|
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
|
|
|
NEXGEN STRAIGHT STEM 100X14
|
Facility
|
OP
|
$5,245.00
|
|
| Hospital Charge Code |
270665819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.75 |
| Max. Negotiated Rate |
$2,622.50 |
| Rate for Payer: Aetna Commercial |
$1,573.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,573.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,337.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,337.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,049.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,337.47
|
| Rate for Payer: Cigna Commercial |
$2,622.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,269.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.75
|
|
|
NEXGEN STRAIGHT STEM 100X14
|
Facility
|
IP
|
$5,245.00
|
|
| Hospital Charge Code |
270665819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.75 |
| Max. Negotiated Rate |
$1,269.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,049.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,269.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.75
|
|
|
NEXGEN STRAIGHT STEM 12 X14
|
Facility
|
OP
|
$5,245.00
|
|
| Hospital Charge Code |
270665818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.75 |
| Max. Negotiated Rate |
$2,622.50 |
| Rate for Payer: Aetna Commercial |
$1,573.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,573.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,337.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,337.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,049.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,337.47
|
| Rate for Payer: Cigna Commercial |
$2,622.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,269.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.75
|
|
|
NEXGEN STRAIGHT STEM 12 X14
|
Facility
|
IP
|
$5,245.00
|
|
| Hospital Charge Code |
270665818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.75 |
| Max. Negotiated Rate |
$1,269.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,049.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,269.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.75
|
|
|
NEXGEN TAPER PLUG
|
Facility
|
IP
|
$2,780.85
|
|
| Hospital Charge Code |
270657047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.13 |
| Max. Negotiated Rate |
$672.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$556.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$672.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$417.13
|
|
|
NEXGEN TAPER PLUG
|
Facility
|
IP
|
$2,780.85
|
|
| Hospital Charge Code |
270657849
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$417.13 |
| Max. Negotiated Rate |
$417.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$417.13
|
|
|
NEXGEN TAPER PLUG
|
Facility
|
OP
|
$2,780.85
|
|
| Hospital Charge Code |
270657047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.13 |
| Max. Negotiated Rate |
$1,390.42 |
| Rate for Payer: Aetna Commercial |
$834.25
|
| Rate for Payer: Aetna Medicare Advantage |
$834.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$709.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$709.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$556.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$709.12
|
| Rate for Payer: Cigna Commercial |
$1,390.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$672.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$417.13
|
|
|
NEXGEN TAPER PLUG
|
Facility
|
OP
|
$2,780.85
|
|
| Hospital Charge Code |
270657849
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$361.51 |
| Max. Negotiated Rate |
$1,390.42 |
| Rate for Payer: Aetna Commercial |
$834.25
|
| Rate for Payer: Aetna Medicare Advantage |
$834.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$709.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$709.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$709.12
|
| Rate for Payer: Cigna Commercial |
$1,390.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.51
|
| Rate for Payer: Oxford Commercial |
$1,390.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$417.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,390.42
|
|
|
NEXGEN TAPER PLUG
|
Facility
|
OP
|
$556.17
|
|
| Hospital Charge Code |
270665467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$166.85
|
| Rate for Payer: Aetna Medicare Advantage |
$166.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$141.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$141.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$141.82
|
| Rate for Payer: Cigna Commercial |
$278.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.43
|
|
|
NEXGEN TAPER PLUG
|
Facility
|
IP
|
$556.17
|
|
| Hospital Charge Code |
270665467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$134.59 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.43
|
|
|
NEXGEN TRAB MET LPS MONO 10MM
|
Facility
|
IP
|
$12,048.30
|
|
| Hospital Charge Code |
270662345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.24 |
| Max. Negotiated Rate |
$2,915.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,409.66
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,915.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,807.24
|
|
|
NEXGEN TRAB MET LPS MONO 10MM
|
Facility
|
OP
|
$12,048.30
|
|
| Hospital Charge Code |
270662345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.24 |
| Max. Negotiated Rate |
$6,024.15 |
| Rate for Payer: Aetna Commercial |
$3,614.49
|
| Rate for Payer: Aetna Medicare Advantage |
$3,614.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,072.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,072.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,409.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,072.32
|
| Rate for Payer: Cigna Commercial |
$6,024.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,915.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,807.24
|
|
|
NEXG.LEG.KNEE SIZEC,D 23MM 1,2
|
Facility
|
IP
|
$5,862.60
|
|
| Hospital Charge Code |
270657041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.39 |
| Max. Negotiated Rate |
$1,418.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.39
|
|
|
NEXG.LEG.KNEE SIZEC,D 23MM 1,2
|
Facility
|
OP
|
$5,862.60
|
|
| Hospital Charge Code |
270657041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.39 |
| Max. Negotiated Rate |
$2,931.30 |
| Rate for Payer: Aetna Commercial |
$1,758.78
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.96
|
| Rate for Payer: Cigna Commercial |
$2,931.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.39
|
|
|
NEXIUM 20MG INJ
|
Facility
|
OP
|
$172.50
|
|
| Hospital Charge Code |
60629847
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Aetna Commercial |
$51.75
|
| Rate for Payer: Aetna Medicare Advantage |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.99
|
| Rate for Payer: Cigna Commercial |
$86.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.43
|
| Rate for Payer: Oxford Commercial |
$86.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.25
|
|
|
NEXIUM 20MG INJ
|
Facility
|
IP
|
$172.50
|
|
| Hospital Charge Code |
60629847
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$25.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.88
|
|
|
NEXIUM 40MG INJ
|
Facility
|
OP
|
$182.95
|
|
| Hospital Charge Code |
60629848
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$91.47 |
| Rate for Payer: Aetna Commercial |
$54.88
|
| Rate for Payer: Aetna Medicare Advantage |
$54.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.65
|
| Rate for Payer: Cigna Commercial |
$91.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.78
|
| Rate for Payer: Oxford Commercial |
$91.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$91.47
|
|
|
NEXIUM 40MG INJ
|
Facility
|
IP
|
$182.95
|
|
| Hospital Charge Code |
60629848
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$27.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.44
|
|
|
NEXIUM 40 MG IV
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
60635539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.69
|
| Rate for Payer: Oxford Commercial |
$6.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
|
|
NEXIUM 40 MG IV
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
60635539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
NEX SIZE E,F 17MM 3,4 POLY INS
|
Facility
|
OP
|
$5,862.10
|
|
| Hospital Charge Code |
270657040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.32 |
| 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) NJ Health |
$1,172.42
|
| 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 |
$1,418.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEX SIZE E,F 17MM 3,4 POLY INS
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270657040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$1,418.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEXUSSHORTTIPANDTUBING 1.9MM
|
Facility
|
IP
|
$3,262.71
|
|
| Hospital Charge Code |
270692353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.41 |
| Max. Negotiated Rate |
$489.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.41
|
|
|
NEXUSSHORTTIPANDTUBING 1.9MM
|
Facility
|
OP
|
$3,262.71
|
|
| Hospital Charge Code |
270692353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.15 |
| Max. Negotiated Rate |
$1,631.36 |
| Rate for Payer: Aetna Commercial |
$978.81
|
| Rate for Payer: Aetna Medicare Advantage |
$978.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$831.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$831.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$831.99
|
| Rate for Payer: Cigna Commercial |
$1,631.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$424.15
|
| Rate for Payer: Oxford Commercial |
$1,631.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,631.36
|
|