|
ALLODERM MATRIX TISS GRAFT 4X6
|
Facility
|
OP
|
$2,888.00
|
|
| Hospital Charge Code |
270338801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$1,444.00 |
| Rate for Payer: Aetna Commercial |
$1,097.44
|
| Rate for Payer: Aetna Medicare Advantage |
$866.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$736.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$736.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$736.44
|
| Rate for Payer: Cigna Commercial |
$1,444.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$698.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$433.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$91.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.02
|
|
|
ALLODERM MATRIX TISS GRAFT 4X6
|
Facility
|
IP
|
$2,888.00
|
|
| Hospital Charge Code |
270338801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$433.20 |
| Max. Negotiated Rate |
$698.90 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$698.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$433.20
|
|
|
ALLODERM MATRIX TISS GRAFT 8X6
|
Facility
|
OP
|
$7,392.00
|
|
| Hospital Charge Code |
270338803
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$209.93 |
| Max. Negotiated Rate |
$3,696.00 |
| Rate for Payer: Aetna Commercial |
$2,808.96
|
| Rate for Payer: Aetna Medicare Advantage |
$2,217.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,884.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,884.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,884.96
|
| Rate for Payer: Cigna Commercial |
$3,696.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,788.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,108.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$233.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$209.93
|
|
|
ALLODERM MATRIX TISS GRAFT 8X6
|
Facility
|
IP
|
$7,392.00
|
|
| Hospital Charge Code |
270338803
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,108.80 |
| Max. Negotiated Rate |
$1,788.86 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,788.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,108.80
|
|
|
ALLODERM MEDIUM 12X20CM
|
Facility
|
OP
|
$50,805.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270695703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$12,294.81 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10,161.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,294.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,620.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,605.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,442.86
|
|
|
ALLODERM MEDIUM 12X20CM
|
Facility
|
IP
|
$50,805.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270695703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,620.75 |
| Max. Negotiated Rate |
$12,294.81 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10,161.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,294.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,620.75
|
|
|
ALLO DERM REGENERATIVE TISSUE
|
Facility
|
OP
|
$13,755.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270678871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$3,328.71 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,751.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,328.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,063.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$434.66
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$390.64
|
|
|
ALLO DERM REGENERATIVE TISSUE
|
Facility
|
IP
|
$13,755.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270678871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,063.25 |
| Max. Negotiated Rate |
$3,328.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,751.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,328.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,063.25
|
|
|
ALLO DERM REGEN TISSUE 4X12CMC
|
Facility
|
OP
|
$9,025.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270678873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$2,184.05 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,805.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,184.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,353.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$285.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$256.31
|
|
|
ALLO DERM REGEN TISSUE 4X12CMC
|
Facility
|
IP
|
$9,025.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270678873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,353.75 |
| Max. Negotiated Rate |
$2,184.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,805.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,184.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,353.75
|
|
|
ALLO DERM REGEN TISSUE 4X7 CMC
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270678168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.97 |
| Max. Negotiated Rate |
$536.29 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$373.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$451.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$279.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$58.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.97
|
|
|
ALLO DERM REGEN TISSUE 4X7 CMC
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270678168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.75 |
| Max. Negotiated Rate |
$451.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$373.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$451.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$279.75
|
|
|
ALLODERM REG TISSUE MATRIX
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270679527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.75
|
|
|
ALLODERM REG TISSUE MATRIX
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270679527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$536.29 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$156.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.77
|
|
|
ALLODERM TISSUE MARIX 8X12CM
|
Facility
|
OP
|
$19,080.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270681885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$4,617.36 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Medicare Advantage |
$479.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,816.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.29
|
| Rate for Payer: Cigna Commercial |
$296.35
|
| Rate for Payer: Cigna Medicare Advantage |
$147.84
|
| Rate for Payer: Clover Medicare Advantage |
$140.45
|
| Rate for Payer: EmblemHealth Commercial |
$443.52
|
| Rate for Payer: Humana Medicare Advantage |
$152.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$147.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,617.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,862.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$602.93
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$541.87
|
|
|
ALLODERM TISSUE MARIX 8X12CM
|
Facility
|
IP
|
$19,080.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270681885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,862.00 |
| Max. Negotiated Rate |
$4,617.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,816.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,617.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,862.00
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$74,905.45
|
|
|
Service Code
|
APR-DRG 0071
|
| Min. Negotiated Rate |
$73,436.72 |
| Max. Negotiated Rate |
$74,905.45 |
| Rate for Payer: UnitedHealthcare Community & State |
$73,436.72
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$74,905.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$73,436.72
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$120,574.56
|
|
|
Service Code
|
APR-DRG 0073
|
| Min. Negotiated Rate |
$118,210.35 |
| Max. Negotiated Rate |
$120,574.56 |
| Rate for Payer: UnitedHealthcare Community & State |
$118,210.35
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$120,574.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$118,210.35
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$399,152.89
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$121,536.94 |
| Max. Negotiated Rate |
$399,152.89 |
| Rate for Payer: Aetna Medicare Advantage |
$399,152.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$317,499.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$317,499.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$127,933.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$317,499.30
|
| Rate for Payer: Cigna Commercial |
$267,915.04
|
| Rate for Payer: Cigna Medicare Advantage |
$127,933.62
|
| Rate for Payer: Clover Medicare Advantage |
$121,536.94
|
| Rate for Payer: EmblemHealth Commercial |
$383,800.86
|
| Rate for Payer: Humana Medicare Advantage |
$131,771.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$127,933.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$127,933.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$127,933.62
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$94,975.46
|
|
|
Service Code
|
APR-DRG 0072
|
| Min. Negotiated Rate |
$93,113.20 |
| Max. Negotiated Rate |
$94,975.46 |
| Rate for Payer: UnitedHealthcare Community & State |
$93,113.20
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94,975.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$93,113.20
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$210,342.64
|
|
|
Service Code
|
APR-DRG 0074
|
| Min. Negotiated Rate |
$206,218.27 |
| Max. Negotiated Rate |
$210,342.64 |
| Rate for Payer: UnitedHealthcare Community & State |
$206,218.27
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$210,342.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$206,218.27
|
|
|
ALLOGENIC BONE CELLOGIX
|
Facility
|
IP
|
$19,250.00
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
270692206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,887.50 |
| Max. Negotiated Rate |
$4,658.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,658.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,887.50
|
|
|
ALLOGENIC BONE CELLOGIX
|
Facility
|
OP
|
$19,250.00
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
270692206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.70 |
| Max. Negotiated Rate |
$9,625.00 |
| Rate for Payer: Aetna Commercial |
$7,315.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,775.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,908.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,908.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,908.75
|
| Rate for Payer: Cigna Commercial |
$9,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,658.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,887.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$608.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$546.70
|
|
|
ALLOGENIC BONE SCAFFOLD 10CC
|
Facility
|
IP
|
$36,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,512.50 |
| Max. Negotiated Rate |
$8,893.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,893.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,512.50
|
|
|
ALLOGENIC BONE SCAFFOLD 10CC
|
Facility
|
OP
|
$36,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,043.70 |
| Max. Negotiated Rate |
$18,375.00 |
| Rate for Payer: Aetna Commercial |
$13,965.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,025.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,371.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,371.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,371.25
|
| Rate for Payer: Cigna Commercial |
$18,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,893.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,512.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,161.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,043.70
|
|
