|
POST ANGLED 30 DEGREES HII MRI
|
Facility
|
OP
|
$578.15
|
|
| Hospital Charge Code |
270648003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$289.07 |
| Rate for Payer: Aetna Commercial |
$219.70
|
| Rate for Payer: Aetna Medicare Advantage |
$173.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$147.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$147.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$147.43
|
| Rate for Payer: Cigna Commercial |
$289.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.72
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.42
|
|
|
POST ANGLED 30 DEGREES HII MRI
|
Facility
|
IP
|
$578.15
|
|
| Hospital Charge Code |
270648003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$139.91 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.72
|
|
|
POST ATTUNE FEMORAL SZ 5 CEMEN
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270686915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
POST ATTUNE FEMORAL SZ 5 CEMEN
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270686915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.30 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$4,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$339.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$305.30
|
|
|
POST ATTUNE FEMORAL SZ 5 CEMEN
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
POST ATTUNE FEMORAL SZ 5 CEMEN
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.30 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$4,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$339.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$305.30
|
|
|
POST ATTUNE FEMORAL SZ 6 CEMNT
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.30 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$4,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$339.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$305.30
|
|
|
POST ATTUNE FEMORAL SZ 6 CEMNT
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
POST ATTUNE FEMORAL SZ 7 CEMEN
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687592
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.30 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$4,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$339.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$305.30
|
|
|
POST ATTUNE FEMORAL SZ 7 CEMEN
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270687592
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
POST AUG SZ 95MM REV PSN
|
Facility
|
OP
|
$7,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270690148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.49 |
| Max. Negotiated Rate |
$3,987.50 |
| Rate for Payer: Aetna Commercial |
$3,030.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,392.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,595.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,033.62
|
| Rate for Payer: Cigna Commercial |
$3,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,929.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$252.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$226.49
|
|
|
POST AUG SZ 95MM REV PSN
|
Facility
|
IP
|
$7,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270690148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$1,929.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,929.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
|
|
POST CAPSULAR RELEASE KNEE
|
Facility
|
IP
|
$10,493.36
|
|
|
Service Code
|
HCPCS 27435
|
| Hospital Charge Code |
1600000464
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,574.00 |
| Max. Negotiated Rate |
$1,574.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,574.00
|
|
|
POST CAPSULAR RELEASE KNEE
|
Facility
|
OP
|
$10,493.36
|
|
|
Service Code
|
HCPCS 27435
|
| Hospital Charge Code |
1600000464
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$298.01 |
| Max. Negotiated Rate |
$14,100.89 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14,100.89
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,728.27
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,574.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$331.59
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$298.01
|
|
|
POST CHAMBER LENS MC60CM ALCON
|
Facility
|
IP
|
$174.00
|
|
| Hospital Charge Code |
270335902
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$42.11 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.10
|
|
|
POST CHAMBER LENS MC60CM ALCON
|
Facility
|
OP
|
$174.00
|
|
| Hospital Charge Code |
270335902
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Commercial |
$66.12
|
| Rate for Payer: Aetna Medicare Advantage |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.37
|
| Rate for Payer: Cigna Commercial |
$87.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.94
|
|
|
POST CHAMBER LENS SA60AT-ALCON
|
Facility
|
IP
|
$306.00
|
|
| Hospital Charge Code |
270335901
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.90
|
|
|
POST CHAMBER LENS SA60AT-ALCON
|
Facility
|
OP
|
$306.00
|
|
| Hospital Charge Code |
270335901
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: Aetna Medicare Advantage |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.03
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.69
|
|
|
POST CHAMBER LENS-SN60WF ALCON
|
Facility
|
OP
|
$347.00
|
|
| Hospital Charge Code |
270335900
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$173.50 |
| Rate for Payer: Aetna Commercial |
$131.86
|
| Rate for Payer: Aetna Medicare Advantage |
$104.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$88.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$88.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$88.48
|
| Rate for Payer: Cigna Commercial |
$173.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$83.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.85
|
|
|
POST CHAMBER LENS-SN60WF ALCON
|
Facility
|
IP
|
$347.00
|
|
| Hospital Charge Code |
270335900
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$52.05 |
| Max. Negotiated Rate |
$83.97 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$83.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.05
|
|
|
POST-ENDO RECOVERY/HR
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
1500112
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$304.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.00
|
| Rate for Payer: Oxford Commercial |
$160.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$160.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.72
|
|
|
POST-ENDO RECOVERY/HR
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
1500112
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
POSTERIOR TBI FIXED SZ3 8MM
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270700498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
POSTERIOR TBI FIXED SZ3 8MM
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270700498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$142.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$127.80
|
|
|
POST EX-FIX LG 30DEG OUTR 11MM
|
Facility
|
IP
|
$582.40
|
|
| Hospital Charge Code |
270642898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.36
|
|