|
TIBIAL INSERT CR/CONG SZ3 14MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ3 16MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ3 16MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672570
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ4 10MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672617
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ4 10MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ4 12MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672618
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ4 12MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ4 14MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672619
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ4 14MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ4 16MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672620
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ4 16MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ5 10MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ5 10MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672621
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ5 12MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672622
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ5 12MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ5 14MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ5 14MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672623
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ5 16MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ5 16MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672624
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ6 10MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ6 10MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672625
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ6 12MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ6 12MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672626
|
|
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
|
|
|
TIBIAL INSERT CR/CONG SZ6 14MM
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270672627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
TIBIAL INSERT CR/CONG SZ6 14MM
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270672627
|
|
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
|
|