|
ACETABULAR LINR +4OFF-32/58-60
|
Facility
|
IP
|
$6,660.00
|
|
| Hospital Charge Code |
270668954
|
|
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 +4OFF-32/58-60
|
Facility
|
OP
|
$6,660.00
|
|
| Hospital Charge Code |
270668954
|
|
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 LINR +4OFF-32/62-64
|
Facility
|
IP
|
$6,660.00
|
|
| Hospital Charge Code |
270668955
|
|
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 +4OFF-32/62-64
|
Facility
|
OP
|
$6,660.00
|
|
| Hospital Charge Code |
270668955
|
|
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 LINR +4OFF-32/66-70
|
Facility
|
OP
|
$6,660.00
|
|
| Hospital Charge Code |
270668956
|
|
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 LINR +4OFF-32/66-70
|
Facility
|
IP
|
$6,660.00
|
|
| Hospital Charge Code |
270668956
|
|
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 +4OFF-36/58-60
|
Facility
|
OP
|
$6,660.00
|
|
| Hospital Charge Code |
270668961
|
|
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 LINR +4OFF-36/58-60
|
Facility
|
IP
|
$6,660.00
|
|
| Hospital Charge Code |
270668961
|
|
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 +4OFF-36/62-64
|
Facility
|
OP
|
$6,660.00
|
|
| Hospital Charge Code |
270668962
|
|
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 LINR +4OFF-36/62-64
|
Facility
|
IP
|
$6,660.00
|
|
| Hospital Charge Code |
270668962
|
|
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 +4OFF-36/66-70
|
Facility
|
IP
|
$6,660.00
|
|
| Hospital Charge Code |
270668963
|
|
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 +4OFF-36/66-70
|
Facility
|
OP
|
$6,660.00
|
|
| Hospital Charge Code |
270668963
|
|
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 REAMER BASKETS 46MM
|
Facility
|
IP
|
$1,345.00
|
|
| Hospital Charge Code |
270668101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
|
|
ACETABULAR REAMER BASKETS 46MM
|
Facility
|
OP
|
$1,345.00
|
|
| Hospital Charge Code |
270668101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$672.50 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Medicare Advantage |
$403.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$342.98
|
| Rate for Payer: Cigna Commercial |
$672.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$349.70
|
| Rate for Payer: Oxford Commercial |
$269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.20
|
|
|
ACETABULAR REAMER BASKETS 48MM
|
Facility
|
OP
|
$1,345.00
|
|
| Hospital Charge Code |
270668102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$672.50 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Medicare Advantage |
$403.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$342.98
|
| Rate for Payer: Cigna Commercial |
$672.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$349.70
|
| Rate for Payer: Oxford Commercial |
$269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.20
|
|
|
ACETABULAR REAMER BASKETS 48MM
|
Facility
|
IP
|
$1,345.00
|
|
| Hospital Charge Code |
270668102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
|
|
ACETABULAR REAMER BASKETS 50MM
|
Facility
|
OP
|
$1,345.00
|
|
| Hospital Charge Code |
270668103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$672.50 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Medicare Advantage |
$403.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$342.98
|
| Rate for Payer: Cigna Commercial |
$672.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$349.70
|
| Rate for Payer: Oxford Commercial |
$269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.20
|
|
|
ACETABULAR REAMER BASKETS 50MM
|
Facility
|
IP
|
$1,345.00
|
|
| Hospital Charge Code |
270668103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
|
|
ACETABULAR REAMER BASKETS 52MM
|
Facility
|
OP
|
$1,345.00
|
|
| Hospital Charge Code |
270668104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$672.50 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Medicare Advantage |
$403.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$342.98
|
| Rate for Payer: Cigna Commercial |
$672.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$349.70
|
| Rate for Payer: Oxford Commercial |
$269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.20
|
|
|
ACETABULAR REAMER BASKETS 52MM
|
Facility
|
IP
|
$1,345.00
|
|
| Hospital Charge Code |
270668104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
|
|
ACETABULAR REAMER BASKETS 54MM
|
Facility
|
IP
|
$1,345.00
|
|
| Hospital Charge Code |
270668105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
|
|
ACETABULAR REAMER BASKETS 54MM
|
Facility
|
OP
|
$1,345.00
|
|
| Hospital Charge Code |
270668105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$672.50 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Medicare Advantage |
$403.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$342.98
|
| Rate for Payer: Cigna Commercial |
$672.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$349.70
|
| Rate for Payer: Oxford Commercial |
$269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.20
|
|
|
ACETABULAR REAMER BASKETS 56MM
|
Facility
|
IP
|
$1,345.00
|
|
| Hospital Charge Code |
270668106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
|
|
ACETABULAR REAMER BASKETS 56MM
|
Facility
|
OP
|
$1,345.00
|
|
| Hospital Charge Code |
270668106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$672.50 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Medicare Advantage |
$403.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$342.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$342.98
|
| Rate for Payer: Cigna Commercial |
$672.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$349.70
|
| Rate for Payer: Oxford Commercial |
$269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.20
|
|
|
ACETABULAR REAMER BASKETS 58MM
|
Facility
|
IP
|
$1,345.00
|
|
| Hospital Charge Code |
270668107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.75
|
|