|
ONLAY TIB INSRT SZ1 10MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ1 12MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ1 12MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ 1 8MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ 1 8MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ 1 9MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ 1 9MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ2 10MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ2 10MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ2 12MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ2 12MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ 2 8MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ 2 8MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ 2 9MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ 2 9MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ3 12MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ3 12MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ3 8MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ3 8MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ3 9MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ3 9MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ4 10MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ4 10MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ4 12MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ4 12MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|