|
INTEGRA WOUND MATRIX 2INx2IN
|
Facility
|
IP
|
$7,290.00
|
|
|
Service Code
|
HCPCS Q4108
|
| Hospital Charge Code |
270686598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.50 |
| Max. Negotiated Rate |
$1,764.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,458.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,764.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,093.50
|
|
|
INTEGRA WOUND MATRIX 2INx2IN
|
Facility
|
OP
|
$7,290.00
|
|
|
Service Code
|
HCPCS Q4108
|
| Hospital Charge Code |
270686598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$1,764.18 |
| 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 |
$1,458.00
|
| 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 |
$1,764.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,093.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$230.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$207.04
|
|
|
INTEGRA/X POR RED PROX 8MM
|
Facility
|
IP
|
$10,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270680609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$2,541.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,541.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,575.00
|
|
|
INTEGRA/X POR RED PROX 8MM
|
Facility
|
OP
|
$10,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270680609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$3,990.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,677.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,677.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,677.50
|
| Rate for Payer: Cigna Commercial |
$5,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,541.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,575.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$331.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$298.20
|
|
|
INTEGRL 180MM RDCD PROX 17X180
|
Facility
|
OP
|
$50,388.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.02 |
| Max. Negotiated Rate |
$25,194.00 |
| Rate for Payer: Aetna Commercial |
$19,147.44
|
| Rate for Payer: Aetna Medicare Advantage |
$15,116.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,848.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,848.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10,077.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,848.94
|
| Rate for Payer: Cigna Commercial |
$25,194.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,193.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,558.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,592.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,431.02
|
|
|
INTEGRL 180MM RDCD PROX 17X180
|
Facility
|
IP
|
$50,388.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,558.20 |
| Max. Negotiated Rate |
$12,193.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10,077.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,193.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,558.20
|
|
|
INTEGRO BONE MATRIX PASTE 2 CC
|
Facility
|
OP
|
$1,002.00
|
|
| Hospital Charge Code |
270339087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Aetna Commercial |
$380.76
|
| Rate for Payer: Aetna Medicare Advantage |
$300.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.51
|
| Rate for Payer: Cigna Commercial |
$501.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.46
|
|
|
INTEGRO BONE MATRIX PASTE 2 CC
|
Facility
|
IP
|
$1,002.00
|
|
| Hospital Charge Code |
270339087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$242.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.30
|
|
|
INTEGR SHRT GTRW/2 CABLE 23X53
|
Facility
|
OP
|
$8,482.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.90 |
| Max. Negotiated Rate |
$4,241.25 |
| Rate for Payer: Aetna Commercial |
$3,223.35
|
| Rate for Payer: Aetna Medicare Advantage |
$2,544.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,163.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,163.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,696.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,163.04
|
| Rate for Payer: Cigna Commercial |
$4,241.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,052.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,272.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$268.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$240.90
|
|
|
INTEGR SHRT GTRW/2 CABLE 23X53
|
Facility
|
IP
|
$8,482.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.38 |
| Max. Negotiated Rate |
$2,052.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,696.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,052.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,272.38
|
|
|
INTELLIJOINT HIP KIT
|
Facility
|
IP
|
$5,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270704147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.75 |
| Max. Negotiated Rate |
$1,312.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,085.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,312.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$813.75
|
|
|
INTELLIJOINT HIP KIT
|
Facility
|
OP
|
$5,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270704147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.07 |
| Max. Negotiated Rate |
$2,712.50 |
| Rate for Payer: Aetna Commercial |
$2,061.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,627.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,383.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,383.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,085.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,383.38
|
| Rate for Payer: Cigna Commercial |
$2,712.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,312.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$813.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.07
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$22,356.32
|
|
|
Service Code
|
APR-DRG 8174
|
| Min. Negotiated Rate |
$21,917.96 |
| Max. Negotiated Rate |
$22,356.32 |
| Rate for Payer: UnitedHealthcare Community & State |
$21,917.96
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$22,356.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21,917.96
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$5,170.92
|
|
|
Service Code
|
APR-DRG 8171
|
| Min. Negotiated Rate |
$5,069.53 |
| Max. Negotiated Rate |
$5,170.92 |
| Rate for Payer: UnitedHealthcare Community & State |
$5,069.53
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$5,170.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5,069.53
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$6,607.62
|
|
|
Service Code
|
APR-DRG 8172
|
| Min. Negotiated Rate |
$6,478.06 |
| Max. Negotiated Rate |
$6,607.62 |
| Rate for Payer: UnitedHealthcare Community & State |
$6,478.06
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$6,607.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6,478.06
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$11,254.70
|
|
|
Service Code
|
APR-DRG 8173
|
| Min. Negotiated Rate |
$11,034.02 |
| Max. Negotiated Rate |
$11,254.70 |
| Rate for Payer: UnitedHealthcare Community & State |
$11,034.02
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$11,254.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11,034.02
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4818709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.81
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4818709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4518709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4515709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.81
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4510709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4832709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.81
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4515709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4824709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4511709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
