|
132 CEMENTED HIP STEM
|
Facility
|
IP
|
$22,305.00
|
|
| Hospital Charge Code |
270656398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,345.75 |
| Max. Negotiated Rate |
$5,397.81 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,461.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,397.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,345.75
|
|
|
132 NECK ANGLE HIP STEM
|
Facility
|
OP
|
$307.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270686734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$153.93 |
| Rate for Payer: Aetna Commercial |
$92.36
|
| Rate for Payer: Aetna Medicare Advantage |
$92.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.50
|
| Rate for Payer: Cigna Commercial |
$153.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.18
|
|
|
132 NECK ANGLE HIP STEM
|
Facility
|
IP
|
$307.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270686734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$74.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.18
|
|
|
1.35 K WIRE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270659329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$24.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
1.35 K WIRE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270659329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.00 |
| 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) NJ Health |
$20.00
|
| 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 |
$24.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
1.3MM TI CORTEX SCREW SELF-TAP
|
Facility
|
IP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTEX SCREW SELF-TAP
|
Facility
|
OP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$168.70 |
| Rate for Payer: Aetna Commercial |
$101.22
|
| Rate for Payer: Aetna Medicare Advantage |
$101.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.04
|
| Rate for Payer: Cigna Commercial |
$168.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTEX SRW SLF-TAP 10
|
Facility
|
OP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$168.70 |
| Rate for Payer: Aetna Commercial |
$101.22
|
| Rate for Payer: Aetna Medicare Advantage |
$101.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.04
|
| Rate for Payer: Cigna Commercial |
$168.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTEX SRW SLF-TAP 10
|
Facility
|
IP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTEX SRW SLF-TAP 11
|
Facility
|
IP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTEX SRW SLF-TAP 11
|
Facility
|
OP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$168.70 |
| Rate for Payer: Aetna Commercial |
$101.22
|
| Rate for Payer: Aetna Medicare Advantage |
$101.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.04
|
| Rate for Payer: Cigna Commercial |
$168.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTEX SRW SLF-TAP 12
|
Facility
|
IP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTEX SRW SLF-TAP 12
|
Facility
|
OP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$168.70 |
| Rate for Payer: Aetna Commercial |
$101.22
|
| Rate for Payer: Aetna Medicare Advantage |
$101.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.04
|
| Rate for Payer: Cigna Commercial |
$168.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTX SCRW SLFTAP 6MM
|
Facility
|
IP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTX SCRW SLFTAP 6MM
|
Facility
|
OP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$168.70 |
| Rate for Payer: Aetna Commercial |
$101.22
|
| Rate for Payer: Aetna Medicare Advantage |
$101.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.04
|
| Rate for Payer: Cigna Commercial |
$168.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTX SCRW SLFTAP 7MM
|
Facility
|
IP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
1.3MM TI CORTX SCRW SLFTAP 7MM
|
Facility
|
OP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$168.70 |
| Rate for Payer: Aetna Commercial |
$101.22
|
| Rate for Payer: Aetna Medicare Advantage |
$101.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.04
|
| Rate for Payer: Cigna Commercial |
$168.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
13MMX100MM STEM EXTENSION
|
Facility
|
OP
|
$5,245.85
|
|
| Hospital Charge Code |
270656848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.88 |
| Max. Negotiated Rate |
$2,622.93 |
| Rate for Payer: Aetna Commercial |
$1,573.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,573.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,337.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,337.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,049.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,337.69
|
| Rate for Payer: Cigna Commercial |
$2,622.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,269.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.88
|
|
|
13MMX100MM STEM EXTENSION
|
Facility
|
IP
|
$5,245.85
|
|
| Hospital Charge Code |
270656848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.88 |
| Max. Negotiated Rate |
$1,269.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,049.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,269.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.88
|
|
|
13MM X 8 DEGREE PLATE
|
Facility
|
OP
|
$12,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna Commercial |
$3,600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,060.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,060.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,060.00
|
| Rate for Payer: Cigna Commercial |
$6,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,904.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,800.00
|
|
|
13MM X 8 DEGREE PLATE
|
Facility
|
IP
|
$12,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,904.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,800.00
|
|
|
140/80 HA PINS
|
Facility
|
OP
|
$720.00
|
|
| Hospital Charge Code |
270339495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Medicare Advantage |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$183.60
|
| Rate for Payer: Cigna Commercial |
$360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.60
|
| Rate for Payer: Oxford Commercial |
$360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$360.00
|
|
|
140/80 HA PINS
|
Facility
|
IP
|
$720.00
|
|
| Hospital Charge Code |
270339495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
14.3.3 ETA PROTEIN (SERUM)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3032492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
14.3.3 ETA PROTEIN (SERUM)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3032492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$55.95
|
| Rate for Payer: Aetna Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.28
|
| Rate for Payer: Cigna Commercial |
$17.27
|
| Rate for Payer: Cigna Medicare Advantage |
$8.63
|
| Rate for Payer: Clover Medicare Advantage |
$16.41
|
| Rate for Payer: EmblemHealth Commercial |
$51.81
|
| Rate for Payer: Humana Medicare Advantage |
$17.79
|
| 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 |
$17.27
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$18.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
|