|
STEM -P STD #1
|
Facility
|
OP
|
$8,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270688765
|
|
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 RADIAL ALIGN 8MM 2MM
|
Facility
|
IP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270680784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$2,783.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,783.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,725.00
|
|
|
STEM RADIAL ALIGN 8MM 2MM
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270680784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.60 |
| Max. Negotiated Rate |
$5,750.00 |
| Rate for Payer: Aetna Commercial |
$4,370.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,932.50
|
| Rate for Payer: Cigna Commercial |
$5,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,783.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,725.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$363.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$326.60
|
|
|
STEM RADIAL ALIGN 9 MM X 0 MM
|
Facility
|
IP
|
$9,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270678337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,466.25 |
| Max. Negotiated Rate |
$2,365.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,955.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,365.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,466.25
|
|
|
STEM RADIAL ALIGN 9 MM X 0 MM
|
Facility
|
OP
|
$9,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270678337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.61 |
| Max. Negotiated Rate |
$4,887.50 |
| Rate for Payer: Aetna Commercial |
$3,714.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,492.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,492.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,955.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,492.62
|
| Rate for Payer: Cigna Commercial |
$4,887.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,365.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,466.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$308.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$277.61
|
|
|
STEM RADIAL ALIGN 9MMx0MM
|
Facility
|
IP
|
$9,775.00
|
|
| Hospital Charge Code |
270378337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,466.25 |
| Max. Negotiated Rate |
$2,365.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,955.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,365.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,466.25
|
|
|
STEM RADIAL ALIGN 9MMx0MM
|
Facility
|
OP
|
$9,775.00
|
|
| Hospital Charge Code |
270378337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.61 |
| Max. Negotiated Rate |
$4,887.50 |
| Rate for Payer: Aetna Commercial |
$3,714.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,492.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,492.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,955.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,492.62
|
| Rate for Payer: Cigna Commercial |
$4,887.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,365.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,466.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$308.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$277.61
|
|
|
STEM RADIAL ALIGN 9X4MM
|
Facility
|
IP
|
$11,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,790.25 |
| Max. Negotiated Rate |
$2,888.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.25
|
|
|
STEM RADIAL ALIGN 9X4MM
|
Facility
|
OP
|
$11,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.95 |
| Max. Negotiated Rate |
$5,967.50 |
| Rate for Payer: Aetna Commercial |
$4,535.30
|
| Rate for Payer: Aetna Medicare Advantage |
$3,580.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,043.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,043.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,043.43
|
| Rate for Payer: Cigna Commercial |
$5,967.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$377.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$338.95
|
|
|
STEM REVISION D 18MM x200 MM
|
Facility
|
OP
|
$28,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270682980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$795.20 |
| Max. Negotiated Rate |
$14,000.00 |
| Rate for Payer: Aetna Commercial |
$10,640.00
|
| Rate for Payer: Aetna Medicare Advantage |
$8,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,140.00
|
| Rate for Payer: Cigna Commercial |
$14,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,776.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,200.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$884.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$795.20
|
|
|
STEM REVISION D 18MM x200 MM
|
Facility
|
IP
|
$28,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270682980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$6,776.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,776.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,200.00
|
|
|
STEM REV STR SPLINE 12 X 135MM
|
Facility
|
OP
|
$12,506.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270690147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.18 |
| Max. Negotiated Rate |
$6,253.12 |
| Rate for Payer: Aetna Commercial |
$4,752.38
|
| Rate for Payer: Aetna Medicare Advantage |
$3,751.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,189.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,189.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,501.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,189.09
|
| Rate for Payer: Cigna Commercial |
$6,253.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,026.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$395.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$355.18
|
|
|
STEM REV STR SPLINE 12 X 135MM
|
Facility
|
IP
|
$12,506.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270690147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.94 |
| Max. Negotiated Rate |
$3,026.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,501.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,026.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.94
|
|
|
STEM SECUREFIT SZ11 40MM
|
Facility
|
OP
|
$11,937.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.03 |
| Max. Negotiated Rate |
$5,968.90 |
| Rate for Payer: Aetna Commercial |
$4,536.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,581.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,044.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,044.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,044.14
|
| Rate for Payer: Cigna Commercial |
$5,968.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$377.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$339.03
|
|
|
STEM SECUREFIT SZ11 40MM
|
Facility
|
IP
|
$11,937.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,790.67 |
| Max. Negotiated Rate |
$2,888.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.67
|
|
|
STEM SECURE R FIT 127 #6
|
Facility
|
OP
|
$11,937.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.03 |
| Max. Negotiated Rate |
$5,968.90 |
| Rate for Payer: Aetna Commercial |
$4,536.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,581.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,044.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,044.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,044.14
|
| Rate for Payer: Cigna Commercial |
$5,968.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$377.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$339.03
|
|
|
STEM SECURE R FIT 127 #6
|
Facility
|
IP
|
$11,937.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,790.67 |
| Max. Negotiated Rate |
$2,888.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.67
|
|
|
STEM SECUR-FIT MAX 127 HIP #7
|
Facility
|
IP
|
$11,662.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270693033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.42 |
| Max. Negotiated Rate |
$2,822.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,332.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,822.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,749.42
|
|
|
STEM SECUR-FIT MAX 127 HIP #7
|
Facility
|
OP
|
$11,662.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270693033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.22 |
| Max. Negotiated Rate |
$5,831.40 |
| Rate for Payer: Aetna Commercial |
$4,431.86
|
| Rate for Payer: Aetna Medicare Advantage |
$3,498.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,974.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,974.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,332.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,974.01
|
| Rate for Payer: Cigna Commercial |
$5,831.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,822.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,749.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$368.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$331.22
|
|
|
STEM SECURFIT SZ11 40MM 170MM
|
Facility
|
OP
|
$11,449.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$325.16 |
| Max. Negotiated Rate |
$5,724.70 |
| Rate for Payer: Aetna Commercial |
$4,350.77
|
| Rate for Payer: Aetna Medicare Advantage |
$3,434.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,919.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,919.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,289.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,919.60
|
| Rate for Payer: Cigna Commercial |
$5,724.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,770.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,717.41
|
| Rate for Payer: UnitedHealthcare Community & State |
$361.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$325.16
|
|
|
STEM SECURFIT SZ11 40MM 170MM
|
Facility
|
IP
|
$11,449.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270694831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,717.41 |
| Max. Negotiated Rate |
$2,770.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,289.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,770.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,717.41
|
|
|
STEM SECUR MAX 127 DEG #8
|
Facility
|
IP
|
$11,937.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,790.67 |
| Max. Negotiated Rate |
$2,888.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.67
|
|
|
STEM SECUR MAX 127 DEG #8
|
Facility
|
OP
|
$11,937.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270692080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.03 |
| Max. Negotiated Rate |
$5,968.90 |
| Rate for Payer: Aetna Commercial |
$4,536.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,581.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,044.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,044.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,387.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,044.14
|
| Rate for Payer: Cigna Commercial |
$5,968.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,888.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,790.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$377.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$339.03
|
|
|
STEM SHORT HUMERAL 10SZ
|
Facility
|
OP
|
$17,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691232
|
|
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 SHORT HUMERAL 10SZ
|
Facility
|
IP
|
$17,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691232
|
|
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
|
|