PROLONG
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270664940
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$879.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEXGEN LPS FLEX FIXED PROLONG
|
Facility
|
OP
|
$5,862.10
|
|
| Hospital Charge Code |
270664940
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$762.07 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Aetna Commercial |
$1,758.63
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.84
|
| Rate for Payer: Cigna Commercial |
$2,931.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$762.07
|
| Rate for Payer: Oxford Commercial |
$2,931.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,931.05
|
|
|
NEXGEN LPS FLEX FIXED PROLONG
|
Facility
|
OP
|
$5,862.10
|
|
| Hospital Charge Code |
270663735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$762.07 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Aetna Commercial |
$1,758.63
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.84
|
| Rate for Payer: Cigna Commercial |
$2,931.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$762.07
|
| Rate for Payer: Oxford Commercial |
$2,931.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,931.05
|
|
|
NEXGEN LPS FLEX FIXED PROLONG
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270663735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$879.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEXGEN LPS-FLEX FIXED PROLONG
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270665484
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$879.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEXGEN LPS-FLEX FIXED PROLONG
|
Facility
|
OP
|
$5,862.10
|
|
| Hospital Charge Code |
270665483
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$762.07 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Aetna Commercial |
$1,758.63
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.84
|
| Rate for Payer: Cigna Commercial |
$2,931.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$762.07
|
| Rate for Payer: Oxford Commercial |
$2,931.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,931.05
|
|
|
NEXGEN LPS-FLEX FIXED PROLONG
|
Facility
|
OP
|
$5,862.10
|
|
| Hospital Charge Code |
270665484
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$762.07 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Aetna Commercial |
$1,758.63
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.84
|
| Rate for Payer: Cigna Commercial |
$2,931.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$762.07
|
| Rate for Payer: Oxford Commercial |
$2,931.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,931.05
|
|
|
NEXGEN LPS-FLEX FIXED PROLONG
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270665483
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$879.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEXGEN LPS -FLEX FIX POLONG
|
Facility
|
IP
|
$17,040.00
|
|
| Hospital Charge Code |
270660824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,556.00 |
| Max. Negotiated Rate |
$4,123.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,408.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,123.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,556.00
|
|
|
NEXGEN LPS -FLEX FIX POLONG
|
Facility
|
OP
|
$17,040.00
|
|
| Hospital Charge Code |
270660824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,556.00 |
| Max. Negotiated Rate |
$8,520.00 |
| Rate for Payer: Aetna Commercial |
$5,112.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,112.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,345.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,345.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,345.20
|
| Rate for Payer: Cigna Commercial |
$8,520.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,123.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,556.00
|
|
|
NEXGEN LPS-FLEX OPTION FEMO
|
Facility
|
OP
|
$11,725.00
|
|
| Hospital Charge Code |
270667444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,758.75 |
| Max. Negotiated Rate |
$5,862.50 |
| Rate for Payer: Aetna Commercial |
$3,517.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,517.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,989.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,989.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,989.88
|
| Rate for Payer: Cigna Commercial |
$5,862.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,837.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,758.75
|
|
|
NEXGEN LPS-FLEX OPTION FEMO
|
Facility
|
IP
|
$11,725.00
|
|
| Hospital Charge Code |
270667444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,758.75 |
| Max. Negotiated Rate |
$2,837.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,345.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,837.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,758.75
|
|
|
NEXGEN LPS FLX FIXED PROLONG
|
Facility
|
IP
|
$2,297.75
|
|
| Hospital Charge Code |
270657851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.66 |
| Max. Negotiated Rate |
$556.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$459.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$344.66
|
|
|
NEXGEN LPS FLX FIXED PROLONG
|
Facility
|
OP
|
$2,297.75
|
|
| Hospital Charge Code |
270657851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.66 |
| Max. Negotiated Rate |
$1,148.88 |
| Rate for Payer: Aetna Commercial |
$689.33
|
| Rate for Payer: Aetna Medicare Advantage |
$689.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$585.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$585.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$459.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$585.93
|
| Rate for Payer: Cigna Commercial |
$1,148.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$344.66
|
|
|
NEXGEN PRECOAT STEMMED TIBIAL
|
Facility
|
IP
|
$8,520.00
|
|
| Hospital Charge Code |
270660655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.00 |
| Max. Negotiated Rate |
$2,061.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,704.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,061.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,278.00
|
|
|
NEXGEN PRECOAT STEMMED TIBIAL
|
Facility
|
IP
|
$6,156.70
|
|
| Hospital Charge Code |
270663736
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$923.50
|
|
|
NEXGEN PRECOAT STEMMED TIBIAL
|
Facility
|
IP
|
$6,156.70
|
|
| Hospital Charge Code |
270664941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$1,489.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,231.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,489.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$923.50
|
|
|
NEXGEN PRECOAT STEMMED TIBIAL
|
Facility
|
OP
|
$6,156.70
|
|
| Hospital Charge Code |
270664941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$3,078.35 |
| Rate for Payer: Aetna Commercial |
$1,847.01
|
| Rate for Payer: Aetna Medicare Advantage |
$1,847.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,569.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,569.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,231.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,569.96
|
| Rate for Payer: Cigna Commercial |
$3,078.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,489.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$923.50
|
|
|
NEXGEN PRECOAT STEMMED TIBIAL
|
Facility
|
OP
|
$6,156.70
|
|
| Hospital Charge Code |
270663736
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$800.37 |
| Max. Negotiated Rate |
$3,078.35 |
| Rate for Payer: Aetna Commercial |
$1,847.01
|
| Rate for Payer: Aetna Medicare Advantage |
$1,847.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,569.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,569.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,569.96
|
| Rate for Payer: Cigna Commercial |
$3,078.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$800.37
|
| Rate for Payer: Oxford Commercial |
$3,078.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$923.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,078.35
|
|
|
NEXGEN PRECOAT STEMMED TIBIAL
|
Facility
|
OP
|
$8,520.00
|
|
| Hospital Charge Code |
270660655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.00 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$2,556.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,556.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,172.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,172.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,704.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$4,260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,061.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,278.00
|
|
|
NEXGEN SPS - FLEX FIXED PROLON
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270665482
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$879.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|