|
NEXGEN KNEE REPLACEMENT EXTENS
|
Facility
|
IP
|
$1,320.00
|
|
| Hospital Charge Code |
270657045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$319.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$264.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$319.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.00
|
|
|
NEXGEN KNEE REPLACEMENT EXTENS
|
Facility
|
OP
|
$1,320.00
|
|
| Hospital Charge Code |
270657045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$501.60
|
| Rate for Payer: Aetna Medicare Advantage |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$336.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$336.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$264.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$336.60
|
| Rate for Payer: Cigna Commercial |
$660.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$319.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$41.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.49
|
|
|
NEXGEN LCCK ART SURG, CD 3-
|
Facility
|
OP
|
$9,270.00
|
|
| Hospital Charge Code |
270665816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.27 |
| Max. Negotiated Rate |
$4,635.00 |
| Rate for Payer: Aetna Commercial |
$3,522.60
|
| Rate for Payer: Aetna Medicare Advantage |
$2,781.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,363.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,363.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,854.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,363.85
|
| Rate for Payer: Cigna Commercial |
$4,635.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,243.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,390.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$292.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$263.27
|
|
|
NEXGEN LCCK ART SURG, CD 3-
|
Facility
|
IP
|
$9,270.00
|
|
| Hospital Charge Code |
270665816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,390.50 |
| Max. Negotiated Rate |
$2,243.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,854.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,243.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,390.50
|
|
|
NEXGEN LCCK FEMORAL SIZE D-
|
Facility
|
IP
|
$28,660.00
|
|
| Hospital Charge Code |
270665817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,299.00 |
| Max. Negotiated Rate |
$6,935.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,732.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,935.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,299.00
|
|
|
NEXGEN LCCK FEMORAL SIZE D-
|
Facility
|
OP
|
$28,660.00
|
|
| Hospital Charge Code |
270665817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.94 |
| Max. Negotiated Rate |
$14,330.00 |
| Rate for Payer: Aetna Commercial |
$10,890.80
|
| Rate for Payer: Aetna Medicare Advantage |
$8,598.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,308.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,308.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,732.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,308.30
|
| Rate for Payer: Cigna Commercial |
$14,330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,935.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,299.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$905.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$813.94
|
|
|
NEXGEN LPS FLEX FIXED 17MM
|
Facility
|
OP
|
$5,862.10
|
|
| Hospital Charge Code |
270667443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.48 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Aetna Commercial |
$2,227.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.84
|
| Rate for Payer: Cigna Commercial |
$2,931.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$166.48
|
|
|
NEXGEN LPS FLEX FIXED 17MM
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270667443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$1,418.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEXGEN LPS-FLEX FIXED CD 17
|
Facility
|
OP
|
$5,860.00
|
|
| Hospital Charge Code |
270667170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.42 |
| Max. Negotiated Rate |
$2,930.00 |
| Rate for Payer: Aetna Commercial |
$2,226.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.30
|
| Rate for Payer: Cigna Commercial |
$2,930.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$166.42
|
|
|
NEXGEN LPS-FLEX FIXED CD 17
|
Facility
|
IP
|
$5,860.00
|
|
| Hospital Charge Code |
270667170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.00 |
| Max. Negotiated Rate |
$1,418.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,172.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,418.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.00
|
|
|
NEXGEN LPS FLEX FIXED PROLONG
|
Facility
|
OP
|
$5,862.10
|
|
| Hospital Charge Code |
270663735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.48 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Aetna Commercial |
$2,227.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.84
|
| Rate for Payer: Cigna Commercial |
$2,931.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,524.15
|
| Rate for Payer: Oxford Commercial |
$1,172.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,172.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$166.48
|
|
|
NEXGEN LPS FLEX FIXED PROLONG
|
Facility
|
OP
|
$5,862.10
|
|
| Hospital Charge Code |
270664940
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.48 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Aetna Commercial |
$2,227.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.84
|
| Rate for Payer: Cigna Commercial |
$2,931.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,524.15
|
| Rate for Payer: Oxford Commercial |
$1,172.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,172.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$166.48
|
|
|
NEXGEN LPS FLEX FIXED PROLONG
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270663735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$879.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEXGEN LPS FLEX FIXED PROLONG
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270664940
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$879.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEXGEN LPS-FLEX FIXED PROLONG
|
Facility
|
OP
|
$5,862.10
|
|
| Hospital Charge Code |
270665483
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.48 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Aetna Commercial |
$2,227.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.84
|
| Rate for Payer: Cigna Commercial |
$2,931.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,524.15
|
| Rate for Payer: Oxford Commercial |
$1,172.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,172.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$166.48
|
|
|
NEXGEN LPS-FLEX FIXED PROLONG
|
Facility
|
OP
|
$5,862.10
|
|
| Hospital Charge Code |
270665484
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.48 |
| Max. Negotiated Rate |
$2,931.05 |
| Rate for Payer: Aetna Commercial |
$2,227.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,758.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,494.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,494.84
|
| Rate for Payer: Cigna Commercial |
$2,931.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,524.15
|
| Rate for Payer: Oxford Commercial |
$1,172.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,172.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$166.48
|
|
|
NEXGEN LPS-FLEX FIXED PROLONG
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270665483
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$879.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEXGEN LPS-FLEX FIXED PROLONG
|
Facility
|
IP
|
$5,862.10
|
|
| Hospital Charge Code |
270665484
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$879.32 |
| Max. Negotiated Rate |
$879.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$879.32
|
|
|
NEXGEN LPS -FLEX FIX POLONG
|
Facility
|
OP
|
$17,040.00
|
|
| Hospital Charge Code |
270660824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.94 |
| Max. Negotiated Rate |
$8,520.00 |
| Rate for Payer: Aetna Commercial |
$6,475.20
|
| Rate for Payer: Aetna Medicare Advantage |
$5,112.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,345.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,345.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,345.20
|
| Rate for Payer: Cigna Commercial |
$8,520.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,123.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,556.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$538.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$483.94
|
|
|
NEXGEN LPS -FLEX FIX POLONG
|
Facility
|
IP
|
$17,040.00
|
|
| Hospital Charge Code |
270660824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,556.00 |
| Max. Negotiated Rate |
$4,123.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,408.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,123.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,556.00
|
|
|
NEXGEN LPS-FLEX OPTION FEMO
|
Facility
|
OP
|
$11,724.30
|
|
| Hospital Charge Code |
270667444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.97 |
| Max. Negotiated Rate |
$5,862.15 |
| Rate for Payer: Aetna Commercial |
$4,455.23
|
| Rate for Payer: Aetna Medicare Advantage |
$3,517.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,989.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,989.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,344.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,989.70
|
| Rate for Payer: Cigna Commercial |
$5,862.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,837.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,758.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$370.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$332.97
|
|
|
NEXGEN LPS-FLEX OPTION FEMO
|
Facility
|
IP
|
$11,724.30
|
|
| Hospital Charge Code |
270667444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,758.64 |
| Max. Negotiated Rate |
$2,837.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,344.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,837.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,758.64
|
|
|
NEXGEN PRECOAT STEMMED TIBIAL
|
Facility
|
OP
|
$8,520.00
|
|
| Hospital Charge Code |
270660655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.97 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,237.60
|
| Rate for Payer: Aetna Medicare Advantage |
$2,556.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,172.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,172.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,704.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$4,260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,061.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,278.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$269.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$241.97
|
|
|
NEXGEN PRECOAT STEMMED TIBIAL
|
Facility
|
IP
|
$6,156.70
|
|
| Hospital Charge Code |
270663736
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$923.50
|
|
|
NEXGEN PRECOAT STEMMED TIBIAL
|
Facility
|
OP
|
$6,156.70
|
|
| Hospital Charge Code |
270663736
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$3,078.35 |
| Rate for Payer: Aetna Commercial |
$2,339.55
|
| Rate for Payer: Aetna Medicare Advantage |
$1,847.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,569.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,569.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,569.96
|
| Rate for Payer: Cigna Commercial |
$3,078.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,600.74
|
| Rate for Payer: Oxford Commercial |
$1,231.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$923.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,231.34
|
| Rate for Payer: UnitedHealthcare Community & State |
$194.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$174.85
|
|