|
FEMORAL HIP SYSTEM SZ 3
|
Facility
|
IP
|
$4,750.00
|
|
| Hospital Charge Code |
270703306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$1,149.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,149.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
|
|
FEMORAL HIP SYSTEM SZ 3
|
Facility
|
OP
|
$4,750.00
|
|
| Hospital Charge Code |
270703306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.90 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$1,805.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,211.25
|
| Rate for Payer: Cigna Commercial |
$2,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,149.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$150.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$134.90
|
|
|
FEMORAL HIP TAPERFILL SZ 7
|
Facility
|
IP
|
$17,062.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.38 |
| Max. Negotiated Rate |
$4,129.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,129.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,559.38
|
|
|
FEMORAL HIP TAPERFILL SZ 7
|
Facility
|
OP
|
$17,062.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.57 |
| Max. Negotiated Rate |
$8,531.25 |
| Rate for Payer: Aetna Commercial |
$6,483.75
|
| Rate for Payer: Aetna Medicare Advantage |
$5,118.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,350.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,350.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,412.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,350.94
|
| Rate for Payer: Cigna Commercial |
$8,531.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,129.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,559.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$539.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$484.57
|
|
|
FEMORAL INTERLOK LT 60MM
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270639169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$3,800.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,550.00
|
| Rate for Payer: Cigna Commercial |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$316.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$284.00
|
|
|
FEMORAL INTERLOK LT 60MM
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270639169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
FEMORAL KNEE 60MM CEMENTED
|
Facility
|
IP
|
$14,800.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270682049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,220.00 |
| Max. Negotiated Rate |
$3,581.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,960.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,581.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,220.00
|
|
|
FEMORAL KNEE 60MM CEMENTED
|
Facility
|
OP
|
$14,800.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270682049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.32 |
| Max. Negotiated Rate |
$7,400.00 |
| Rate for Payer: Aetna Commercial |
$5,624.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,440.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,774.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,774.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,960.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,774.00
|
| Rate for Payer: Cigna Commercial |
$7,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,581.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$467.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$420.32
|
|
|
FEMORAL KNEE SZ7 LEFT
|
Facility
|
IP
|
$19,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270693993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,850.00 |
| Max. Negotiated Rate |
$4,598.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,598.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,850.00
|
|
|
FEMORAL KNEE SZ7 LEFT
|
Facility
|
OP
|
$19,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270693993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.60 |
| Max. Negotiated Rate |
$9,500.00 |
| Rate for Payer: Aetna Commercial |
$7,220.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,845.00
|
| Rate for Payer: Cigna Commercial |
$9,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,598.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,850.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$600.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$539.60
|
|
|
FEMORAL LCCK SZ G -RT NEXGEN
|
Facility
|
IP
|
$36,900.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270686835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,535.00 |
| Max. Negotiated Rate |
$8,929.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,380.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,929.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,535.00
|
|
|
FEMORAL LCCK SZ G -RT NEXGEN
|
Facility
|
OP
|
$36,900.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270686835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.96 |
| Max. Negotiated Rate |
$18,450.00 |
| Rate for Payer: Aetna Commercial |
$14,022.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,070.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,409.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,409.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,380.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,409.50
|
| Rate for Payer: Cigna Commercial |
$18,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,929.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,535.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,166.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,047.96
|
|
|
FEMORAL LPS-FLEX GSF OPTION
|
Facility
|
OP
|
$12,165.00
|
|
| Hospital Charge Code |
270660823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.49 |
| Max. Negotiated Rate |
$6,082.50 |
| Rate for Payer: Aetna Commercial |
$4,622.70
|
| Rate for Payer: Aetna Medicare Advantage |
$3,649.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,102.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,102.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,433.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,102.07
|
| Rate for Payer: Cigna Commercial |
$6,082.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,943.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,824.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$384.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$345.49
|
|
|
FEMORAL LPS-FLEX GSF OPTION
|
Facility
|
IP
|
$12,165.00
|
|
| Hospital Charge Code |
270660823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.75 |
| Max. Negotiated Rate |
$2,943.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,433.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,943.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,824.75
|
|
|
FEMORAL MOLD CEMENT 75 MM
|
Facility
|
IP
|
$10,460.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,569.00 |
| Max. Negotiated Rate |
$2,531.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,092.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,531.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,569.00
|
|
|
FEMORAL MOLD CEMENT 75 MM
|
Facility
|
OP
|
$10,460.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.06 |
| Max. Negotiated Rate |
$5,230.00 |
| Rate for Payer: Aetna Commercial |
$3,974.80
|
| Rate for Payer: Aetna Medicare Advantage |
$3,138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,667.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,667.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,092.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,667.30
|
| Rate for Payer: Cigna Commercial |
$5,230.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,531.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,569.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$330.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$297.06
|
|
|
FEMORAL NAIL EX SPIRAL 70 MM B
|
Facility
|
OP
|
$2,563.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.81 |
| Max. Negotiated Rate |
$1,281.92 |
| Rate for Payer: Aetna Commercial |
$974.26
|
| Rate for Payer: Aetna Medicare Advantage |
$769.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$653.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$653.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$512.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$653.78
|
| Rate for Payer: Cigna Commercial |
$1,281.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$620.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$384.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$81.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$72.81
|
|
|
FEMORAL NAIL EX SPIRAL 70 MM B
|
Facility
|
IP
|
$2,563.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.58 |
| Max. Negotiated Rate |
$620.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$512.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$620.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$384.58
|
|
|
FEMORAL N BLOCK SGL RT
|
Facility
|
IP
|
$4,204.50
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
16000266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$630.67 |
| Max. Negotiated Rate |
$630.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$630.67
|
|
|
FEMORAL N BLOCK SGL RT
|
Facility
|
OP
|
$4,204.50
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
16000266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$119.41 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$2,281.02
|
| Rate for Payer: Aetna Medicare Advantage |
$2,717.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,042.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$838.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,042.06
|
| Rate for Payer: Cigna Commercial |
$1,680.99
|
| Rate for Payer: Cigna Medicare Advantage |
$838.61
|
| Rate for Payer: Clover Medicare Advantage |
$796.68
|
| Rate for Payer: EmblemHealth Commercial |
$2,515.83
|
| Rate for Payer: Humana Medicare Advantage |
$863.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$838.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,093.17
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$630.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$132.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$119.41
|
|
|
FEMORAL NECK SYS PLT 2 H STERI
|
Facility
|
OP
|
$3,231.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$1,615.67 |
| Rate for Payer: Aetna Commercial |
$1,227.91
|
| Rate for Payer: Aetna Medicare Advantage |
$969.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$823.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$823.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$646.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$823.99
|
| Rate for Payer: Cigna Commercial |
$1,615.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$781.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$484.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$102.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$91.77
|
|
|
FEMORAL NECK SYS PLT 2 H STERI
|
Facility
|
IP
|
$3,231.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.70 |
| Max. Negotiated Rate |
$781.99 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$646.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$781.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$484.70
|
|
|
FEMORAL NECK SYSTEM PLATE 1 HO
|
Facility
|
OP
|
$4,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$2,002.50 |
| Rate for Payer: Aetna Commercial |
$1,521.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,201.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,021.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,021.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$801.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,021.27
|
| Rate for Payer: Cigna Commercial |
$2,002.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$969.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.74
|
|
|
FEMORAL NECK SYSTEM PLATE 1 HO
|
Facility
|
IP
|
$4,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.75 |
| Max. Negotiated Rate |
$969.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$801.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$969.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.75
|
|
|
FEMORAL NEXGEN LCCK, SZ D-LT
|
Facility
|
IP
|
$28,661.45
|
|
| Hospital Charge Code |
270669762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,299.22 |
| Max. Negotiated Rate |
$6,936.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,732.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,936.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,299.22
|
|