|
FUSEFORCE FIXATION SYS 10x10MM
|
Facility
|
IP
|
$3,750.00
|
|
| Hospital Charge Code |
270676420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$907.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
|
|
FUSEFORCE FIXATION SYS 10x10MM
|
Facility
|
OP
|
$3,750.00
|
|
| Hospital Charge Code |
270676420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$956.25
|
| Rate for Payer: Cigna Commercial |
$1,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$907.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
|
|
FUSIN WIREGUDELCKINDEVFSWLP10
|
Facility
|
OP
|
$72.50
|
|
| Hospital Charge Code |
270635780
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$36.25 |
| Rate for Payer: Aetna Commercial |
$21.75
|
| Rate for Payer: Aetna Medicare Advantage |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.49
|
| Rate for Payer: Cigna Commercial |
$36.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.43
|
| Rate for Payer: Oxford Commercial |
$36.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.25
|
|
|
FUSIN WIREGUDELCKINDEVFSWLP10
|
Facility
|
IP
|
$72.50
|
|
| Hospital Charge Code |
270635780
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.88
|
|
|
FUSION 12 DVS
|
Facility
|
IP
|
$35,000.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
270702848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,250.00 |
| Max. Negotiated Rate |
$8,470.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,470.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,250.00
|
|
|
FUSION 12 DVS
|
Facility
|
OP
|
$35,000.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
270702848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,250.00 |
| Max. Negotiated Rate |
$17,500.00 |
| Rate for Payer: Aetna Commercial |
$10,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$10,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,925.00
|
| Rate for Payer: Cigna Commercial |
$17,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,470.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,250.00
|
|
|
FUSION DEVICE 15X12X7MM 7DEG
|
Facility
|
OP
|
$8,520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.00 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$2,556.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,556.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,172.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,172.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,704.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$4,260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,061.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,278.00
|
|
|
FUSION DEVICE 15X12X7MM 7DEG
|
Facility
|
IP
|
$8,520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.00 |
| Max. Negotiated Rate |
$2,061.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,704.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,061.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,278.00
|
|
|
FUSION DEVICE 15X12X8MM 7DEG
|
Facility
|
OP
|
$8,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$4,125.00 |
| Rate for Payer: Aetna Commercial |
$2,475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,103.75
|
| Rate for Payer: Cigna Commercial |
$4,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,996.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,237.50
|
|
|
FUSION DEVICE 15X12X8MM 7DEG
|
Facility
|
IP
|
$8,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$1,996.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,996.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,237.50
|
|
|
FUSION DEVICE 17X14X7MM 7DEG
|
Facility
|
OP
|
$8,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$4,125.00 |
| Rate for Payer: Aetna Commercial |
$2,475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,103.75
|
| Rate for Payer: Cigna Commercial |
$4,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,996.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,237.50
|
|
|
FUSION DEVICE 17X14X7MM 7DEG
|
Facility
|
IP
|
$8,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$1,996.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,996.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,237.50
|
|
|
FUSION DEVICE 17X14X8MM 7DEG
|
Facility
|
IP
|
$8,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$1,996.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,996.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,237.50
|
|
|
FUSION DEVICE 17X14X8MM 7DEG
|
Facility
|
OP
|
$8,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$4,125.00 |
| Rate for Payer: Aetna Commercial |
$2,475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,103.75
|
| Rate for Payer: Cigna Commercial |
$4,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,996.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,237.50
|
|
|
FUSION/GRAFT OF FINGER JOINT
|
Facility
|
OP
|
$14,284.88
|
|
|
Service Code
|
HCPCS 26862
|
| Hospital Charge Code |
16000860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,857.03 |
| Max. Negotiated Rate |
$7,791.93 |
| Rate for Payer: Aetna Commercial |
$4,285.46
|
| Rate for Payer: Aetna Medicare Advantage |
$4,285.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,642.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,642.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,642.64
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,857.03
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,142.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
FUSION/GRAFT OF FINGER JOINT
|
Facility
|
IP
|
$14,284.88
|
|
|
Service Code
|
HCPCS 26862
|
| Hospital Charge Code |
16000860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,142.73 |
| Max. Negotiated Rate |
$2,142.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,142.73
|
|
|
FUSION IMPLANT PROXIMAL 2.8MM
|
Facility
|
IP
|
$1,300.00
|
|
| Hospital Charge Code |
270669818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$314.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$314.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.00
|
|
|
FUSION IMPLANT PROXIMAL 2.8MM
|
Facility
|
OP
|
$1,300.00
|
|
| Hospital Charge Code |
270669818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$390.00
|
| Rate for Payer: Aetna Medicare Advantage |
$390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$260.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$331.50
|
| Rate for Payer: Cigna Commercial |
$650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$314.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.00
|
|
|
FUSION IMP MID PHALANX 3.8X6MM
|
Facility
|
IP
|
$1,300.00
|
|
| Hospital Charge Code |
270669817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$314.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$314.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.00
|
|
|
FUSION IMP MID PHALANX 3.8X6MM
|
Facility
|
OP
|
$1,300.00
|
|
| Hospital Charge Code |
270669817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$390.00
|
| Rate for Payer: Aetna Medicare Advantage |
$390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$260.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$331.50
|
| Rate for Payer: Cigna Commercial |
$650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$314.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.00
|
|
|
FUSION IPJ
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690330
|
|
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
|
|
|
FUSION IPJ
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690330
|
|
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
|
|
|
FUSION OF STOMACH AND BOWEL
|
Facility
|
OP
|
$7,177.00
|
|
|
Service Code
|
HCPCS 43820
|
| Hospital Charge Code |
1600000637
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.01 |
| Max. Negotiated Rate |
$6,873.00 |
| Rate for Payer: Aetna Commercial |
$2,153.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,153.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,830.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,830.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,830.13
|
| Rate for Payer: Cigna Commercial |
$1,369.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$933.01
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,076.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
|
|
FUSION OF STOMACH AND BOWEL
|
Facility
|
IP
|
$7,177.00
|
|
|
Service Code
|
HCPCS 43820
|
| Hospital Charge Code |
1600000637
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,076.55 |
| Max. Negotiated Rate |
$1,076.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,076.55
|
|
|
FUZEON 90 MG
|
Facility
|
OP
|
$130.00
|
|
| Hospital Charge Code |
60635667
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$39.00
|
| Rate for Payer: Aetna Medicare Advantage |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.15
|
| Rate for Payer: Cigna Commercial |
$65.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.90
|
| Rate for Payer: Oxford Commercial |
$65.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.00
|
|