|
1181-20 HIP FIXATION
|
Facility
|
IP
|
$560.30
|
|
| Hospital Charge Code |
270656836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.05 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.05
|
|
|
1181-20 HIP FIXATION
|
Facility
|
OP
|
$560.30
|
|
| Hospital Charge Code |
270656836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.05 |
| Max. Negotiated Rate |
$280.15 |
| Rate for Payer: Aetna Commercial |
$168.09
|
| Rate for Payer: Aetna Medicare Advantage |
$168.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$142.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$142.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$142.88
|
| Rate for Payer: Cigna Commercial |
$280.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.05
|
|
|
11-DEOXYCORTISOL,LC/MS/MS
|
Facility
|
OP
|
$199.70
|
|
|
Service Code
|
HCPCS 82634
|
| Hospital Charge Code |
39900512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$94.87
|
| Rate for Payer: Aetna Medicare Advantage |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.28
|
| Rate for Payer: Cigna Commercial |
$29.28
|
| Rate for Payer: Cigna Medicare Advantage |
$14.64
|
| Rate for Payer: Clover Medicare Advantage |
$27.82
|
| Rate for Payer: EmblemHealth Commercial |
$87.84
|
| Rate for Payer: Humana Medicare Advantage |
$30.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.96
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.28
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$31.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.28
|
|
|
11-DEOXYCORTISOL,LC/MS/MS
|
Facility
|
IP
|
$199.70
|
|
|
Service Code
|
HCPCS 82634
|
| Hospital Charge Code |
39900512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.95 |
| Max. Negotiated Rate |
$29.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.95
|
|
|
1.1 DOUBLE G/WIRE
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
270684631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$30.00
|
| Rate for Payer: Aetna Medicare Advantage |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.50
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.00
|
| Rate for Payer: Oxford Commercial |
$50.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.00
|
|
|
1.1 DOUBLE G/WIRE
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
270684631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
1.1 GUIDEWIRE
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270664042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|
|
1.1 GUIDEWIRE
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270666242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.00 |
| Max. Negotiated Rate |
$1,180.00 |
| Rate for Payer: Aetna Commercial |
$708.00
|
| Rate for Payer: Aetna Medicare Advantage |
$708.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$601.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$601.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$472.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$601.80
|
| Rate for Payer: Cigna Commercial |
$1,180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$571.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$354.00
|
|
|
1.1 GUIDEWIRE
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270664015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$102.50 |
| Rate for Payer: Aetna Commercial |
$61.50
|
| Rate for Payer: Aetna Medicare Advantage |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.27
|
| Rate for Payer: Cigna Commercial |
$102.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.75
|
|
|
1.1 GUIDEWIRE
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270666242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.00 |
| Max. Negotiated Rate |
$571.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$472.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$571.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$354.00
|
|
|
1.1 GUIDEWIRE
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270664042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$121.12
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|
|
1.1 GUIDEWIRE
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270664015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$49.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.75
|
|
|
11MM/125DEG TI CANN TFNA 320MM
|
Facility
|
IP
|
$14,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
278704757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.45 |
| Max. Negotiated Rate |
$3,403.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,812.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,403.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,109.45
|
|
|
11MM/125DEG TI CANN TFNA 320MM
|
Facility
|
OP
|
$14,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
278704757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.45 |
| Max. Negotiated Rate |
$7,031.50 |
| Rate for Payer: Aetna Commercial |
$4,218.90
|
| Rate for Payer: Aetna Medicare Advantage |
$4,218.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,586.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,586.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,812.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,586.07
|
| Rate for Payer: Cigna Commercial |
$7,031.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,403.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,109.45
|
|
|
11MM/125DEG TI CANN TFNA 320MM
|
Facility
|
IP
|
$14,063.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270704757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.45 |
| Max. Negotiated Rate |
$3,403.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,812.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,403.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,109.45
|
|
|
11MM/125DEG TI CANN TFNA 320MM
|
Facility
|
OP
|
$14,063.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270704757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.45 |
| Max. Negotiated Rate |
$7,031.50 |
| Rate for Payer: Aetna Commercial |
$4,218.90
|
| Rate for Payer: Aetna Medicare Advantage |
$4,218.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,586.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,586.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,812.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,586.07
|
| Rate for Payer: Cigna Commercial |
$7,031.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,403.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,109.45
|
|
|
11MM/125DEG TI CANN TNFA
|
Facility
|
OP
|
$14,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.95 |
| Max. Negotiated Rate |
$7,106.50 |
| Rate for Payer: Aetna Commercial |
$4,263.90
|
| Rate for Payer: Aetna Medicare Advantage |
$4,263.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,624.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,624.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,842.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,624.32
|
| Rate for Payer: Cigna Commercial |
$7,106.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,439.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,131.95
|
|
|
11MM/125DEG TI CANN TNFA
|
Facility
|
IP
|
$14,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.95 |
| Max. Negotiated Rate |
$3,439.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,842.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,439.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,131.95
|
|
|
11MM/130DEG TI CANN TFNA360MM/
|
Facility
|
IP
|
$9,653.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.97 |
| Max. Negotiated Rate |
$2,336.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,930.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,336.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,447.97
|
|
|
11MM/130DEG TI CANN TFNA360MM/
|
Facility
|
OP
|
$9,653.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.97 |
| Max. Negotiated Rate |
$4,826.57 |
| Rate for Payer: Aetna Commercial |
$2,895.95
|
| Rate for Payer: Aetna Medicare Advantage |
$2,895.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,461.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,461.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,930.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,461.55
|
| Rate for Payer: Cigna Commercial |
$4,826.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,336.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,447.97
|
|
|
11MM/130 DEG TI CANN THN 400
|
Facility
|
OP
|
$9,942.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$4,971.38 |
| Rate for Payer: Aetna Commercial |
$2,982.82
|
| Rate for Payer: Aetna Medicare Advantage |
$2,982.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,535.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,535.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,988.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,535.40
|
| Rate for Payer: Cigna Commercial |
$4,971.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,406.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,491.41
|
|
|
11MM/130 DEG TI CANN THN 400
|
Facility
|
IP
|
$9,942.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$2,406.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,988.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,406.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,491.41
|
|
|
11MM/130DEG TI CAN TFNA340MM/R
|
Facility
|
IP
|
$9,942.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$2,406.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,988.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,406.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,491.41
|
|
|
11MM/130DEG TI CAN TFNA340MM/R
|
Facility
|
OP
|
$9,942.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$4,971.38 |
| Rate for Payer: Aetna Commercial |
$2,982.82
|
| Rate for Payer: Aetna Medicare Advantage |
$2,982.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,535.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,535.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,988.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,535.40
|
| Rate for Payer: Cigna Commercial |
$4,971.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,406.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,491.41
|
|
|
11 MM DRILL BIT 4MM STP
|
Facility
|
OP
|
$795.00
|
|
| Hospital Charge Code |
270656599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$397.50 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Medicare Advantage |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$202.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$202.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$202.72
|
| Rate for Payer: Cigna Commercial |
$397.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$103.35
|
| Rate for Payer: Oxford Commercial |
$397.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$119.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$397.50
|
|