|
STD FEM STEM ECHO SZ 10
|
Facility
|
IP
|
$15,000.00
|
|
| Hospital Charge Code |
270702516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,250.00 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,630.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,250.00
|
|
|
STD HUMERAL DIAPH 0 CEMENT SZ8
|
Facility
|
OP
|
$17,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270696739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$8,750.00 |
| Rate for Payer: Aetna Commercial |
$6,650.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,462.50
|
| Rate for Payer: Cigna Commercial |
$8,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,235.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,625.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$553.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$497.00
|
|
|
STD HUMERAL DIAPH 0 CEMENT SZ8
|
Facility
|
IP
|
$17,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270696739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,625.00 |
| Max. Negotiated Rate |
$4,235.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,235.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,625.00
|
|
|
STD TULIP
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
STD TULIP
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$570.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.60
|
|
|
STEBT MULTI-LINK RX 4.0X28MM
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270643627C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,140.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$94.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$85.20
|
|
|
STEBT MULTI-LINK RX 4.0X28MM
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270643627C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
STEEM 16MM
|
Facility
|
OP
|
$5,400.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270688090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.36 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$2,052.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,620.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,377.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,377.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,080.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,377.00
|
| Rate for Payer: Cigna Commercial |
$2,700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,306.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$810.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$170.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$153.36
|
|
|
STEEM 16MM
|
Facility
|
IP
|
$5,400.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270688090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$1,306.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,080.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,306.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$810.00
|
|
|
STEIMAN PIN 3/32 X 9 IN TROCAR
|
Facility
|
OP
|
$56.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna Commercial |
$21.38
|
| Rate for Payer: Aetna Medicare Advantage |
$16.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.34
|
| Rate for Payer: Cigna Commercial |
$28.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.60
|
|
|
STEIMAN PIN 3/32 X 9 IN TROCAR
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.44
|
|
|
STEINMANN 1/8
|
Facility
|
OP
|
$17.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Medicare Advantage |
$5.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.40
|
| Rate for Payer: Cigna Commercial |
$8.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.49
|
|
|
STEINMANN 1/8
|
Facility
|
IP
|
$17.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.59
|
|
|
STEINMANN 3/16
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.28
|
|
|
STEINMANN 3/16
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$10.93 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Medicare Advantage |
$6.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.57
|
| Rate for Payer: Cigna Commercial |
$10.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.28
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.62
|
|
|
STEINMANN 5/32
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$10.93 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Medicare Advantage |
$6.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.57
|
| Rate for Payer: Cigna Commercial |
$10.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.28
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.62
|
|
|
STEINMANN 5/32
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.28
|
|
|
STEINMANN 7/64
|
Facility
|
OP
|
$13.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: Aetna Commercial |
$5.24
|
| Rate for Payer: Aetna Medicare Advantage |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.52
|
| Rate for Payer: Cigna Commercial |
$6.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.39
|
|
|
STEINMANN 7/64
|
Facility
|
IP
|
$13.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$3.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.07
|
|
|
STEINMANN 9/64
|
Facility
|
OP
|
$17.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Medicare Advantage |
$5.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.40
|
| Rate for Payer: Cigna Commercial |
$8.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.49
|
|
|
STEINMANN 9/64
|
Facility
|
IP
|
$17.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.59
|
|
|
STEINMANN PIN WITH 5.0MM
|
Facility
|
IP
|
$594.00
|
|
| Hospital Charge Code |
270663423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.10
|
|
|
STEINMANN PIN WITH 5.0MM
|
Facility
|
OP
|
$594.00
|
|
| Hospital Charge Code |
270663423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Medicare Advantage |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$151.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$151.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$151.47
|
| Rate for Payer: Cigna Commercial |
$297.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$154.44
|
| Rate for Payer: Oxford Commercial |
$118.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$118.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.87
|
|
|
STEINMAN PIN 2MM
|
Facility
|
IP
|
$23.10
|
|
| Hospital Charge Code |
270699578
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.46
|
|
|
STEINMAN PIN 2MM
|
Facility
|
OP
|
$23.10
|
|
| Hospital Charge Code |
270699578
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Aetna Medicare Advantage |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.89
|
| Rate for Payer: Cigna Commercial |
$11.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.01
|
| Rate for Payer: Oxford Commercial |
$4.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.66
|
|