|
STEM COLLARED STD 4
|
Facility
|
OP
|
$8,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270688585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$3,040.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,040.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,040.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,040.00
|
| Rate for Payer: Cigna Commercial |
$4,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,936.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,200.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$252.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$227.20
|
|
|
STEM COMPLETE XR 123 DEG SZ 8
|
Facility
|
OP
|
$10,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$3,990.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,677.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,677.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,677.50
|
| Rate for Payer: Cigna Commercial |
$5,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,541.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,575.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$331.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$298.20
|
|
|
STEM COMPLETE XR 123 DEG SZ 8
|
Facility
|
IP
|
$10,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$2,541.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,541.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,575.00
|
|
|
STEM COMP PRIMARY 7MM MINI
|
Facility
|
IP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270690732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.00 |
| Max. Negotiated Rate |
$3,509.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,509.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.00
|
|
|
STEM COMP PRIMARY 7MM MINI
|
Facility
|
OP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270690732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.80 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: Aetna Commercial |
$5,510.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,697.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,697.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,697.50
|
| Rate for Payer: Cigna Commercial |
$7,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,509.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$458.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$411.80
|
|
|
STEM COMP PRIMARY STD 12X122MM
|
Facility
|
OP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270695586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.80 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: Aetna Commercial |
$5,510.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,697.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,697.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,697.50
|
| Rate for Payer: Cigna Commercial |
$7,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,509.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$458.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$411.80
|
|
|
STEM COMP PRIMARY STD 12X122MM
|
Facility
|
IP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270695586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.00 |
| Max. Negotiated Rate |
$3,509.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,509.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.00
|
|
|
STEM COMP PRIMARY STD 9X122MM
|
Facility
|
IP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.00 |
| Max. Negotiated Rate |
$3,509.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,509.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.00
|
|
|
STEM COMP PRIMARY STD 9X122MM
|
Facility
|
OP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.80 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: Aetna Commercial |
$5,510.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,697.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,697.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,697.50
|
| Rate for Payer: Cigna Commercial |
$7,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,509.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$458.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$411.80
|
|
|
STEM COMP STD PRIMARY 7X122MM
|
Facility
|
OP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270695499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.80 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: Aetna Commercial |
$5,510.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,697.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,697.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,697.50
|
| Rate for Payer: Cigna Commercial |
$7,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,509.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$458.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$411.80
|
|
|
STEM COMP STD PRIMARY 7X122MM
|
Facility
|
IP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270695499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.00 |
| Max. Negotiated Rate |
$3,509.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,509.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,175.00
|
|
|
STEM DEF FEMORAL SZ 4 STD 114
|
Facility
|
OP
|
$9,025.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.31 |
| Max. Negotiated Rate |
$4,512.50 |
| Rate for Payer: Aetna Commercial |
$3,429.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,707.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,301.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,301.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,805.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,301.38
|
| Rate for Payer: Cigna Commercial |
$4,512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,184.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,353.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$285.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$256.31
|
|
|
STEM DEF FEMORAL SZ 4 STD 114
|
Facility
|
IP
|
$9,025.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,353.75 |
| Max. Negotiated Rate |
$2,184.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,805.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,184.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,353.75
|
|
|
STEM DISTAL BULLET BOWED
|
Facility
|
IP
|
$18,660.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270690937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,799.00 |
| Max. Negotiated Rate |
$4,515.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,732.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,515.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,799.00
|
|
|
STEM DISTAL BULLET BOWED
|
Facility
|
OP
|
$18,660.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270690937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.94 |
| Max. Negotiated Rate |
$9,330.00 |
| Rate for Payer: Aetna Commercial |
$7,090.80
|
| Rate for Payer: Aetna Medicare Advantage |
$5,598.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,758.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,758.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,732.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,758.30
|
| Rate for Payer: Cigna Commercial |
$9,330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,515.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,799.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$589.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$529.94
|
|
|
STEM DISTAL TAPERLOC 14x148MM
|
Facility
|
OP
|
$10,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270675678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$3,990.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,677.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,677.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,677.50
|
| Rate for Payer: Cigna Commercial |
$5,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,541.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,575.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$331.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$298.20
|
|
|
STEM DISTAL TAPERLOC 14x148MM
|
Facility
|
IP
|
$10,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270675678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$2,541.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,541.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,575.00
|
|
|
STEM DISTAL TAPERLOC 15X150MM
|
Facility
|
IP
|
$12,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270676517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,837.50 |
| Max. Negotiated Rate |
$2,964.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,964.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,837.50
|
|
|
STEM DISTAL TAPERLOC 15X150MM
|
Facility
|
OP
|
$12,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270676517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.90 |
| Max. Negotiated Rate |
$6,125.00 |
| Rate for Payer: Aetna Commercial |
$4,655.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,123.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,123.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,123.75
|
| Rate for Payer: Cigna Commercial |
$6,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,964.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,837.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$387.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$347.90
|
|
|
STEM DISTAL TAPERLOC 4X128MM
|
Facility
|
IP
|
$10,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270698811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$2,541.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,541.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,575.00
|
|
|
STEM DISTAL TAPERLOC 4X128MM
|
Facility
|
OP
|
$10,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270698811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$3,990.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,677.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,677.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,677.50
|
| Rate for Payer: Cigna Commercial |
$5,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,541.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,575.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$331.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$298.20
|
|
|
STEM DISTAL W/SCREW 16x190mm
|
Facility
|
IP
|
$20,320.00
|
|
| Hospital Charge Code |
270675923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.00 |
| Max. Negotiated Rate |
$4,917.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,064.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,917.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,048.00
|
|
|
STEM DISTAL W/SCREW 16x190mm
|
Facility
|
OP
|
$20,320.00
|
|
| Hospital Charge Code |
270675923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.09 |
| Max. Negotiated Rate |
$10,160.00 |
| Rate for Payer: Aetna Commercial |
$7,721.60
|
| Rate for Payer: Aetna Medicare Advantage |
$6,096.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,181.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,181.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,064.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,181.60
|
| Rate for Payer: Cigna Commercial |
$10,160.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,917.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,048.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$642.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$577.09
|
|
|
STEM E1 VNGD PS+TIB BRG
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270681468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
STEM E1 VNGD PS+TIB BRG
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270681468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,280.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,530.00
|
| Rate for Payer: Cigna Commercial |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$189.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$170.40
|
|