|
ALLOGRAFT FLOW 1CC FD
|
Facility
|
OP
|
$650.00
|
|
| Hospital Charge Code |
270671267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$247.00
|
| Rate for Payer: Aetna Medicare Advantage |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$165.75
|
| Rate for Payer: Cigna Commercial |
$325.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.46
|
|
|
ALLOGRAFT FLOW 1CC FD
|
Facility
|
IP
|
$650.00
|
|
| Hospital Charge Code |
270671267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.50
|
|
|
ALLOGRAFT FLOW .5CC FD
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
270671266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$152.00
|
| Rate for Payer: Aetna Medicare Advantage |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.36
|
|
|
ALLOGRAFT FLOW .5CC FD
|
Facility
|
IP
|
$400.00
|
|
| Hospital Charge Code |
270671266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$96.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
ALLOGRAFT FLOW 5CC FD
|
Facility
|
OP
|
$2,610.00
|
|
| Hospital Charge Code |
270671268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.12 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$991.80
|
| Rate for Payer: Aetna Medicare Advantage |
$783.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$665.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$665.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$665.55
|
| Rate for Payer: Cigna Commercial |
$1,305.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$631.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$391.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$82.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.12
|
|
|
ALLOGRAFT FLOW 5CC FD
|
Facility
|
IP
|
$2,610.00
|
|
| Hospital Charge Code |
270671268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.50 |
| Max. Negotiated Rate |
$631.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$522.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$631.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$391.50
|
|
|
ALLOGRAFT GRAFTLINK CONV PK
|
Facility
|
OP
|
$4,700.00
|
|
| Hospital Charge Code |
270676749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.48 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$1,786.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,410.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,198.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,198.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,198.50
|
| Rate for Payer: Cigna Commercial |
$2,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,222.00
|
| Rate for Payer: Oxford Commercial |
$940.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$705.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$940.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$148.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$133.48
|
|
|
ALLOGRAFT GRAFTLINK CONV PK
|
Facility
|
IP
|
$4,700.00
|
|
| Hospital Charge Code |
270676749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$705.00
|
|
|
ALLOGRAFT HD 8X16
|
Facility
|
OP
|
$25,345.00
|
|
| Hospital Charge Code |
270664855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.80 |
| Max. Negotiated Rate |
$12,672.50 |
| Rate for Payer: Aetna Commercial |
$9,631.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,603.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,462.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,462.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,069.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,462.98
|
| Rate for Payer: Cigna Commercial |
$12,672.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,133.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,801.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$800.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$719.80
|
|
|
ALLOGRAFT HD 8X16
|
Facility
|
IP
|
$25,345.00
|
|
| Hospital Charge Code |
270664855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,801.75 |
| Max. Negotiated Rate |
$6,133.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,069.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,133.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,801.75
|
|
|
ALLOGRAFT HTM SELECT 16X20CM
|
Facility
|
OP
|
$69,780.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270695111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$16,886.76 |
| 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 |
$13,956.00
|
| 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 |
$16,886.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10,467.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,205.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,981.75
|
|
|
ALLOGRAFT HTM SELECT 16X20CM
|
Facility
|
IP
|
$69,780.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
270695111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,467.00 |
| Max. Negotiated Rate |
$16,886.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13,956.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,886.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10,467.00
|
|
|
ALLOGRAFT IC RT MOLD 10CC FD
|
Facility
|
IP
|
$5,165.00
|
|
| Hospital Charge Code |
270671272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$774.75 |
| Max. Negotiated Rate |
$1,249.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,033.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,249.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$774.75
|
|
|
ALLOGRAFT IC RT MOLD 10CC FD
|
Facility
|
OP
|
$5,165.00
|
|
| Hospital Charge Code |
270671272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$2,582.50 |
| Rate for Payer: Aetna Commercial |
$1,962.70
|
| Rate for Payer: Aetna Medicare Advantage |
$1,549.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,317.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,317.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,033.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,317.08
|
| Rate for Payer: Cigna Commercial |
$2,582.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,249.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$774.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$163.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$146.69
|
|
|
ALLOGRAFT IC RT MOLD 20CC FD
|
Facility
|
OP
|
$10,360.00
|
|
| Hospital Charge Code |
270671273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.22 |
| Max. Negotiated Rate |
$5,180.00 |
| Rate for Payer: Aetna Commercial |
$3,936.80
|
| Rate for Payer: Aetna Medicare Advantage |
$3,108.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,641.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,641.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,072.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,641.80
|
| Rate for Payer: Cigna Commercial |
$5,180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,507.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,554.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$327.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$294.22
|
|
|
ALLOGRAFT IC RT MOLD 20CC FD
|
Facility
|
IP
|
$10,360.00
|
|
| Hospital Charge Code |
270671273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,554.00 |
| Max. Negotiated Rate |
$2,507.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,072.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,507.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,554.00
|
|
|
ALLOGRAFT IC RT MOLD 2CC FD
|
Facility
|
IP
|
$1,715.00
|
|
| Hospital Charge Code |
270671270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.25 |
| Max. Negotiated Rate |
$415.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$343.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$415.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$257.25
|
|
|
ALLOGRAFT IC RT MOLD 2CC FD
|
Facility
|
OP
|
$1,715.00
|
|
| Hospital Charge Code |
270671270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.71 |
| Max. Negotiated Rate |
$857.50 |
| Rate for Payer: Aetna Commercial |
$651.70
|
| Rate for Payer: Aetna Medicare Advantage |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$437.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$437.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$437.32
|
| Rate for Payer: Cigna Commercial |
$857.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$415.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$257.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.71
|
|
|
ALLOGRAFT IC RT MOLD 5CC FD
|
Facility
|
IP
|
$3,360.00
|
|
| Hospital Charge Code |
270671271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$813.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$672.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$813.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$504.00
|
|
|
ALLOGRAFT IC RT MOLD 5CC FD
|
Facility
|
OP
|
$3,360.00
|
|
| Hospital Charge Code |
270671271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,276.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,008.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$856.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$856.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$672.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$856.80
|
| Rate for Payer: Cigna Commercial |
$1,680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$813.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$504.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$106.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$95.42
|
|
|
ALLOGRAFT IMPLANT SYS FOR INTE
|
Facility
|
OP
|
$10,068.25
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270705066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.94 |
| Max. Negotiated Rate |
$5,034.12 |
| Rate for Payer: Aetna Commercial |
$3,825.93
|
| Rate for Payer: Aetna Medicare Advantage |
$3,020.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,567.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,567.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,013.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,567.40
|
| Rate for Payer: Cigna Commercial |
$5,034.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,436.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,510.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$318.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$285.94
|
|
|
ALLOGRAFT IMPLANT SYS FOR INTE
|
Facility
|
IP
|
$10,068.25
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270705066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,510.24 |
| Max. Negotiated Rate |
$2,436.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,013.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,436.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,510.24
|
|
|
ALLOGRAFT MAGNUS 10 CC
|
Facility
|
OP
|
$19,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693724
|
|
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
|
|
|
ALLOGRAFT MAGNUS 10 CC
|
Facility
|
IP
|
$19,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693724
|
|
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
|
|
|
ALLOGRAFT MAGNUS 2.5CC
|
Facility
|
IP
|
$5,975.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
270698652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.25 |
| Max. Negotiated Rate |
$1,445.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,445.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$896.25
|
|