|
2.7 STANDARD DRILL BIT
|
Facility
|
OP
|
$775.15
|
|
| Hospital Charge Code |
270661358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.77 |
| Max. Negotiated Rate |
$387.57 |
| Rate for Payer: Aetna Commercial |
$232.54
|
| Rate for Payer: Aetna Medicare Advantage |
$232.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.66
|
| Rate for Payer: Cigna Commercial |
$387.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.77
|
| Rate for Payer: Oxford Commercial |
$387.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.57
|
|
|
2.7 STANDARD DRILL BIT
|
Facility
|
IP
|
$775.15
|
|
| Hospital Charge Code |
270661358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.27 |
| Max. Negotiated Rate |
$116.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.27
|
|
|
2.7 VA LOCKING ANT PATELLA PL
|
Facility
|
OP
|
$10,419.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.96 |
| Max. Negotiated Rate |
$5,209.88 |
| Rate for Payer: Aetna Commercial |
$3,125.93
|
| Rate for Payer: Aetna Medicare Advantage |
$3,125.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,657.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,657.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,083.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,657.04
|
| Rate for Payer: Cigna Commercial |
$5,209.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,521.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,562.96
|
|
|
2.7 VA LOCKING ANT PATELLA PL
|
Facility
|
IP
|
$10,419.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.96 |
| Max. Negotiated Rate |
$2,521.58 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,083.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,521.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,562.96
|
|
|
2.7 X 12 LOCKING SCREW
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
270656432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$127.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
|
|
2.7 X 12 LOCKING SCREW
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
270656432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Medicare Advantage |
$157.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.88
|
| Rate for Payer: Cigna Commercial |
$262.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
|
|
2.7 X 12MM SNAP OFF SCREW
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
2.7 X 12MM SNAP OFF SCREW
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
2.7 X 14 LOCKING SCREW
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Medicare Advantage |
$157.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.88
|
| Rate for Payer: Cigna Commercial |
$262.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
|
|
2.7 X 14 LOCKING SCREW
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$127.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
|
|
2.7 X 16MM SCREW
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270656711
|
|
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
|
|
|
2.7 X 16MM SCREW
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270656711
|
|
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
|
|
|
2.7 X 18MM ANGELED TENFUSE
|
Facility
|
IP
|
$5,390.00
|
|
| Hospital Charge Code |
270663811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$808.50 |
| Max. Negotiated Rate |
$1,304.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,078.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,304.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$808.50
|
|
|
2.7 X 18MM ANGELED TENFUSE
|
Facility
|
OP
|
$5,390.00
|
|
| Hospital Charge Code |
270663811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$808.50 |
| Max. Negotiated Rate |
$2,695.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,617.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,374.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,374.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,374.45
|
| Rate for Payer: Cigna Commercial |
$2,695.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,304.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$808.50
|
|
|
2.7 X 18MM SCREW
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656727
|
|
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
|
|
|
2.7 X 18MM SCREW
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656727
|
|
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
|
|
|
2.7X3.5X109MM PLATE 6-HOLE
|
Facility
|
IP
|
$8,685.00
|
|
| Hospital Charge Code |
270704198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.75 |
| Max. Negotiated Rate |
$2,101.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,737.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,101.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,302.75
|
|
|
2.7X3.5X109MM PLATE 6-HOLE
|
Facility
|
OP
|
$8,685.00
|
|
| Hospital Charge Code |
270704198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.75 |
| Max. Negotiated Rate |
$4,342.50 |
| Rate for Payer: Aetna Commercial |
$2,605.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,605.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,214.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,214.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,737.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,214.68
|
| Rate for Payer: Cigna Commercial |
$4,342.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,101.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,302.75
|
|
|
2.7X37MM HOOK PLATE, 3HOLES
|
Facility
|
IP
|
$10,040.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.00 |
| Max. Negotiated Rate |
$2,429.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,008.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,429.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,506.00
|
|
|
2.7X37MM HOOK PLATE, 3HOLES
|
Facility
|
OP
|
$10,040.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.00 |
| Max. Negotiated Rate |
$5,020.00 |
| Rate for Payer: Aetna Commercial |
$3,012.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,012.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,560.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,560.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,008.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,560.20
|
| Rate for Payer: Cigna Commercial |
$5,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,429.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,506.00
|
|
|
27X40X12MM CAGE
|
Facility
|
IP
|
$31,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,725.00 |
| Max. Negotiated Rate |
$7,623.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,623.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,725.00
|
|
|
27X40X12MM CAGE
|
Facility
|
OP
|
$31,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,725.00 |
| Max. Negotiated Rate |
$15,750.00 |
| Rate for Payer: Aetna Commercial |
$9,450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,032.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,032.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,032.50
|
| Rate for Payer: Cigna Commercial |
$15,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,623.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,725.00
|
|
|
27X40X14MM CAGE
|
Facility
|
OP
|
$31,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,725.00 |
| Max. Negotiated Rate |
$15,750.00 |
| Rate for Payer: Aetna Commercial |
$9,450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,032.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,032.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,032.50
|
| Rate for Payer: Cigna Commercial |
$15,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,623.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,725.00
|
|
|
27X40X14MM CAGE
|
Facility
|
IP
|
$31,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,725.00 |
| Max. Negotiated Rate |
$7,623.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,623.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,725.00
|
|
|
28-3.5MM FEMORAL HEAD CERAMIC
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270705863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,800.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,530.00
|
| Rate for Payer: Cigna Commercial |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|