|
SHOE ORTHOWEDGE LARGE
|
Facility
|
OP
|
$184.95
|
|
| Hospital Charge Code |
270650012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$92.47 |
| Rate for Payer: Aetna Commercial |
$70.28
|
| Rate for Payer: Aetna Medicare Advantage |
$55.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.16
|
| Rate for Payer: Cigna Commercial |
$92.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.09
|
| Rate for Payer: Oxford Commercial |
$36.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.99
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.25
|
|
|
SHOE ORTHO WEDGE MEDIUM
|
Facility
|
OP
|
$174.75
|
|
| Hospital Charge Code |
270641374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$87.38 |
| Rate for Payer: Aetna Commercial |
$66.41
|
| Rate for Payer: Aetna Medicare Advantage |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.56
|
| Rate for Payer: Cigna Commercial |
$87.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.44
|
| Rate for Payer: Oxford Commercial |
$34.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.96
|
|
|
SHOE ORTHO WEDGE MEDIUM
|
Facility
|
IP
|
$174.75
|
|
| Hospital Charge Code |
270641374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$26.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.21
|
|
|
SHOE ORTHOWEDGE XL
|
Facility
|
IP
|
$176.50
|
|
| Hospital Charge Code |
270647499
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.48
|
|
|
SHOE ORTHOWEDGE XL
|
Facility
|
OP
|
$176.50
|
|
| Hospital Charge Code |
270647499
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$88.25 |
| Rate for Payer: Aetna Commercial |
$67.07
|
| Rate for Payer: Aetna Medicare Advantage |
$52.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.01
|
| Rate for Payer: Cigna Commercial |
$88.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.89
|
| Rate for Payer: Oxford Commercial |
$35.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.01
|
|
|
SHOE POST-OP FEMALE LARGE
|
Facility
|
OP
|
$48.95
|
|
| Hospital Charge Code |
270649887
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$24.48 |
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna Medicare Advantage |
$14.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.48
|
| Rate for Payer: Cigna Commercial |
$24.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.73
|
| Rate for Payer: Oxford Commercial |
$9.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.39
|
|
|
SHOE POST-OP FEMALE LARGE
|
Facility
|
IP
|
$48.95
|
|
| Hospital Charge Code |
270649887
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.34
|
|
|
SHOE POST OP FEMALE MEDIUM
|
Facility
|
OP
|
$48.95
|
|
| Hospital Charge Code |
270649886
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$24.48 |
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna Medicare Advantage |
$14.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.48
|
| Rate for Payer: Cigna Commercial |
$24.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.73
|
| Rate for Payer: Oxford Commercial |
$9.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.39
|
|
|
SHOE POST OP FEMALE MEDIUM
|
Facility
|
IP
|
$48.95
|
|
| Hospital Charge Code |
270649886
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.34
|
|
|
SHOE POST OP FEMALE SMALL
|
Facility
|
OP
|
$49.55
|
|
| Hospital Charge Code |
270649885
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: Aetna Medicare Advantage |
$14.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.64
|
| Rate for Payer: Cigna Commercial |
$24.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.88
|
| Rate for Payer: Oxford Commercial |
$9.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.41
|
|
|
SHOE POST OP FEMALE SMALL
|
Facility
|
IP
|
$49.55
|
|
| Hospital Charge Code |
270649885
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.43
|
|
|
SHOE POST-OP MALE LARGE
|
Facility
|
IP
|
$55.40
|
|
| Hospital Charge Code |
270649874
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$8.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.31
|
|
|
SHOE POST-OP MALE LARGE
|
Facility
|
OP
|
$55.40
|
|
| Hospital Charge Code |
270649874
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: Aetna Commercial |
$21.05
|
| Rate for Payer: Aetna Medicare Advantage |
$16.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.13
|
| Rate for Payer: Cigna Commercial |
$27.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.40
|
| Rate for Payer: Oxford Commercial |
$11.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.57
|
|
|
SHOE POST-OP MALE MEDIUM
|
Facility
|
OP
|
$48.95
|
|
| Hospital Charge Code |
270649869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$24.48 |
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna Medicare Advantage |
$14.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.48
|
| Rate for Payer: Cigna Commercial |
$24.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.73
|
| Rate for Payer: Oxford Commercial |
$9.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.39
|
|
|
SHOE POST-OP MALE MEDIUM
|
Facility
|
IP
|
$48.95
|
|
| Hospital Charge Code |
270649869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.34
|
|
|
SHOE POST-OP MALE SMALL
|
Facility
|
OP
|
$49.00
|
|
| Hospital Charge Code |
270649871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Medicare Advantage |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.49
|
| Rate for Payer: Cigna Commercial |
$24.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.74
|
| Rate for Payer: Oxford Commercial |
$9.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.39
|
|
|
SHOE POST-OP MALE SMALL
|
Facility
|
IP
|
$49.00
|
|
| Hospital Charge Code |
270649871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$7.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.35
|
|
|
SHOE POST-OP MEN'S LG
|
Facility
|
IP
|
$19.40
|
|
| Hospital Charge Code |
270302880
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.91
|
|
|
SHOE POST-OP MEN'S LG
|
Facility
|
IP
|
$19.40
|
|
| Hospital Charge Code |
270302880W
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.91
|
|
|
SHOE POST-OP MEN'S LG
|
Facility
|
OP
|
$19.40
|
|
| Hospital Charge Code |
270302880
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Aetna Commercial |
$7.37
|
| Rate for Payer: Aetna Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.95
|
| Rate for Payer: Cigna Commercial |
$9.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.04
|
| Rate for Payer: Oxford Commercial |
$3.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.55
|
|
|
SHOE POST-OP MEN'S LG
|
Facility
|
OP
|
$19.40
|
|
| Hospital Charge Code |
270302880W
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Aetna Commercial |
$7.37
|
| Rate for Payer: Aetna Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.95
|
| Rate for Payer: Cigna Commercial |
$9.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.04
|
| Rate for Payer: Oxford Commercial |
$3.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.55
|
|
|
SHOE POST-OP MEN'S MED
|
Facility
|
IP
|
$19.40
|
|
| Hospital Charge Code |
270302875W
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.91
|
|
|
SHOE POST-OP MEN'S MED
|
Facility
|
IP
|
$19.40
|
|
| Hospital Charge Code |
270302875
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.91
|
|
|
SHOE POST-OP MEN'S MED
|
Facility
|
OP
|
$19.40
|
|
| Hospital Charge Code |
270302875
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Aetna Commercial |
$7.37
|
| Rate for Payer: Aetna Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.95
|
| Rate for Payer: Cigna Commercial |
$9.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.04
|
| Rate for Payer: Oxford Commercial |
$3.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.55
|
|
|
SHOE POST-OP MEN'S MED
|
Facility
|
OP
|
$19.40
|
|
| Hospital Charge Code |
270302875W
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Aetna Commercial |
$7.37
|
| Rate for Payer: Aetna Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.95
|
| Rate for Payer: Cigna Commercial |
$9.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.04
|
| Rate for Payer: Oxford Commercial |
$3.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.55
|
|