|
150MM CARBON ROD
|
Facility
|
IP
|
$775.00
|
|
| Hospital Charge Code |
270339505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$187.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.25
|
|
|
15/3 FIRST FRACTURE KIT
|
Facility
|
OP
|
$21,600.00
|
|
| Hospital Charge Code |
270657324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$10,800.00 |
| Rate for Payer: Aetna Commercial |
$6,480.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,508.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,508.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,320.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,508.00
|
| Rate for Payer: Cigna Commercial |
$10,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,227.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,240.00
|
|
|
15/3 FIRST FRACTURE KIT
|
Facility
|
IP
|
$21,600.00
|
|
| Hospital Charge Code |
270657324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$5,227.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,320.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,227.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,240.00
|
|
|
1.5.CC AUGMENT
|
Facility
|
OP
|
$9,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.50 |
| Max. Negotiated Rate |
$4,975.00 |
| Rate for Payer: Aetna Commercial |
$2,985.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,985.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,537.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,537.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,990.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,537.25
|
| Rate for Payer: Cigna Commercial |
$4,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,407.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,492.50
|
|
|
1.5.CC AUGMENT
|
Facility
|
IP
|
$9,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.50 |
| Max. Negotiated Rate |
$2,407.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,990.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,407.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,492.50
|
|
|
15 CM X 20 CM OVAL
|
Facility
|
IP
|
$7,325.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270684331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.75 |
| Max. Negotiated Rate |
$1,772.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,465.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,772.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,098.75
|
|
|
15 CM X 20 CM OVAL
|
Facility
|
OP
|
$7,325.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270684334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.75 |
| Max. Negotiated Rate |
$3,662.50 |
| Rate for Payer: Aetna Commercial |
$2,197.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,197.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,867.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,867.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,465.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,867.88
|
| Rate for Payer: Cigna Commercial |
$3,662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,772.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,098.75
|
|
|
15 CM X 20 CM OVAL
|
Facility
|
OP
|
$7,325.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270684331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.75 |
| Max. Negotiated Rate |
$3,662.50 |
| Rate for Payer: Aetna Commercial |
$2,197.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,197.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,867.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,867.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,465.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,867.88
|
| Rate for Payer: Cigna Commercial |
$3,662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,772.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,098.75
|
|
|
15 CM X 20 CM OVAL
|
Facility
|
IP
|
$7,325.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270684334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.75 |
| Max. Negotiated Rate |
$1,772.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,465.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,772.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,098.75
|
|
|
1.5 DRILL BIT
|
Facility
|
IP
|
$366.00
|
|
| Hospital Charge Code |
270677816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.90
|
|
|
1.5 DRILL BIT
|
Facility
|
IP
|
$366.00
|
|
| Hospital Charge Code |
270686111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.90
|
|
|
1.5 DRILL BIT
|
Facility
|
OP
|
$366.00
|
|
| Hospital Charge Code |
270686111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna Commercial |
$109.80
|
| Rate for Payer: Aetna Medicare Advantage |
$109.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.33
|
| Rate for Payer: Cigna Commercial |
$183.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.58
|
| Rate for Payer: Oxford Commercial |
$183.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$183.00
|
|
|
1.5 DRILL BIT
|
Facility
|
OP
|
$366.00
|
|
| Hospital Charge Code |
270677816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna Commercial |
$109.80
|
| Rate for Payer: Aetna Medicare Advantage |
$109.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.33
|
| Rate for Payer: Cigna Commercial |
$183.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.58
|
| Rate for Payer: Oxford Commercial |
$183.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$183.00
|
|
|
15 LITRE 1 MIN FLOW METER
|
Facility
|
IP
|
$208.00
|
|
| Hospital Charge Code |
270663148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.20
|
|
|
15 LITRE 1 MIN FLOW METER
|
Facility
|
OP
|
$208.00
|
|
| Hospital Charge Code |
270663148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$62.40
|
| Rate for Payer: Aetna Medicare Advantage |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.04
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.04
|
| Rate for Payer: Oxford Commercial |
$104.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$104.00
|
|
|
1.5 LOCKING SCREW 10MM
|
Facility
|
OP
|
$2,431.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$364.73 |
| Max. Negotiated Rate |
$1,215.78 |
| Rate for Payer: Aetna Commercial |
$729.47
|
| Rate for Payer: Aetna Medicare Advantage |
$729.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$620.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$620.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$486.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$620.05
|
| Rate for Payer: Cigna Commercial |
$1,215.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$588.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$364.73
|
|
|
1.5 LOCKING SCREW 10MM
|
Facility
|
IP
|
$2,431.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$364.73 |
| Max. Negotiated Rate |
$588.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$486.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$588.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$364.73
|
|
|
1.5 MM CORTEX 14MM
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
270662659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$89.50 |
| Rate for Payer: Aetna Commercial |
$53.70
|
| Rate for Payer: Aetna Medicare Advantage |
$53.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.65
|
| Rate for Payer: Cigna Commercial |
$89.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.85
|
|
|
1.5 MM CORTEX 14MM
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
270662659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$43.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.85
|
|
|
1.5MM DRILL BIT/MINI QC/65MM
|
Facility
|
IP
|
$324.65
|
|
| Hospital Charge Code |
270634487
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.70 |
| Max. Negotiated Rate |
$48.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.70
|
|
|
1.5MM DRILL BIT/MINI QC/65MM
|
Facility
|
OP
|
$324.65
|
|
| Hospital Charge Code |
270634487
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$162.32 |
| Rate for Payer: Aetna Commercial |
$97.39
|
| Rate for Payer: Aetna Medicare Advantage |
$97.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.79
|
| Rate for Payer: Cigna Commercial |
$162.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.20
|
| Rate for Payer: Oxford Commercial |
$162.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$162.32
|
|
|
1.5MM TI CORTX SCRW SLFTAP 9MM
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$76.38 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.95
|
| Rate for Payer: Cigna Commercial |
$76.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.91
|
|
|
1.5MM TI CORTX SCRW SLFTAP 9MM
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$36.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.91
|
|
|
1.5MM TI CRTX SCRW SLFTAP 13MM
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$76.38 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.95
|
| Rate for Payer: Cigna Commercial |
$76.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.91
|
|
|
1.5MM TI CRTX SCRW SLFTAP 13MM
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$36.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.91
|
|