|
02 SENSOR
|
Facility
|
IP
|
$400.00
|
|
| Hospital Charge Code |
270656111
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
02 SENSOR
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
270656111
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$120.00
|
| Rate for Payer: Aetna Medicare Advantage |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.00
|
| Rate for Payer: Oxford Commercial |
$200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$200.00
|
|
|
.035 KWIRE
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
270684633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
|
|
.035 KWIRE
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
270684633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Medicare Advantage |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.12
|
| Rate for Payer: Cigna Commercial |
$37.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.75
|
| Rate for Payer: Oxford Commercial |
$37.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$37.50
|
|
|
03.5 X 26MM POLYAXIAL SCREW
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$580.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$480.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$580.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$360.00
|
|
|
03.5 X 26MM POLYAXIAL SCREW
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Medicare Advantage |
$720.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$580.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$360.00
|
|
|
.045 GUIDEWIRE
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
270656146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
.045 GUIDEWIRE
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
270656146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.50
|
| Rate for Payer: Oxford Commercial |
$25.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.00
|
|
|
.045 K-WIRE
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
270656148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.50
|
| Rate for Payer: Oxford Commercial |
$25.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.00
|
|
|
.045 K-WIRE
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
270656148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
0.8X100 K-WIRE
|
Facility
|
OP
|
$121.75
|
|
| Hospital Charge Code |
270668753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$60.88 |
| Rate for Payer: Aetna Commercial |
$36.52
|
| Rate for Payer: Aetna Medicare Advantage |
$36.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.05
|
| Rate for Payer: Cigna Commercial |
$60.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.83
|
| Rate for Payer: Oxford Commercial |
$60.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$60.88
|
|
|
0.8X100 K-WIRE
|
Facility
|
IP
|
$121.75
|
|
| Hospital Charge Code |
270668753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$18.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.26
|
|
|
0.9MM ANTI SKIVE PIN PROSTEP
|
Facility
|
OP
|
$427.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270702758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$213.72 |
| Rate for Payer: Aetna Commercial |
$128.24
|
| Rate for Payer: Aetna Medicare Advantage |
$128.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.00
|
| Rate for Payer: Cigna Commercial |
$213.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$103.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.12
|
|
|
0.9MM ANTI SKIVE PIN PROSTEP
|
Facility
|
IP
|
$427.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270702758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$103.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$103.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.12
|
|
|
.09% NACL 1000cc BOTTLE
|
Facility
|
IP
|
$5.10
|
|
| Hospital Charge Code |
270650059
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.77
|
|
|
.09% NACL 1000cc BOTTLE
|
Facility
|
OP
|
$5.10
|
|
| Hospital Charge Code |
270650059
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: Aetna Medicare Advantage |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.30
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.66
|
| Rate for Payer: Oxford Commercial |
$2.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.55
|
|
|
.09 NS 3000ML (CBI)
|
Facility
|
OP
|
$33.10
|
|
| Hospital Charge Code |
270651076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare Advantage |
$9.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.44
|
| Rate for Payer: Cigna Commercial |
$16.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.30
|
| Rate for Payer: Oxford Commercial |
$16.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.55
|
|
|
.09 NS 3000ML (CBI)
|
Facility
|
IP
|
$33.10
|
|
| Hospital Charge Code |
270651076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.96
|
|
|
0 DEG ECCENTRIC INSERT 36MM.
|
Facility
|
IP
|
$4,529.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.36 |
| Max. Negotiated Rate |
$1,096.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$905.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,096.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$679.36
|
|
|
0 DEG ECCENTRIC INSERT 36MM.
|
Facility
|
OP
|
$4,529.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.36 |
| Max. Negotiated Rate |
$2,264.53 |
| Rate for Payer: Aetna Commercial |
$1,358.71
|
| Rate for Payer: Aetna Medicare Advantage |
$1,358.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,154.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,154.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$905.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,154.91
|
| Rate for Payer: Cigna Commercial |
$2,264.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,096.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$679.36
|
|
|
0DM LINER 28MM
|
Facility
|
IP
|
$6,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270677461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$1,512.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,512.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$937.50
|
|
|
0DM LINER 28MM
|
Facility
|
OP
|
$6,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270677461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna Commercial |
$1,875.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,875.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,593.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,593.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,593.75
|
| Rate for Payer: Cigna Commercial |
$3,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,512.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$937.50
|
|
|
100MM X 7.5MM HEADED SCREW
|
Facility
|
IP
|
$2,270.00
|
|
| Hospital Charge Code |
270656776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.50 |
| Max. Negotiated Rate |
$549.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$454.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$549.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.50
|
|
|
100MM X 7.5MM HEADED SCREW
|
Facility
|
OP
|
$2,270.00
|
|
| Hospital Charge Code |
270656776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.50 |
| Max. Negotiated Rate |
$1,135.00 |
| Rate for Payer: Aetna Commercial |
$681.00
|
| Rate for Payer: Aetna Medicare Advantage |
$681.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$578.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$578.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$454.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$578.85
|
| Rate for Payer: Cigna Commercial |
$1,135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$549.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.50
|
|
|
10.2MM CANN DRILL BIT LENGTH 2
|
Facility
|
IP
|
$3,300.00
|
|
| Hospital Charge Code |
270686947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$495.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$495.00
|
|