|
16MM CANNULATED PERC FLEX DRIL
|
Facility
|
IP
|
$4,016.60
|
|
| Hospital Charge Code |
270681682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$602.49 |
| Max. Negotiated Rate |
$602.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$602.49
|
|
|
16MM FIXED SELF DRILLSCREW
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
16MM FIXED SELF DRILLSCREW
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
16MM SD FIXED SCREWS
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Medicare Advantage |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.00
|
| Rate for Payer: Cigna Commercial |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
|
|
16MM SD FIXED SCREWS
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
|
|
16MM SELF DRILLING SCREW
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
16MM SELF DRILLING SCREW
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
1.6MM THREADED GUIDE WIRE 150M
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270604929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Aetna Commercial |
$44.40
|
| Rate for Payer: Aetna Medicare Advantage |
$44.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.74
|
| Rate for Payer: Cigna Commercial |
$74.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.20
|
|
|
1.6MM THREADED GUIDE WIRE 150M
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270604929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.20
|
|
|
16MM UNIPLATE
|
Facility
|
IP
|
$5,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.75 |
| Max. Negotiated Rate |
$1,361.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,361.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$843.75
|
|
|
16MM UNIPLATE
|
Facility
|
OP
|
$5,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.75 |
| Max. Negotiated Rate |
$2,812.50 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,687.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,434.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,434.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,434.38
|
| Rate for Payer: Cigna Commercial |
$2,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,361.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$843.75
|
|
|
16MM VARIABLE SELF DRILLSCREW
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
16MM VARIABLE SELF DRILLSCREW
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
1.6MMX6IN PRTIL THRED TIP GIDE
|
Facility
|
IP
|
$479.70
|
|
| Hospital Charge Code |
270663177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.95 |
| Max. Negotiated Rate |
$71.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.95
|
|
|
1.6MMX6IN PRTIL THRED TIP GIDE
|
Facility
|
OP
|
$479.70
|
|
| Hospital Charge Code |
270663177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.36 |
| Max. Negotiated Rate |
$239.85 |
| Rate for Payer: Aetna Commercial |
$143.91
|
| Rate for Payer: Aetna Medicare Advantage |
$143.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$122.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$122.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$122.32
|
| Rate for Payer: Cigna Commercial |
$239.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.36
|
| Rate for Payer: Oxford Commercial |
$239.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$239.85
|
|
|
16X13X6 INTERBODY SYS
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
16X13X6 INTERBODY SYS
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$1,650.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
16X14X7MM STATIC CERVICAL
|
Facility
|
OP
|
$17,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.50 |
| Max. Negotiated Rate |
$8,625.00 |
| Rate for Payer: Aetna Commercial |
$5,175.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,398.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,398.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,398.75
|
| Rate for Payer: Cigna Commercial |
$8,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,174.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,587.50
|
|
|
16X14X7MM STATIC CERVICAL
|
Facility
|
IP
|
$17,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.50 |
| Max. Negotiated Rate |
$4,174.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,174.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,587.50
|
|
|
16X14X8MM STATIC CERVICAL
|
Facility
|
OP
|
$17,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.50 |
| Max. Negotiated Rate |
$8,625.00 |
| Rate for Payer: Aetna Commercial |
$5,175.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,398.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,398.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,398.75
|
| Rate for Payer: Cigna Commercial |
$8,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,174.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,587.50
|
|
|
16X14X8MM STATIC CERVICAL
|
Facility
|
IP
|
$17,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.50 |
| Max. Negotiated Rate |
$4,174.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,174.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,587.50
|
|
|
1.6X58MM TW DRILL WKLG 26MM
|
Facility
|
IP
|
$461.85
|
|
| Hospital Charge Code |
270705882
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$69.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.28
|
|
|
1.6X58MM TW DRILL WKLG 26MM
|
Facility
|
OP
|
$461.85
|
|
| Hospital Charge Code |
270705882
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$60.04 |
| Max. Negotiated Rate |
$230.93 |
| Rate for Payer: Aetna Commercial |
$138.56
|
| Rate for Payer: Aetna Medicare Advantage |
$138.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$117.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$117.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$117.77
|
| Rate for Payer: Cigna Commercial |
$230.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.04
|
| Rate for Payer: Oxford Commercial |
$230.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$230.93
|
|
|
1.6X5MM TW DRILL
|
Facility
|
OP
|
$461.85
|
|
| Hospital Charge Code |
270705881
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$60.04 |
| Max. Negotiated Rate |
$230.93 |
| Rate for Payer: Aetna Commercial |
$138.56
|
| Rate for Payer: Aetna Medicare Advantage |
$138.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$117.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$117.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$117.77
|
| Rate for Payer: Cigna Commercial |
$230.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.04
|
| Rate for Payer: Oxford Commercial |
$230.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$230.93
|
|
|
1.6X5MM TW DRILL
|
Facility
|
IP
|
$461.85
|
|
| Hospital Charge Code |
270705881
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$69.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.28
|
|