|
STEM HIP SECURE FIT #7 30x130M
|
Facility
|
OP
|
$12,957.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270676938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.98 |
| Max. Negotiated Rate |
$6,478.50 |
| Rate for Payer: Aetna Commercial |
$4,923.66
|
| Rate for Payer: Aetna Medicare Advantage |
$3,887.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,304.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,304.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,591.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,304.03
|
| Rate for Payer: Cigna Commercial |
$6,478.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,135.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,943.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$409.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$367.98
|
|
|
STEM HIP SZ10 35X46X160X16MM
|
Facility
|
IP
|
$14,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270670749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,227.50 |
| Max. Negotiated Rate |
$3,593.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,970.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,593.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,227.50
|
|
|
STEM HIP SZ10 35X46X160X16MM
|
Facility
|
OP
|
$14,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270670749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.74 |
| Max. Negotiated Rate |
$7,425.00 |
| Rate for Payer: Aetna Commercial |
$5,643.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,455.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,786.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,786.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,970.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,786.75
|
| Rate for Payer: Cigna Commercial |
$7,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,593.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,227.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$469.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$421.74
|
|
|
STEM HIP SZ10 40MM
|
Facility
|
IP
|
$33,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270677226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,951.05 |
| Max. Negotiated Rate |
$7,987.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,601.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,987.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,951.05
|
|
|
STEM HIP SZ10 40MM
|
Facility
|
OP
|
$33,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270677226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.40 |
| Max. Negotiated Rate |
$16,503.50 |
| Rate for Payer: Aetna Commercial |
$12,542.66
|
| Rate for Payer: Aetna Medicare Advantage |
$9,902.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,416.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,416.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,601.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,416.78
|
| Rate for Payer: Cigna Commercial |
$16,503.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,987.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,951.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,043.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$937.40
|
|
|
STEM HIP SZ10 C-TPR 35x155MM
|
Facility
|
IP
|
$20,948.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270680586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,142.34 |
| Max. Negotiated Rate |
$5,069.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,189.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,069.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,142.34
|
|
|
STEM HIP SZ10 C-TPR 35x155MM
|
Facility
|
OP
|
$20,948.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270680586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.95 |
| Max. Negotiated Rate |
$10,474.48 |
| Rate for Payer: Aetna Commercial |
$7,960.60
|
| Rate for Payer: Aetna Medicare Advantage |
$6,284.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,341.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,341.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,189.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,341.98
|
| Rate for Payer: Cigna Commercial |
$10,474.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,069.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,142.34
|
| Rate for Payer: UnitedHealthcare Community & State |
$661.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$594.95
|
|
|
STEM HIP SZ10 C-TPR 40x155MM
|
Facility
|
OP
|
$34,213.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270672696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.66 |
| Max. Negotiated Rate |
$17,106.75 |
| Rate for Payer: Aetna Commercial |
$13,001.13
|
| Rate for Payer: Aetna Medicare Advantage |
$10,264.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,724.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,724.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,842.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,724.44
|
| Rate for Payer: Cigna Commercial |
$17,106.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,279.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,132.02
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,081.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$971.66
|
|
|
STEM HIP SZ10 C-TPR 40x155MM
|
Facility
|
IP
|
$34,213.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270672696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,132.02 |
| Max. Negotiated Rate |
$8,279.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,842.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,279.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,132.02
|
|
|
STEM HIP SZ6 DEG 127 28MM
|
Facility
|
OP
|
$14,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270673425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.74 |
| Max. Negotiated Rate |
$7,425.00 |
| Rate for Payer: Aetna Commercial |
$5,643.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,455.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,786.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,786.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,970.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,786.75
|
| Rate for Payer: Cigna Commercial |
$7,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,593.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,227.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$469.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$421.74
|
|
|
STEM HIP SZ6 DEG 127 28MM
|
Facility
|
IP
|
$14,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270673425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,227.50 |
| Max. Negotiated Rate |
$3,593.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,970.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,593.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,227.50
|
|
|
STEM HIP SZ7 C-TPR 30x155MM
|
Facility
|
OP
|
$30,917.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270678035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.05 |
| Max. Negotiated Rate |
$15,458.62 |
| Rate for Payer: Aetna Commercial |
$11,748.56
|
| Rate for Payer: Aetna Medicare Advantage |
$9,275.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,883.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,883.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,183.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,883.90
|
| Rate for Payer: Cigna Commercial |
$15,458.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,481.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,637.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$976.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$878.05
|
|
|
STEM HIP SZ7 C-TPR 30x155MM
|
Facility
|
IP
|
$30,917.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270678035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,637.59 |
| Max. Negotiated Rate |
$7,481.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,183.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,481.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,637.59
|
|
|
STEM HIP SZ8 C-TPR 30x155MM
|
Facility
|
OP
|
$30,917.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270678226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.05 |
| Max. Negotiated Rate |
$15,458.62 |
| Rate for Payer: Aetna Commercial |
$11,748.56
|
| Rate for Payer: Aetna Medicare Advantage |
$9,275.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,883.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,883.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,183.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,883.90
|
| Rate for Payer: Cigna Commercial |
$15,458.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,481.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,637.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$976.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$878.05
|
|
|
STEM HIP SZ8 C-TPR 30x155MM
|
Facility
|
IP
|
$30,917.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270678226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,637.59 |
| Max. Negotiated Rate |
$7,481.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,183.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,481.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,637.59
|
|
|
STEM HIP SZ 9 C-TPR 40x205MM
|
Facility
|
OP
|
$16,826.25
|
|
| Hospital Charge Code |
270676953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.87 |
| Max. Negotiated Rate |
$8,413.12 |
| Rate for Payer: Aetna Commercial |
$6,393.98
|
| Rate for Payer: Aetna Medicare Advantage |
$5,047.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,290.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,290.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,365.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,290.69
|
| Rate for Payer: Cigna Commercial |
$8,413.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,071.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,523.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$531.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$477.87
|
|
|
STEM HIP SZ 9 C-TPR 40x205MM
|
Facility
|
IP
|
$16,826.25
|
|
| Hospital Charge Code |
270676953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,523.94 |
| Max. Negotiated Rate |
$4,071.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,365.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,071.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,523.94
|
|
|
STEM HUM 8MM COMP STD
|
Facility
|
IP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270693793
|
|
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 HUM 8MM COMP STD
|
Facility
|
OP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270693793
|
|
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 HUM COMP PRIM STD 13MM
|
Facility
|
OP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270698391
|
|
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 HUM COMP PRIM STD 13MM
|
Facility
|
IP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270698391
|
|
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 HUM COMPR PPS 8X122MM
|
Facility
|
IP
|
$17,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270695299
|
|
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
|
|
|
STEM HUM COMPR PPS 8X122MM
|
Facility
|
OP
|
$17,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270695299
|
|
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
|
|
|
STEM HUMERAL 10MM
|
Facility
|
IP
|
$11,175.00
|
|
| Hospital Charge Code |
270672288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,676.25 |
| Max. Negotiated Rate |
$2,704.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,704.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,676.25
|
|
|
STEM HUMERAL 10MM
|
Facility
|
OP
|
$11,175.00
|
|
| Hospital Charge Code |
270672288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.37 |
| Max. Negotiated Rate |
$5,587.50 |
| Rate for Payer: Aetna Commercial |
$4,246.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,849.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,849.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,849.62
|
| Rate for Payer: Cigna Commercial |
$5,587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,704.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,676.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$353.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$317.37
|
|