|
ACETABULAR LINER NEUT-40/56
|
Facility
|
IP
|
$6,660.00
|
|
| Hospital Charge Code |
270668922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.00 |
| Max. Negotiated Rate |
$1,611.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,332.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,611.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$999.00
|
|
|
ACETABULAR LINER NEUT-40/56
|
Facility
|
OP
|
$6,660.00
|
|
| Hospital Charge Code |
270668922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Aetna Commercial |
$2,530.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,998.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,698.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,698.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,332.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,698.30
|
| Rate for Payer: Cigna Commercial |
$3,330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,611.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$999.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$210.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$189.14
|
|
|
ACETABULAR LINER NEUT-40/58-60
|
Facility
|
OP
|
$6,660.00
|
|
| Hospital Charge Code |
270668923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Aetna Commercial |
$2,530.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,998.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,698.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,698.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,332.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,698.30
|
| Rate for Payer: Cigna Commercial |
$3,330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,611.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$999.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$210.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$189.14
|
|
|
ACETABULAR LINER NEUT-40/58-60
|
Facility
|
IP
|
$6,660.00
|
|
| Hospital Charge Code |
270668923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.00 |
| Max. Negotiated Rate |
$1,611.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,332.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,611.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$999.00
|
|
|
ACETABULAR LINER NEUT-40/62-64
|
Facility
|
IP
|
$6,660.00
|
|
| Hospital Charge Code |
270668937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.00 |
| Max. Negotiated Rate |
$1,611.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,332.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,611.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$999.00
|
|
|
ACETABULAR LINER NEUT-40/62-64
|
Facility
|
OP
|
$6,660.00
|
|
| Hospital Charge Code |
270668937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Aetna Commercial |
$2,530.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,998.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,698.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,698.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,332.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,698.30
|
| Rate for Payer: Cigna Commercial |
$3,330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,611.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$999.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$210.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$189.14
|
|
|
ACETABULAR LINER NEUT-40/66-70
|
Facility
|
OP
|
$6,660.00
|
|
| Hospital Charge Code |
270668938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Aetna Commercial |
$2,530.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,998.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,698.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,698.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,332.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,698.30
|
| Rate for Payer: Cigna Commercial |
$3,330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,611.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$999.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$210.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$189.14
|
|
|
ACETABULAR LINER NEUT-40/66-70
|
Facility
|
IP
|
$6,660.00
|
|
| Hospital Charge Code |
270668938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.00 |
| Max. Negotiated Rate |
$1,611.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,332.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,611.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$999.00
|
|
|
ACETABULAR LINR +4 EL-28/58-60
|
Facility
|
IP
|
$6,995.00
|
|
| Hospital Charge Code |
270669143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.25 |
| Max. Negotiated Rate |
$1,692.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
|
|
ACETABULAR LINR +4 EL-28/58-60
|
Facility
|
OP
|
$6,995.00
|
|
| Hospital Charge Code |
270669143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.66 |
| Max. Negotiated Rate |
$3,497.50 |
| Rate for Payer: Aetna Commercial |
$2,658.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,098.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,783.72
|
| Rate for Payer: Cigna Commercial |
$3,497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.66
|
|
|
ACETABULAR LINR +4 EL-28/62-64
|
Facility
|
IP
|
$6,995.00
|
|
| Hospital Charge Code |
270669144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.25 |
| Max. Negotiated Rate |
$1,692.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
|
|
ACETABULAR LINR +4 EL-28/62-64
|
Facility
|
OP
|
$6,995.00
|
|
| Hospital Charge Code |
270669144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.66 |
| Max. Negotiated Rate |
$3,497.50 |
| Rate for Payer: Aetna Commercial |
$2,658.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,098.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,783.72
|
| Rate for Payer: Cigna Commercial |
$3,497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.66
|
|
|
ACETABULAR LINR +4 EL-28/66-70
|
Facility
|
OP
|
$6,995.00
|
|
| Hospital Charge Code |
270669145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.66 |
| Max. Negotiated Rate |
$3,497.50 |
| Rate for Payer: Aetna Commercial |
$2,658.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,098.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,783.72
|
| Rate for Payer: Cigna Commercial |
$3,497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.66
|
|
|
ACETABULAR LINR +4 EL-28/66-70
|
Facility
|
IP
|
$6,995.00
|
|
| Hospital Charge Code |
270669145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.25 |
| Max. Negotiated Rate |
$1,692.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
|
|
ACETABULAR LINR +4 EL-32/58-60
|
Facility
|
IP
|
$6,995.00
|
|
| Hospital Charge Code |
270669151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.25 |
| Max. Negotiated Rate |
$1,692.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
|
|
ACETABULAR LINR +4 EL-32/58-60
|
Facility
|
OP
|
$6,995.00
|
|
| Hospital Charge Code |
270669151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.66 |
| Max. Negotiated Rate |
$3,497.50 |
| Rate for Payer: Aetna Commercial |
$2,658.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,098.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,783.72
|
| Rate for Payer: Cigna Commercial |
$3,497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.66
|
|
|
ACETABULAR LINR +4 EL-32/62-64
|
Facility
|
IP
|
$6,995.00
|
|
| Hospital Charge Code |
270669152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.25 |
| Max. Negotiated Rate |
$1,692.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
|
|
ACETABULAR LINR +4 EL-32/62-64
|
Facility
|
OP
|
$6,995.00
|
|
| Hospital Charge Code |
270669152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.66 |
| Max. Negotiated Rate |
$3,497.50 |
| Rate for Payer: Aetna Commercial |
$2,658.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,098.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,783.72
|
| Rate for Payer: Cigna Commercial |
$3,497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.66
|
|
|
ACETABULAR LINR +4 EL-32/66-70
|
Facility
|
OP
|
$6,995.00
|
|
| Hospital Charge Code |
270669153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.66 |
| Max. Negotiated Rate |
$3,497.50 |
| Rate for Payer: Aetna Commercial |
$2,658.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,098.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,783.72
|
| Rate for Payer: Cigna Commercial |
$3,497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.66
|
|
|
ACETABULAR LINR +4 EL-32/66-70
|
Facility
|
IP
|
$6,995.00
|
|
| Hospital Charge Code |
270669153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.25 |
| Max. Negotiated Rate |
$1,692.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
|
|
ACETABULAR LINR +4 EL-36/58-60
|
Facility
|
OP
|
$6,995.00
|
|
| Hospital Charge Code |
270669157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.66 |
| Max. Negotiated Rate |
$3,497.50 |
| Rate for Payer: Aetna Commercial |
$2,658.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,098.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,783.72
|
| Rate for Payer: Cigna Commercial |
$3,497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.66
|
|
|
ACETABULAR LINR +4 EL-36/58-60
|
Facility
|
IP
|
$6,995.00
|
|
| Hospital Charge Code |
270669157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.25 |
| Max. Negotiated Rate |
$1,692.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
|
|
ACETABULAR LINR +4 EL-36/62-64
|
Facility
|
OP
|
$6,995.00
|
|
| Hospital Charge Code |
270669158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.66 |
| Max. Negotiated Rate |
$3,497.50 |
| Rate for Payer: Aetna Commercial |
$2,658.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,098.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,783.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,783.72
|
| Rate for Payer: Cigna Commercial |
$3,497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.66
|
|
|
ACETABULAR LINR +4 EL-36/62-64
|
Facility
|
IP
|
$6,995.00
|
|
| Hospital Charge Code |
270669158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.25 |
| Max. Negotiated Rate |
$1,692.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
|
|
ACETABULAR LINR +4 EL-36/66-70
|
Facility
|
IP
|
$6,995.00
|
|
| Hospital Charge Code |
270669159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.25 |
| Max. Negotiated Rate |
$1,692.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,399.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,692.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,049.25
|
|