|
STRAP TOE 2ND RT
|
Facility
|
IP
|
$468.75
|
|
|
Service Code
|
HCPCS 29550T6
|
| Hospital Charge Code |
5792220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
STRAP TOE 3RD LT
|
Facility
|
OP
|
$468.75
|
|
|
Service Code
|
HCPCS 29550T2
|
| Hospital Charge Code |
5792200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.94 |
| Max. Negotiated Rate |
$234.38 |
| Rate for Payer: Aetna Commercial |
$140.62
|
| Rate for Payer: Aetna Medicare Advantage |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$119.53
|
| Rate for Payer: Cigna Commercial |
$234.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
STRAP TOE 3RD LT
|
Facility
|
IP
|
$468.75
|
|
|
Service Code
|
HCPCS 29550T2
|
| Hospital Charge Code |
5792200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
STRAP TOE 4TH LT
|
Facility
|
IP
|
$468.75
|
|
|
Service Code
|
HCPCS 29550T3
|
| Hospital Charge Code |
5792205
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
STRAP TOE 4TH LT
|
Facility
|
OP
|
$468.75
|
|
|
Service Code
|
HCPCS 29550T3
|
| Hospital Charge Code |
5792205
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.94 |
| Max. Negotiated Rate |
$234.38 |
| Rate for Payer: Aetna Commercial |
$140.62
|
| Rate for Payer: Aetna Medicare Advantage |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$119.53
|
| Rate for Payer: Cigna Commercial |
$234.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
STRAP TOE 4TH RT
|
Facility
|
IP
|
$468.75
|
|
|
Service Code
|
HCPCS 29550T8
|
| Hospital Charge Code |
5792225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
STRAP TOE 4TH RT
|
Facility
|
OP
|
$468.75
|
|
|
Service Code
|
HCPCS 29550T8
|
| Hospital Charge Code |
5792225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.94 |
| Max. Negotiated Rate |
$234.38 |
| Rate for Payer: Aetna Commercial |
$140.62
|
| Rate for Payer: Aetna Medicare Advantage |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$119.53
|
| Rate for Payer: Cigna Commercial |
$234.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
STRAP TOE 5TH LT
|
Facility
|
OP
|
$468.75
|
|
|
Service Code
|
HCPCS 29550T4
|
| Hospital Charge Code |
5792210
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.94 |
| Max. Negotiated Rate |
$234.38 |
| Rate for Payer: Aetna Commercial |
$140.62
|
| Rate for Payer: Aetna Medicare Advantage |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$119.53
|
| Rate for Payer: Cigna Commercial |
$234.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
STRAP TOE 5TH LT
|
Facility
|
IP
|
$468.75
|
|
|
Service Code
|
HCPCS 29550T4
|
| Hospital Charge Code |
5792210
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
|
STRAP ZIM ANKLE 1164-001-10
|
Facility
|
OP
|
$32.85
|
|
| Hospital Charge Code |
270620630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$16.43 |
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna Medicare Advantage |
$9.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.38
|
| Rate for Payer: Cigna Commercial |
$16.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.27
|
| Rate for Payer: Oxford Commercial |
$16.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.43
|
|
|
STRAP ZIM ANKLE 1164-001-10
|
Facility
|
IP
|
$32.85
|
|
| Hospital Charge Code |
270620630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.93
|
|
|
STRATIFT JCV AB/INHIBITION ASY
|
Facility
|
IP
|
$238.80
|
|
|
Service Code
|
HCPCS 86711
|
| Hospital Charge Code |
38479741
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.82
|
|
|
STRATIFT JCV AB/INHIBITION ASY
|
Facility
|
OP
|
$238.80
|
|
|
Service Code
|
HCPCS 86711
|
| Hospital Charge Code |
38479741
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$54.72
|
| Rate for Payer: Aetna Medicare Advantage |
$16.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.88
|
| Rate for Payer: Cigna Commercial |
$16.89
|
| Rate for Payer: Cigna Medicare Advantage |
$8.45
|
| Rate for Payer: Clover Medicare Advantage |
$16.05
|
| Rate for Payer: EmblemHealth Commercial |
$50.67
|
| Rate for Payer: Humana Medicare Advantage |
$17.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.04
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.89
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.89
|
|
|
STRATIFY JCV AB W REFLEX INHIB
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86711
|
| Hospital Charge Code |
401086711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$54.72
|
| Rate for Payer: Aetna Medicare Advantage |
$16.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.88
|
| Rate for Payer: Cigna Commercial |
$16.89
|
| Rate for Payer: Cigna Medicare Advantage |
$8.45
|
| Rate for Payer: Clover Medicare Advantage |
$16.05
|
| Rate for Payer: EmblemHealth Commercial |
$50.67
|
| Rate for Payer: Humana Medicare Advantage |
$17.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.89
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$17.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.89
|
|
|
STRATIFY JCV AB W REFLEX INHIB
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86711
|
| Hospital Charge Code |
401086711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
STRATOFUSE 5CC
|
Facility
|
IP
|
$3,187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.12 |
| Max. Negotiated Rate |
$771.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$637.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$771.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$478.12
|
|
|
STRATOFUSE 5CC
|
Facility
|
OP
|
$3,187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.12 |
| Max. Negotiated Rate |
$1,593.75 |
| Rate for Payer: Aetna Commercial |
$956.25
|
| Rate for Payer: Aetna Medicare Advantage |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$812.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$812.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$812.81
|
| Rate for Payer: Cigna Commercial |
$1,593.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$771.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$478.12
|
|
|
STRATOFUSE V OSTEO MATRIX 10CC
|
Facility
|
OP
|
$39,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,921.25 |
| Max. Negotiated Rate |
$19,737.50 |
| Rate for Payer: Aetna Commercial |
$11,842.50
|
| Rate for Payer: Aetna Medicare Advantage |
$11,842.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,066.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,066.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,895.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,066.12
|
| Rate for Payer: Cigna Commercial |
$19,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,552.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,921.25
|
|
|
STRATOFUSE V OSTEO MATRIX 10CC
|
Facility
|
IP
|
$39,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,921.25 |
| Max. Negotiated Rate |
$9,552.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,895.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,552.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,921.25
|
|
|
STRATOFUSE VOSTEO MATRIX 5CC
|
Facility
|
OP
|
$20,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,112.50 |
| Max. Negotiated Rate |
$10,375.00 |
| Rate for Payer: Aetna Commercial |
$6,225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,291.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,291.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,291.25
|
| Rate for Payer: Cigna Commercial |
$10,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,021.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,112.50
|
|
|
STRATOFUSE VOSTEO MATRIX 5CC
|
Facility
|
IP
|
$20,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,112.50 |
| Max. Negotiated Rate |
$5,021.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,021.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,112.50
|
|
|
STRATOV-OSTEOVIABLEMATRIX5CC
|
Facility
|
OP
|
$21,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,187.50 |
| Max. Negotiated Rate |
$10,625.00 |
| Rate for Payer: Aetna Commercial |
$6,375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,418.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,418.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,418.75
|
| Rate for Payer: Cigna Commercial |
$10,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,142.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,187.50
|
|
|
STRATOV-OSTEOVIABLEMATRIX5CC
|
Facility
|
IP
|
$21,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,187.50 |
| Max. Negotiated Rate |
$5,142.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,142.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,187.50
|
|
|
STRATTERA 60MG CAP
|
Facility
|
IP
|
$81.14
|
|
|
Service Code
|
NDC 2323930
|
| Hospital Charge Code |
606361021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.17
|
|
|
STRATTERA 60MG CAP
|
Facility
|
OP
|
$81.14
|
|
|
Service Code
|
NDC 2323930
|
| Hospital Charge Code |
606361021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$40.57 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Medicare Advantage |
$24.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.69
|
| Rate for Payer: Cigna Commercial |
$40.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.55
|
| Rate for Payer: Oxford Commercial |
$40.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.57
|
|