|
PLATE RECON 3.5MM 10H
|
Facility
|
IP
|
$2,003.25
|
|
| Hospital Charge Code |
270604374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.49 |
| Max. Negotiated Rate |
$484.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.49
|
|
|
PLATE RECON 3.5MM 11H
|
Facility
|
IP
|
$1,579.25
|
|
| Hospital Charge Code |
270604375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.89 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$382.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$236.89
|
|
|
PLATE RECON 3.5MM 11H
|
Facility
|
OP
|
$1,579.25
|
|
| Hospital Charge Code |
270604375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.89 |
| Max. Negotiated Rate |
$789.62 |
| Rate for Payer: Aetna Commercial |
$473.77
|
| Rate for Payer: Aetna Medicare Advantage |
$473.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$402.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$402.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$402.71
|
| Rate for Payer: Cigna Commercial |
$789.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$382.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$236.89
|
|
|
PLATE RECON 3.5MM 12H
|
Facility
|
IP
|
$1,732.85
|
|
| Hospital Charge Code |
270604376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.93 |
| Max. Negotiated Rate |
$419.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$346.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$419.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$259.93
|
|
|
PLATE RECON 3.5MM 12H
|
Facility
|
OP
|
$1,732.85
|
|
| Hospital Charge Code |
270604376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.93 |
| Max. Negotiated Rate |
$866.42 |
| Rate for Payer: Aetna Commercial |
$519.86
|
| Rate for Payer: Aetna Medicare Advantage |
$519.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$441.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$441.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$346.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$441.88
|
| Rate for Payer: Cigna Commercial |
$866.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$419.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$259.93
|
|
|
PLATE RECON 3.5MM 13H
|
Facility
|
OP
|
$2,309.65
|
|
| Hospital Charge Code |
270604377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.45 |
| Max. Negotiated Rate |
$1,154.83 |
| Rate for Payer: Aetna Commercial |
$692.89
|
| Rate for Payer: Aetna Medicare Advantage |
$692.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$588.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$588.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$461.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$588.96
|
| Rate for Payer: Cigna Commercial |
$1,154.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$558.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$346.45
|
|
|
PLATE RECON 3.5MM 13H
|
Facility
|
IP
|
$2,309.65
|
|
| Hospital Charge Code |
270604377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.45 |
| Max. Negotiated Rate |
$558.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$461.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$558.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$346.45
|
|
|
PLATE RECON 3.5MM 14H
|
Facility
|
OP
|
$1,810.45
|
|
| Hospital Charge Code |
270604378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.57 |
| Max. Negotiated Rate |
$905.23 |
| Rate for Payer: Aetna Commercial |
$543.13
|
| Rate for Payer: Aetna Medicare Advantage |
$543.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$461.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$461.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$362.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$461.66
|
| Rate for Payer: Cigna Commercial |
$905.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$438.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$271.57
|
|
|
PLATE RECON 3.5MM 14H
|
Facility
|
IP
|
$1,810.45
|
|
| Hospital Charge Code |
270604378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.57 |
| Max. Negotiated Rate |
$438.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$362.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$438.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$271.57
|
|
|
PLATE RECON 3.5MM 15H
|
Facility
|
IP
|
$1,878.45
|
|
| Hospital Charge Code |
270604379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.77 |
| Max. Negotiated Rate |
$454.58 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$454.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.77
|
|
|
PLATE RECON 3.5MM 15H
|
Facility
|
OP
|
$1,878.45
|
|
| Hospital Charge Code |
270604379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.77 |
| Max. Negotiated Rate |
$939.23 |
| Rate for Payer: Aetna Commercial |
$563.53
|
| Rate for Payer: Aetna Medicare Advantage |
$563.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$479.00
|
| Rate for Payer: Cigna Commercial |
$939.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$454.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.77
|
|
|
PLATE RECON 3.5MM 16H
|
Facility
|
IP
|
$1,954.45
|
|
| Hospital Charge Code |
270604380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.17 |
| Max. Negotiated Rate |
$472.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$390.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$472.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$293.17
|
|
|
PLATE RECON 3.5MM 16H
|
Facility
|
OP
|
$1,954.45
|
|
| Hospital Charge Code |
270604380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.17 |
| Max. Negotiated Rate |
$977.23 |
| Rate for Payer: Aetna Commercial |
$586.34
|
| Rate for Payer: Aetna Medicare Advantage |
$586.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$498.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$498.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$390.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$498.38
|
| Rate for Payer: Cigna Commercial |
$977.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$472.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$293.17
|
|
|
PLATE RECON 3.5MM 18H
|
Facility
|
OP
|
$2,054.45
|
|
| Hospital Charge Code |
270604381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$308.17 |
| Max. Negotiated Rate |
$1,027.22 |
| Rate for Payer: Aetna Commercial |
$616.34
|
| Rate for Payer: Aetna Medicare Advantage |
$616.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$523.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$523.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$410.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$523.88
|
| Rate for Payer: Cigna Commercial |
$1,027.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$497.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$308.17
|
|
|
PLATE RECON 3.5MM 18H
|
Facility
|
IP
|
$2,054.45
|
|
| Hospital Charge Code |
270604381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$308.17 |
| Max. Negotiated Rate |
$497.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$410.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$497.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$308.17
|
|
|
PLATE RECON 3.5MM 20H
|
Facility
|
OP
|
$2,499.25
|
|
| Hospital Charge Code |
270604382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.89 |
| Max. Negotiated Rate |
$1,249.62 |
| Rate for Payer: Aetna Commercial |
$749.77
|
| Rate for Payer: Aetna Medicare Advantage |
$749.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$637.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$637.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$499.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$637.31
|
| Rate for Payer: Cigna Commercial |
$1,249.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$604.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$374.89
|
|
|
PLATE RECON 3.5MM 20H
|
Facility
|
IP
|
$2,499.25
|
|
| Hospital Charge Code |
270604382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.89 |
| Max. Negotiated Rate |
$604.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$499.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$604.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$374.89
|
|
|
PLATE RECON 3.5MM 22H
|
Facility
|
IP
|
$3,057.65
|
|
| Hospital Charge Code |
270604383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$458.65 |
| Max. Negotiated Rate |
$739.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$611.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$739.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$458.65
|
|
|
PLATE RECON 3.5MM 22H
|
Facility
|
OP
|
$3,057.65
|
|
| Hospital Charge Code |
270604383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$458.65 |
| Max. Negotiated Rate |
$1,528.83 |
| Rate for Payer: Aetna Commercial |
$917.29
|
| Rate for Payer: Aetna Medicare Advantage |
$917.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$779.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$779.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$611.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$779.70
|
| Rate for Payer: Cigna Commercial |
$1,528.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$739.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$458.65
|
|
|
PLATE RECON 3.5MM 4H
|
Facility
|
IP
|
$1,142.45
|
|
| Hospital Charge Code |
270604368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.37 |
| Max. Negotiated Rate |
$276.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$276.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.37
|
|
|
PLATE RECON 3.5MM 4H
|
Facility
|
OP
|
$1,142.45
|
|
| Hospital Charge Code |
270604368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.37 |
| Max. Negotiated Rate |
$571.23 |
| Rate for Payer: Aetna Commercial |
$342.74
|
| Rate for Payer: Aetna Medicare Advantage |
$342.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$291.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$291.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$291.32
|
| Rate for Payer: Cigna Commercial |
$571.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$276.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.37
|
|
|
PLATE RECON 3.5MM 6H
|
Facility
|
OP
|
$1,535.00
|
|
| Hospital Charge Code |
270604370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.25 |
| Max. Negotiated Rate |
$767.50 |
| Rate for Payer: Aetna Commercial |
$460.50
|
| Rate for Payer: Aetna Medicare Advantage |
$460.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$391.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$391.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$307.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$391.43
|
| Rate for Payer: Cigna Commercial |
$767.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$371.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$230.25
|
|
|
PLATE RECON 3.5MM 6H
|
Facility
|
IP
|
$1,535.00
|
|
| Hospital Charge Code |
270604370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.25 |
| Max. Negotiated Rate |
$371.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$307.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$371.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$230.25
|
|
|
PLATE RECON 3.5mm 6 HOLE
|
Facility
|
IP
|
$795.60
|
|
| Hospital Charge Code |
270671857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$192.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$159.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$192.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$119.34
|
|
|
PLATE RECON 3.5mm 6 HOLE
|
Facility
|
OP
|
$795.60
|
|
| Hospital Charge Code |
270671857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: Aetna Medicare Advantage |
$238.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$202.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$202.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$202.88
|
| Rate for Payer: Cigna Commercial |
$397.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$192.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$119.34
|
|