|
2.5MM HEADED SCREW LENGTH 14MM
|
Facility
|
OP
|
$1,421.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.27 |
| Max. Negotiated Rate |
$710.90 |
| Rate for Payer: Aetna Commercial |
$426.54
|
| Rate for Payer: Aetna Medicare Advantage |
$426.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$362.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$362.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$284.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$362.56
|
| Rate for Payer: Cigna Commercial |
$710.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.27
|
|
|
2.5MM HEADED SCREW LENGTH 14MM
|
Facility
|
IP
|
$1,421.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.27 |
| Max. Negotiated Rate |
$344.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$284.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.27
|
|
|
2.5 M MM TI CAN COMPRESSION HE
|
Facility
|
IP
|
$3,796.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.40 |
| Max. Negotiated Rate |
$918.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$759.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$918.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$569.40
|
|
|
2.5 M MM TI CAN COMPRESSION HE
|
Facility
|
OP
|
$3,796.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.40 |
| Max. Negotiated Rate |
$1,898.00 |
| Rate for Payer: Aetna Commercial |
$1,138.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,138.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$967.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$967.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$759.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$967.98
|
| Rate for Payer: Cigna Commercial |
$1,898.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$918.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$569.40
|
|
|
2.5 M MM TI CAN COMPRESSION HE
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$949.00 |
| Rate for Payer: Aetna Commercial |
$569.40
|
| Rate for Payer: Aetna Medicare Advantage |
$569.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$483.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$483.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$379.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$483.99
|
| Rate for Payer: Cigna Commercial |
$949.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$459.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.70
|
|
|
2.5 M MM TI CAN COMPRESSION HE
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$459.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$379.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$459.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.70
|
|
|
25MM SCREW
|
Facility
|
IP
|
$6,221.55
|
|
| Hospital Charge Code |
270656870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.23 |
| Max. Negotiated Rate |
$1,505.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,244.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,505.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$933.23
|
|
|
25MM SCREW
|
Facility
|
OP
|
$6,221.55
|
|
| Hospital Charge Code |
270656870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.23 |
| Max. Negotiated Rate |
$3,110.78 |
| Rate for Payer: Aetna Commercial |
$1,866.46
|
| Rate for Payer: Aetna Medicare Advantage |
$1,866.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,586.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,244.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,586.50
|
| Rate for Payer: Cigna Commercial |
$3,110.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,505.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$933.23
|
|
|
2.5MM THREADED K WIRE
|
Facility
|
IP
|
$254.40
|
|
| Hospital Charge Code |
270687948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.16
|
|
|
2.5MM THREADED K WIRE
|
Facility
|
OP
|
$254.40
|
|
| Hospital Charge Code |
270687948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.07 |
| Max. Negotiated Rate |
$127.20 |
| Rate for Payer: Aetna Commercial |
$76.32
|
| Rate for Payer: Aetna Medicare Advantage |
$76.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.87
|
| Rate for Payer: Cigna Commercial |
$127.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.07
|
| Rate for Payer: Oxford Commercial |
$127.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$127.20
|
|
|
25X10X10 EXPAND CAGE #11-5348
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$12,500.00 |
| Rate for Payer: Aetna Commercial |
$7,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,375.00
|
| Rate for Payer: Cigna Commercial |
$12,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.00
|
|
|
25X10X10 EXPAND CAGE #11-5348
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$6,050.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.00
|
|
|
2.5X15MM OLIVE WIRE
|
Facility
|
OP
|
$5,195.00
|
|
| Hospital Charge Code |
270705553
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$675.35 |
| Max. Negotiated Rate |
$2,597.50 |
| Rate for Payer: Aetna Commercial |
$1,558.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,558.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,324.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,324.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,324.72
|
| Rate for Payer: Cigna Commercial |
$2,597.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$675.35
|
| Rate for Payer: Oxford Commercial |
$2,597.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,597.50
|
|
|
2.5X15MM OLIVE WIRE
|
Facility
|
IP
|
$5,195.00
|
|
| Hospital Charge Code |
270705553
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$779.25 |
| Max. Negotiated Rate |
$779.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.25
|
|
|
2.5 X 18 HEADLESS SCREW
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
2.5 X 18 HEADLESS SCREW
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
2.5 X 18 HEADLESS SCREW
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
2.5 X 18 HEADLESS SCREW
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
2.5X225MM K-WIRES
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
270656710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
2.5X225MM K-WIRES
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
270656710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$60.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.00
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
2.5 X 225MM K-WIRE TORNIER
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
270339522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
2.5 X 225MM K-WIRE TORNIER
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
270339522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$60.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.00
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
26.5 PLATE
|
Facility
|
OP
|
$7,900.00
|
|
| Hospital Charge Code |
270656335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,950.00 |
| Rate for Payer: Aetna Commercial |
$2,370.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,370.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,014.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,014.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,580.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,014.50
|
| Rate for Payer: Cigna Commercial |
$3,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,911.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,185.00
|
|
|
26.5 PLATE
|
Facility
|
IP
|
$7,900.00
|
|
| Hospital Charge Code |
270656335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$1,911.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,580.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,911.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,185.00
|
|
|
2.6 CANN DRILL BIT
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270663089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$262.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$113.75
|
| Rate for Payer: Oxford Commercial |
$437.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$437.50
|
|