|
PLATE BMT TIBIAL 75MM 141214
|
Facility
|
OP
|
$4,028.85
|
|
| Hospital Charge Code |
270606913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.33 |
| Max. Negotiated Rate |
$2,014.42 |
| Rate for Payer: Aetna Commercial |
$1,208.65
|
| Rate for Payer: Aetna Medicare Advantage |
$1,208.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,027.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,027.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$805.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,027.36
|
| Rate for Payer: Cigna Commercial |
$2,014.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$974.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$604.33
|
|
|
PLATE BMT TIBIAL 75MM 141214
|
Facility
|
IP
|
$4,028.85
|
|
| Hospital Charge Code |
270606913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.33 |
| Max. Negotiated Rate |
$974.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$805.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$974.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$604.33
|
|
|
PLATE BMT TIBIAL 75MM 141224
|
Facility
|
OP
|
$7,890.00
|
|
| Hospital Charge Code |
270619032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.50 |
| Max. Negotiated Rate |
$3,945.00 |
| Rate for Payer: Aetna Commercial |
$2,367.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,367.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,011.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,011.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,578.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,011.95
|
| Rate for Payer: Cigna Commercial |
$3,945.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,909.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,183.50
|
|
|
PLATE BMT TIBIAL 75MM 141224
|
Facility
|
IP
|
$7,890.00
|
|
| Hospital Charge Code |
270619032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.50 |
| Max. Negotiated Rate |
$1,909.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,578.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,909.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,183.50
|
|
|
PLATE BMT TIBIAL 79MM 141225
|
Facility
|
IP
|
$7,826.95
|
|
| Hospital Charge Code |
270618618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$1,894.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,565.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,894.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,174.04
|
|
|
PLATE BMT TIBIAL 79MM 141225
|
Facility
|
OP
|
$7,826.95
|
|
| Hospital Charge Code |
270618618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$3,913.47 |
| Rate for Payer: Aetna Commercial |
$2,348.09
|
| Rate for Payer: Aetna Medicare Advantage |
$2,348.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,995.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,995.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,565.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,995.87
|
| Rate for Payer: Cigna Commercial |
$3,913.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,894.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,174.04
|
|
|
PLATE BMT TIBIAL 87MM 141217
|
Facility
|
IP
|
$3,871.25
|
|
| Hospital Charge Code |
270606323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.69 |
| Max. Negotiated Rate |
$936.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$774.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$936.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$580.69
|
|
|
PLATE BMT TIBIAL 87MM 141217
|
Facility
|
OP
|
$3,871.25
|
|
| Hospital Charge Code |
270606323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.69 |
| Max. Negotiated Rate |
$1,935.62 |
| Rate for Payer: Aetna Commercial |
$1,161.38
|
| Rate for Payer: Aetna Medicare Advantage |
$1,161.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$987.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$987.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$774.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$987.17
|
| Rate for Payer: Cigna Commercial |
$1,935.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$936.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$580.69
|
|
|
PLATE BMT VHS 12H 200112
|
Facility
|
IP
|
$3,113.65
|
|
| Hospital Charge Code |
270623040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.05 |
| Max. Negotiated Rate |
$753.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$622.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$753.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$467.05
|
|
|
PLATE BMT VHS 12H 200112
|
Facility
|
OP
|
$3,113.65
|
|
| Hospital Charge Code |
270623040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.05 |
| Max. Negotiated Rate |
$1,556.83 |
| Rate for Payer: Aetna Commercial |
$934.10
|
| Rate for Payer: Aetna Medicare Advantage |
$934.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$793.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$793.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$622.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$793.98
|
| Rate for Payer: Cigna Commercial |
$1,556.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$753.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$467.05
|
|
|
PLATE BMT VHS 4H 88MM 200104
|
Facility
|
IP
|
$2,323.25
|
|
| Hospital Charge Code |
270612178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.49 |
| Max. Negotiated Rate |
$562.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$464.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.49
|
|
|
PLATE BMT VHS 4H 88MM 200104
|
Facility
|
OP
|
$2,323.25
|
|
| Hospital Charge Code |
270612178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.49 |
| Max. Negotiated Rate |
$1,161.62 |
| Rate for Payer: Aetna Commercial |
$696.98
|
| Rate for Payer: Aetna Medicare Advantage |
$696.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$592.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$592.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$464.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$592.43
|
| Rate for Payer: Cigna Commercial |
$1,161.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.49
|
|
|
PLATE BMT VHS 4H 88MM 200304
|
Facility
|
OP
|
$2,323.25
|
|
| Hospital Charge Code |
270617475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.49 |
| Max. Negotiated Rate |
$1,161.62 |
| Rate for Payer: Aetna Commercial |
$696.98
|
| Rate for Payer: Aetna Medicare Advantage |
$696.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$592.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$592.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$464.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$592.43
|
| Rate for Payer: Cigna Commercial |
$1,161.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.49
|
|
|
PLATE BMT VHS 4H 88MM 200304
|
Facility
|
IP
|
$2,323.25
|
|
| Hospital Charge Code |
270617475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.49 |
| Max. Negotiated Rate |
$562.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$464.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.49
|
|
|
PLATE BMT VHS 6H 120MM 200106
|
Facility
|
IP
|
$2,323.25
|
|
| Hospital Charge Code |
270616950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.49 |
| Max. Negotiated Rate |
$562.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$464.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.49
|
|
|
PLATE BMT VHS 6H 120MM 200106
|
Facility
|
OP
|
$2,323.25
|
|
| Hospital Charge Code |
270616950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.49 |
| Max. Negotiated Rate |
$1,161.62 |
| Rate for Payer: Aetna Commercial |
$696.98
|
| Rate for Payer: Aetna Medicare Advantage |
$696.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$592.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$592.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$464.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$592.43
|
| Rate for Payer: Cigna Commercial |
$1,161.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$562.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$348.49
|
|
|
PLATE BOLSTER 7x1 TAWT7
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270647557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
PLATE BOLSTER 7x1 TAWT7
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270647557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
PLATE BOLSTER 9x1 TAWT9
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270647558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
PLATE BOLSTER 9x1 TAWT9
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270647558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
PLATE BROAD 14H 4.5x260MM
|
Facility
|
OP
|
$3,279.00
|
|
| Hospital Charge Code |
270675501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.85 |
| Max. Negotiated Rate |
$1,639.50 |
| Rate for Payer: Aetna Commercial |
$983.70
|
| Rate for Payer: Aetna Medicare Advantage |
$983.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$836.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$836.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$836.14
|
| Rate for Payer: Cigna Commercial |
$1,639.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$793.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$491.85
|
|
|
PLATE BROAD 14H 4.5x260MM
|
Facility
|
IP
|
$3,279.00
|
|
| Hospital Charge Code |
270675501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.85 |
| Max. Negotiated Rate |
$793.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$655.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$793.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$491.85
|
|
|
PLATE BROAD 4 HOLE ALTA
|
Facility
|
IP
|
$610.00
|
|
| Hospital Charge Code |
270335169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$147.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$122.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$147.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.50
|
|
|
PLATE BROAD 4 HOLE ALTA
|
Facility
|
OP
|
$610.00
|
|
| Hospital Charge Code |
270335169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna Commercial |
$183.00
|
| Rate for Payer: Aetna Medicare Advantage |
$183.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$122.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$155.55
|
| Rate for Payer: Cigna Commercial |
$305.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$147.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.50
|
|
|
PLATE BROAD 6 HOLE ALTA
|
Facility
|
IP
|
$713.00
|
|
| Hospital Charge Code |
270335170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$172.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$142.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$172.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$106.95
|
|