|
STEM 7MM DIA X 2MM TR
|
Facility
|
IP
|
$9,820.00
|
|
| Hospital Charge Code |
270666832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.00 |
| Max. Negotiated Rate |
$2,376.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,964.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,376.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,473.00
|
|
|
STEM 7MM STD ECHO BIMETRIC LAT
|
Facility
|
OP
|
$10,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270693216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$3,150.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,677.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,677.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,677.50
|
| Rate for Payer: Cigna Commercial |
$5,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,541.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,575.00
|
|
|
STEM 7MM STD ECHO BIMETRIC LAT
|
Facility
|
IP
|
$10,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270693216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$2,541.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,541.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,575.00
|
|
|
STEM 8.0MM x 4.0MM TI ALLOY
|
Facility
|
OP
|
$10,825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270682453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,623.75 |
| Max. Negotiated Rate |
$5,412.50 |
| Rate for Payer: Aetna Commercial |
$3,247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,760.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,760.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,760.38
|
| Rate for Payer: Cigna Commercial |
$5,412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,619.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,623.75
|
|
|
STEM 8.0MM x 4.0MM TI ALLOY
|
Facility
|
IP
|
$10,825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270682453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,623.75 |
| Max. Negotiated Rate |
$2,619.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,619.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,623.75
|
|
|
STEM 8MM DIA X 4.0MM TR
|
Facility
|
IP
|
$10,825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270682462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,623.75 |
| Max. Negotiated Rate |
$2,619.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,619.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,623.75
|
|
|
STEM 8MM DIA X 4.0MM TR
|
Facility
|
OP
|
$10,825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270682462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,623.75 |
| Max. Negotiated Rate |
$5,412.50 |
| Rate for Payer: Aetna Commercial |
$3,247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,760.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,760.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,760.38
|
| Rate for Payer: Cigna Commercial |
$5,412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,619.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,623.75
|
|
|
STEM 8MM REUNION RFX
|
Facility
|
OP
|
$37,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270700460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,625.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Aetna Commercial |
$11,250.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,562.50
|
| Rate for Payer: Cigna Commercial |
$18,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,075.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,625.00
|
|
|
STEM 8MM REUNION RFX
|
Facility
|
IP
|
$37,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270700460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,625.00 |
| Max. Negotiated Rate |
$9,075.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,075.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,625.00
|
|
|
STEM 9MM DIA X 0MM TR
|
Facility
|
OP
|
$9,820.00
|
|
| Hospital Charge Code |
270666834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.00 |
| Max. Negotiated Rate |
$4,910.00 |
| Rate for Payer: Aetna Commercial |
$2,946.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,946.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,504.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,504.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,964.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,504.10
|
| Rate for Payer: Cigna Commercial |
$4,910.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,376.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,473.00
|
|
|
STEM 9MM DIA X 0MM TR
|
Facility
|
IP
|
$9,820.00
|
|
| Hospital Charge Code |
270666834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.00 |
| Max. Negotiated Rate |
$2,376.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,964.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,376.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,473.00
|
|
|
STEM ACCOLADE 127DEGxSZ7x37MM
|
Facility
|
IP
|
$11,760.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270681084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,764.14 |
| Max. Negotiated Rate |
$2,846.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,352.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,846.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,764.14
|
|
|
STEM ACCOLADE 127DEGxSZ7x37MM
|
Facility
|
OP
|
$11,760.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270681084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,764.14 |
| Max. Negotiated Rate |
$5,880.48 |
| Rate for Payer: Aetna Medicare Advantage |
$3,528.28
|
| Rate for Payer: Aetna Commercial |
$3,528.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,999.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,999.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,352.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,999.04
|
| Rate for Payer: Cigna Commercial |
$5,880.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,846.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,764.14
|
|
|
STEM ACCOLADE II SZ7 132D
|
Facility
|
IP
|
$12,723.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270700759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,908.54 |
| Max. Negotiated Rate |
$3,079.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,544.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,079.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,908.54
|
|
|
STEM ACCOLADE II SZ7 132D
|
Facility
|
OP
|
$12,723.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270700759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,908.54 |
| Max. Negotiated Rate |
$6,361.80 |
| Rate for Payer: Aetna Commercial |
$3,817.08
|
| Rate for Payer: Aetna Medicare Advantage |
$3,817.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,244.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,244.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,544.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,244.52
|
| Rate for Payer: Cigna Commercial |
$6,361.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,079.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,908.54
|
|
|
STEM ACTIS COLLAR
|
Facility
|
IP
|
$14,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.50 |
| Max. Negotiated Rate |
$3,448.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,448.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,137.50
|
|
|
STEM ACTIS COLLAR
|
Facility
|
OP
|
$14,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.50 |
| Max. Negotiated Rate |
$7,125.00 |
| Rate for Payer: Aetna Commercial |
$4,275.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,633.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,633.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,633.75
|
| Rate for Payer: Cigna Commercial |
$7,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,448.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,137.50
|
|
|
STEM ADAPTER 5 DEG OPTETRAK
|
Facility
|
IP
|
$1,284.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$310.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$256.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$310.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$192.60
|
|
|
STEM ADAPTER 5 DEG OPTETRAK
|
Facility
|
OP
|
$1,284.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna Commercial |
$385.20
|
| Rate for Payer: Aetna Medicare Advantage |
$385.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$327.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$327.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$327.42
|
| Rate for Payer: Cigna Commercial |
$642.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$310.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$192.60
|
|
|
STEM AMI P LATERAL SZ4
|
Facility
|
OP
|
$8,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$2,400.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,040.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,040.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,040.00
|
| Rate for Payer: Cigna Commercial |
$4,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,936.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,200.00
|
|
|
STEM AMI P LATERAL SZ4
|
Facility
|
IP
|
$8,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,936.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,200.00
|
|
|
STEM AMISTEM C LAT SZ 6
|
Facility
|
IP
|
$8,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,936.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,200.00
|
|
|
STEM AMISTEM C LAT SZ 6
|
Facility
|
OP
|
$8,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$2,400.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,040.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,040.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,040.00
|
| Rate for Payer: Cigna Commercial |
$4,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,936.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,200.00
|
|
|
STEM AMISTEM-H HA SIZE 4
|
Facility
|
IP
|
$12,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270678721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,836.00 |
| Max. Negotiated Rate |
$2,962.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,448.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,962.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,836.00
|
|
|
STEM AMISTEM-H HA SIZE 4
|
Facility
|
OP
|
$12,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270678721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,836.00 |
| Max. Negotiated Rate |
$6,120.00 |
| Rate for Payer: Aetna Commercial |
$3,672.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,672.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,448.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,121.20
|
| Rate for Payer: Cigna Commercial |
$6,120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,962.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,836.00
|
|