|
2301 AXONICS REMOTE CONTROL
|
Facility
|
IP
|
$4,400.00
|
|
| Hospital Charge Code |
270702023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$1,064.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$880.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,064.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$660.00
|
|
|
2301 AXONICS REMOTE CONTROL
|
Facility
|
OP
|
$4,400.00
|
|
| Hospital Charge Code |
270702023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,320.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,320.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,122.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,122.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$880.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$2,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,064.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$660.00
|
|
|
2.3MM SHORT BEVEL 35 DEG ICW
|
Facility
|
OP
|
$2,455.00
|
|
| Hospital Charge Code |
270678531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.15 |
| Max. Negotiated Rate |
$1,227.50 |
| Rate for Payer: Aetna Commercial |
$736.50
|
| Rate for Payer: Aetna Medicare Advantage |
$736.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$626.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$626.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$626.02
|
| Rate for Payer: Cigna Commercial |
$1,227.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$319.15
|
| Rate for Payer: Oxford Commercial |
$1,227.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$368.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,227.50
|
|
|
2.3MM SHORT BEVEL 35 DEG ICW
|
Facility
|
IP
|
$2,455.00
|
|
| Hospital Charge Code |
270678531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.25 |
| Max. Negotiated Rate |
$368.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$368.25
|
|
|
2.3 X 10 BONE SCREW
|
Facility
|
IP
|
$555.00
|
|
| Hospital Charge Code |
270657983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.25
|
|
|
2.3 X 10 BONE SCREW
|
Facility
|
OP
|
$555.00
|
|
| Hospital Charge Code |
270657983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Medicare Advantage |
$166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$141.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$141.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$141.53
|
| Rate for Payer: Cigna Commercial |
$277.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.25
|
|
|
2.3 X 12 BONE SCREW
|
Facility
|
IP
|
$555.00
|
|
| Hospital Charge Code |
270657993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.25
|
|
|
2.3 X 12 BONE SCREW
|
Facility
|
OP
|
$555.00
|
|
| Hospital Charge Code |
270657993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Medicare Advantage |
$166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$141.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$141.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$141.53
|
| Rate for Payer: Cigna Commercial |
$277.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.25
|
|
|
2.3 X 12 CANNULATED SCREW
|
Facility
|
IP
|
$680.00
|
|
| Hospital Charge Code |
270656420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$164.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
|
|
2.3 X 12 CANNULATED SCREW
|
Facility
|
OP
|
$680.00
|
|
| Hospital Charge Code |
270656420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$204.00
|
| Rate for Payer: Aetna Medicare Advantage |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$173.40
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
|
|
2.3 X 12 CORTICAL SCREW
|
Facility
|
OP
|
$465.00
|
|
| Hospital Charge Code |
270656421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$139.50
|
| Rate for Payer: Aetna Medicare Advantage |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$118.58
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.75
|
|
|
2.3 X 12 CORTICAL SCREW
|
Facility
|
IP
|
$465.00
|
|
| Hospital Charge Code |
270656421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$112.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.75
|
|
|
2.3X12MM AO DRILL
|
Facility
|
OP
|
$4,250.00
|
|
| Hospital Charge Code |
270705959
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$552.50 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,083.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,083.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,083.75
|
| Rate for Payer: Cigna Commercial |
$2,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$552.50
|
| Rate for Payer: Oxford Commercial |
$2,125.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$637.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,125.00
|
|
|
2.3X12MM AO DRILL
|
Facility
|
IP
|
$4,250.00
|
|
| Hospital Charge Code |
270705959
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$637.50 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$637.50
|
|
|
2.3 X 12MM LOCK SCREW
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270656004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
2.3 X 12MM LOCK SCREW
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270656004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
2.3X13MM BONE SCREWS,CROSS PIN
|
Facility
|
IP
|
$683.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.56 |
| Max. Negotiated Rate |
$165.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.56
|
|
|
2.3X13MM BONE SCREWS,CROSS PIN
|
Facility
|
OP
|
$683.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.56 |
| Max. Negotiated Rate |
$341.85 |
| Rate for Payer: Aetna Commercial |
$205.11
|
| Rate for Payer: Aetna Medicare Advantage |
$205.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$174.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$174.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$174.34
|
| Rate for Payer: Cigna Commercial |
$341.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.56
|
|
|
2.3 X 14 CANNULATED SCREW
|
Facility
|
IP
|
$680.00
|
|
| Hospital Charge Code |
270656422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$164.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
|
|
2.3 X 14 CANNULATED SCREW
|
Facility
|
OP
|
$680.00
|
|
| Hospital Charge Code |
270656422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$204.00
|
| Rate for Payer: Aetna Medicare Advantage |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$173.40
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
|
|
2.3 X 14 CORTICAL SCREW
|
Facility
|
IP
|
$465.00
|
|
| Hospital Charge Code |
270656428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$112.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.75
|
|
|
2.3 X 14 CORTICAL SCREW
|
Facility
|
OP
|
$465.00
|
|
| Hospital Charge Code |
270656428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$139.50
|
| Rate for Payer: Aetna Medicare Advantage |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$118.58
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.75
|
|
|
2.3 X 16 CANNULATED SCREW
|
Facility
|
IP
|
$680.00
|
|
| Hospital Charge Code |
270656423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$164.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
|
|
2.3 X 16 CANNULATED SCREW
|
Facility
|
OP
|
$680.00
|
|
| Hospital Charge Code |
270656423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$204.00
|
| Rate for Payer: Aetna Medicare Advantage |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$136.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$173.40
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.00
|
|
|
23 X 16 CORTICAL SCREW
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$121.12
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|