|
HAMMERFUZE IMPLANT 2.5MM STR
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.68 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna Commercial |
$2,565.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,025.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,721.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,721.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,721.25
|
| Rate for Payer: Cigna Commercial |
$3,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,633.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,485.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,012.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$162.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$178.88
|
|
|
HAMMERFUZE IMPLANT 2.5MM STR
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270679985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.50 |
| Max. Negotiated Rate |
$1,633.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,633.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,485.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,012.50
|
|
|
HAMMERGRAFT CANC SPACER2.8X6MM
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$1,087.50 |
| Rate for Payer: Aetna Commercial |
$826.50
|
| Rate for Payer: Aetna Medicare Advantage |
$652.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$554.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$554.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$554.62
|
| Rate for Payer: Cigna Commercial |
$1,087.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$526.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$478.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$326.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.64
|
|
|
HAMMERGRAFT CANC SPACER2.8X6MM
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.25 |
| Max. Negotiated Rate |
$526.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$435.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$526.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$478.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$326.25
|
|
|
HAMMERLOCK 2 LG PROXIMAL 15x7m
|
Facility
|
OP
|
$7,250.00
|
|
| Hospital Charge Code |
270672147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$3,625.00 |
| Rate for Payer: Aetna Commercial |
$2,755.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,848.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,848.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,848.75
|
| Rate for Payer: Cigna Commercial |
$3,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,754.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,595.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,087.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$174.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$192.12
|
|
|
HAMMERLOCK 2 LG PROXIMAL 15x7m
|
Facility
|
IP
|
$7,250.00
|
|
| Hospital Charge Code |
270672147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,754.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,754.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,595.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,087.50
|
|
|
HAMMERLOCK 2 SM PROXIMAL 12x5m
|
Facility
|
IP
|
$7,250.00
|
|
| Hospital Charge Code |
270672150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,754.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,754.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,595.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,087.50
|
|
|
HAMMERLOCK 2 SM PROXIMAL 12x5m
|
Facility
|
OP
|
$7,250.00
|
|
| Hospital Charge Code |
270672150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$3,625.00 |
| Rate for Payer: Aetna Commercial |
$2,755.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,848.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,848.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,848.75
|
| Rate for Payer: Cigna Commercial |
$3,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,754.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,595.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,087.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$174.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$192.12
|
|
|
HAMMERTOE IMPL 2.4x16MM 0 DEG
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270663198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$654.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$78.84
|
|
|
HAMMERTOE IMPL 2.4x16MM 0 DEG
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270663198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$654.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
HAMMERTOE IMPL 2x13MM 0 DEG
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270667356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$654.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
HAMMERTOE IMPL 2x13MM 0 DEG
|
Facility
|
IP
|
$2,975.00
|
|
| Hospital Charge Code |
270661603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$654.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
HAMMERTOE IMPL 2x13MM 0 DEG
|
Facility
|
OP
|
$2,975.00
|
|
| Hospital Charge Code |
270661603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$654.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$78.84
|
|
|
HAMMERTOE IMPL 2x13MM 0 DEG
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270667356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$654.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$78.84
|
|
|
HAMMERTOE IMPL 3.2x16MM 0 DEG
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270669816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$654.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
HAMMERTOE IMPL 3.2x16MM 0 DEG
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270669816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$654.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$78.84
|
|
|
HAMMER TOE IMPLANT 3.4x3.0x6mm
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$880.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
HAMMER TOE IMPLANT 3.4x3.0x6mm
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$880.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$96.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$106.00
|
|
|
HAMMERTOE OP ONE TOE TA
|
Facility
|
OP
|
$10,580.92
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
16000176
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$14,031.70 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,031.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14,031.70
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,174.28
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,587.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,157.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$255.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$280.39
|
|
|
HAMMERTOE OP ONE TOE TA
|
Facility
|
IP
|
$10,580.92
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
16000176
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,587.14 |
| Max. Negotiated Rate |
$1,587.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,587.14
|
|
|
HAMMERTOE PEEK FIXATION SYST
|
Facility
|
OP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.57 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,185.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,265.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$138.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$152.38
|
|
|
HAMMERTOE PEEK FIXATION SYST
|
Facility
|
IP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$1,391.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,265.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
HAMMERTOE PEEK FIXATION SYSTEM
|
Facility
|
OP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270705391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.57 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,185.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,265.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$138.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$152.38
|
|
|
HAMMERTOE PEEK FIXATION SYSTEM
|
Facility
|
IP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270705391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$1,391.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,265.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
HAMMERTOESYST2.5X16MMSTRIMPKIT
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.25 |
| Max. Negotiated Rate |
$2,413.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,413.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,194.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,496.25
|
|