|
PUTTY NEVOS PLUS 1CC
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
PUTTY NORIAN FASTSET 10CC
|
Facility
|
OP
|
$11,916.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.40 |
| Max. Negotiated Rate |
$5,958.00 |
| Rate for Payer: Aetna Commercial |
$3,574.80
|
| Rate for Payer: Aetna Medicare Advantage |
$3,574.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,038.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,038.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,383.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,038.58
|
| Rate for Payer: Cigna Commercial |
$5,958.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,883.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,787.40
|
|
|
PUTTY NORIAN FASTSET 10CC
|
Facility
|
IP
|
$11,916.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.40 |
| Max. Negotiated Rate |
$2,883.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,383.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,883.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,787.40
|
|
|
PUTTY NORIAN FASTSET 3CC
|
Facility
|
OP
|
$3,480.00
|
|
| Hospital Charge Code |
270677457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna Commercial |
$1,044.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,044.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$887.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$887.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$696.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$887.40
|
| Rate for Payer: Cigna Commercial |
$1,740.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$842.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$522.00
|
|
|
PUTTY NORIAN FASTSET 3CC
|
Facility
|
IP
|
$3,480.00
|
|
| Hospital Charge Code |
270677457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$842.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$696.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$842.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$522.00
|
|
|
PUTTY NORIAN FASTSET 5CC
|
Facility
|
OP
|
$5,715.00
|
|
| Hospital Charge Code |
270677458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.25 |
| Max. Negotiated Rate |
$2,857.50 |
| Rate for Payer: Aetna Commercial |
$1,714.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,714.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,457.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,457.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,143.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,457.33
|
| Rate for Payer: Cigna Commercial |
$2,857.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,383.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$857.25
|
|
|
PUTTY NORIAN FASTSET 5CC
|
Facility
|
IP
|
$5,715.00
|
|
| Hospital Charge Code |
270677458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.25 |
| Max. Negotiated Rate |
$1,383.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,143.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,383.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$857.25
|
|
|
PUTTY NORIAN INJECTABLE 3CC
|
Facility
|
IP
|
$3,691.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.79 |
| Max. Negotiated Rate |
$893.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$738.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$893.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$553.79
|
|
|
PUTTY NORIAN INJECTABLE 3CC
|
Facility
|
OP
|
$3,691.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.79 |
| Max. Negotiated Rate |
$1,845.97 |
| Rate for Payer: Aetna Commercial |
$1,107.59
|
| Rate for Payer: Aetna Medicare Advantage |
$1,107.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$941.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$941.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$738.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$941.45
|
| Rate for Payer: Cigna Commercial |
$1,845.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$893.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$553.79
|
|
|
PUTTY NORIAN INJECTABLE 5CC
|
Facility
|
OP
|
$6,063.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.46 |
| Max. Negotiated Rate |
$3,031.53 |
| Rate for Payer: Aetna Commercial |
$1,818.91
|
| Rate for Payer: Aetna Medicare Advantage |
$1,818.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,546.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,546.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,212.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,546.08
|
| Rate for Payer: Cigna Commercial |
$3,031.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,467.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$909.46
|
|
|
PUTTY NORIAN INJECTABLE 5CC
|
Facility
|
IP
|
$6,063.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.46 |
| Max. Negotiated Rate |
$1,467.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,212.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,467.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$909.46
|
|
|
PUTTY NORIAN INJECTBL 10cc
|
Facility
|
IP
|
$11,916.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.40 |
| Max. Negotiated Rate |
$2,883.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,383.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,883.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,787.40
|
|
|
PUTTY NORIAN INJECTBL 10cc
|
Facility
|
OP
|
$11,916.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.40 |
| Max. Negotiated Rate |
$5,958.00 |
| Rate for Payer: Aetna Commercial |
$3,574.80
|
| Rate for Payer: Aetna Medicare Advantage |
$3,574.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,038.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,038.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,383.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,038.58
|
| Rate for Payer: Cigna Commercial |
$5,958.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,883.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,787.40
|
|
|
PUTTY OPTUM DMB 10CC
|
Facility
|
OP
|
$4,866.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270657605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.90 |
| Max. Negotiated Rate |
$2,433.00 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,459.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,240.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,240.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$973.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,240.83
|
| Rate for Payer: Cigna Commercial |
$2,433.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,177.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$729.90
|
|
|
PUTTY OPTUM DMB 10CC
|
Facility
|
IP
|
$4,866.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270657605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.90 |
| Max. Negotiated Rate |
$1,177.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$973.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,177.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$729.90
|
|
|
PUTTY OPTUM DMB 5CC
|
Facility
|
OP
|
$3,307.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$496.12 |
| Max. Negotiated Rate |
$1,653.75 |
| Rate for Payer: Aetna Commercial |
$992.25
|
| Rate for Payer: Aetna Medicare Advantage |
$992.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$843.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$843.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$661.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$843.41
|
| Rate for Payer: Cigna Commercial |
$1,653.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$800.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$496.12
|
|
|
PUTTY OPTUM DMB 5CC
|
Facility
|
IP
|
$3,307.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$496.12 |
| Max. Negotiated Rate |
$800.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$661.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$800.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$496.12
|
|
|
PUTTY OSTEOSTRUX
|
Facility
|
OP
|
$17,675.00
|
|
| Hospital Charge Code |
270674945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,651.25 |
| Max. Negotiated Rate |
$8,837.50 |
| Rate for Payer: Aetna Commercial |
$5,302.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,302.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,507.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,507.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,535.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,507.12
|
| Rate for Payer: Cigna Commercial |
$8,837.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,277.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,651.25
|
|
|
PUTTY OSTEOSTRUX
|
Facility
|
IP
|
$17,675.00
|
|
| Hospital Charge Code |
270674945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,651.25 |
| Max. Negotiated Rate |
$4,277.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,535.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,277.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,651.25
|
|
|
PUTTY OSTEROSURGE 300 10CC
|
Facility
|
IP
|
$10,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.50 |
| Max. Negotiated Rate |
$2,548.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,106.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,548.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,579.50
|
|
|
PUTTY OSTEROSURGE 300 10CC
|
Facility
|
OP
|
$10,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.50 |
| Max. Negotiated Rate |
$5,265.00 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,685.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,685.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,106.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,685.15
|
| Rate for Payer: Cigna Commercial |
$5,265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,548.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,579.50
|
|
|
PUTTY OSTSLIM 5.0 030769044407
|
Facility
|
IP
|
$3,283.60
|
|
| Hospital Charge Code |
270633640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.54 |
| Max. Negotiated Rate |
$794.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$656.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$794.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$492.54
|
|
|
PUTTY OSTSLIM 5.0 030769044407
|
Facility
|
OP
|
$3,283.60
|
|
| Hospital Charge Code |
270633640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.54 |
| Max. Negotiated Rate |
$1,641.80 |
| Rate for Payer: Aetna Commercial |
$985.08
|
| Rate for Payer: Aetna Medicare Advantage |
$985.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$837.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$837.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$656.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$837.32
|
| Rate for Payer: Cigna Commercial |
$1,641.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$794.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$492.54
|
|
|
PUTTY OTPIMUM 5CC
|
Facility
|
IP
|
$3,307.55
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
270667892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$496.13 |
| Max. Negotiated Rate |
$800.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$661.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$800.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$496.13
|
|
|
PUTTY OTPIMUM 5CC
|
Facility
|
OP
|
$3,307.55
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
270667892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$496.13 |
| Max. Negotiated Rate |
$1,653.78 |
| Rate for Payer: Aetna Commercial |
$992.26
|
| Rate for Payer: Aetna Medicare Advantage |
$992.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$843.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$843.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$661.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$843.43
|
| Rate for Payer: Cigna Commercial |
$1,653.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$800.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$496.13
|
|