|
NAIL FEM RET10.5X380 14444238
|
Facility
|
IP
|
$6,720.00
|
|
| Hospital Charge Code |
270645056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.00 |
| Max. Negotiated Rate |
$1,626.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,344.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,626.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,008.00
|
|
|
NAIL FEM RET10.5X380 14444238
|
Facility
|
OP
|
$6,720.00
|
|
| Hospital Charge Code |
270645056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,016.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,713.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,713.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,344.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,713.60
|
| Rate for Payer: Cigna Commercial |
$3,360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,626.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,008.00
|
|
|
NAIL FEM RET 12X360mm 14444336
|
Facility
|
IP
|
$6,720.00
|
|
| Hospital Charge Code |
270645061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.00 |
| Max. Negotiated Rate |
$1,626.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,344.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,626.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,008.00
|
|
|
NAIL FEM RET 12X360mm 14444336
|
Facility
|
OP
|
$6,720.00
|
|
| Hospital Charge Code |
270645061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,016.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,713.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,713.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,344.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,713.60
|
| Rate for Payer: Cigna Commercial |
$3,360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,626.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,008.00
|
|
|
NAIL FEM RETRO 10.5mmx440mm
|
Facility
|
OP
|
$9,710.00
|
|
| Hospital Charge Code |
270663670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.50 |
| Max. Negotiated Rate |
$4,855.00 |
| Rate for Payer: Aetna Commercial |
$2,913.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,913.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,476.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,476.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,942.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,476.05
|
| Rate for Payer: Cigna Commercial |
$4,855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,349.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,456.50
|
|
|
NAIL FEM RETRO 10.5mmx440mm
|
Facility
|
IP
|
$9,710.00
|
|
| Hospital Charge Code |
270663670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.50 |
| Max. Negotiated Rate |
$2,349.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,942.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,349.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,456.50
|
|
|
NAIL FEM RETRO 10.5X340MM
|
Facility
|
IP
|
$9,710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.50 |
| Max. Negotiated Rate |
$2,349.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,942.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,349.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,456.50
|
|
|
NAIL FEM RETRO 10.5X340MM
|
Facility
|
OP
|
$9,710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.50 |
| Max. Negotiated Rate |
$4,855.00 |
| Rate for Payer: Aetna Commercial |
$2,913.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,913.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,476.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,476.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,942.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,476.05
|
| Rate for Payer: Cigna Commercial |
$4,855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,349.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,456.50
|
|
|
NAIL FEM RETRO 12x348mm
|
Facility
|
OP
|
$9,710.00
|
|
| Hospital Charge Code |
270675928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.50 |
| Max. Negotiated Rate |
$4,855.00 |
| Rate for Payer: Aetna Commercial |
$2,913.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,913.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,476.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,476.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,942.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,476.05
|
| Rate for Payer: Cigna Commercial |
$4,855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,349.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,456.50
|
|
|
NAIL FEM RETRO 12x348mm
|
Facility
|
IP
|
$9,710.00
|
|
| Hospital Charge Code |
270675928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.50 |
| Max. Negotiated Rate |
$2,349.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,942.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,349.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,456.50
|
|
|
NAIL FEM RETROGRADE 10.5x360mm
|
Facility
|
IP
|
$9,070.00
|
|
| Hospital Charge Code |
270645513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,360.50 |
| Max. Negotiated Rate |
$2,194.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,814.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,194.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,360.50
|
|
|
NAIL FEM RETROGRADE 10.5x360mm
|
Facility
|
OP
|
$9,070.00
|
|
| Hospital Charge Code |
270645513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,360.50 |
| Max. Negotiated Rate |
$4,535.00 |
| Rate for Payer: Aetna Commercial |
$2,721.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,721.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,312.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,312.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,814.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,312.85
|
| Rate for Payer: Cigna Commercial |
$4,535.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,194.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,360.50
|
|
|
NAIL FEM TRH 10.5x380 14443338
|
Facility
|
OP
|
$9,400.00
|
|
| Hospital Charge Code |
270641743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,700.00 |
| Rate for Payer: Aetna Commercial |
$2,820.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,820.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,397.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,397.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,880.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,397.00
|
| Rate for Payer: Cigna Commercial |
$4,700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,274.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,410.00
|
|
|
NAIL FEM TRH 10.5x380 14443338
|
Facility
|
IP
|
$9,400.00
|
|
| Hospital Charge Code |
270641743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$2,274.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,880.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,274.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,410.00
|
|
|
NAIL FEM TROCH 10.5x360mm RT
|
Facility
|
IP
|
$11,950.00
|
|
| Hospital Charge Code |
270675721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.50 |
| Max. Negotiated Rate |
$2,891.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,390.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,891.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,792.50
|
|
|
NAIL FEM TROCH 10.5x360mm RT
|
Facility
|
OP
|
$11,950.00
|
|
| Hospital Charge Code |
270675721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.50 |
| Max. Negotiated Rate |
$5,975.00 |
| Rate for Payer: Aetna Commercial |
$3,585.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,585.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,047.25
|
| Rate for Payer: Cigna Commercial |
$5,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,891.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,792.50
|
|
|
NAIL FEM TROCH RT 10.5MMX300MM
|
Facility
|
IP
|
$11,950.00
|
|
| Hospital Charge Code |
270664094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.50 |
| Max. Negotiated Rate |
$2,891.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,390.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,891.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,792.50
|
|
|
NAIL FEM TROCH RT 10.5MMX300MM
|
Facility
|
OP
|
$11,950.00
|
|
| Hospital Charge Code |
270664094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.50 |
| Max. Negotiated Rate |
$5,975.00 |
| Rate for Payer: Aetna Medicare Advantage |
$3,585.00
|
| Rate for Payer: Aetna Commercial |
$3,585.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,047.25
|
| Rate for Payer: Cigna Commercial |
$5,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,891.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,792.50
|
|
|
NAIL FEM TROCH RT 10.5x440mm
|
Facility
|
IP
|
$11,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.50 |
| Max. Negotiated Rate |
$2,891.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,390.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,891.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,792.50
|
|
|
NAIL FEM TROCH RT 10.5x440mm
|
Facility
|
OP
|
$11,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.50 |
| Max. Negotiated Rate |
$5,975.00 |
| Rate for Payer: Aetna Commercial |
$3,585.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,585.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,047.25
|
| Rate for Payer: Cigna Commercial |
$5,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,891.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,792.50
|
|
|
NAIL FEM TROCH RT 9x440mm
|
Facility
|
IP
|
$11,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.50 |
| Max. Negotiated Rate |
$2,891.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,390.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,891.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,792.50
|
|
|
NAIL FEM TROCH RT 9x440mm
|
Facility
|
OP
|
$11,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.50 |
| Max. Negotiated Rate |
$5,975.00 |
| Rate for Payer: Aetna Commercial |
$3,585.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,585.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,047.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,047.25
|
| Rate for Payer: Cigna Commercial |
$5,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,891.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,792.50
|
|
|
NAIL FEMUR 125D 11X420MM
|
Facility
|
IP
|
$9,825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.75 |
| Max. Negotiated Rate |
$2,377.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,965.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,377.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,473.75
|
|
|
NAIL FEMUR 125D 11X420MM
|
Facility
|
OP
|
$9,825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.75 |
| Max. Negotiated Rate |
$4,912.50 |
| Rate for Payer: Aetna Commercial |
$2,947.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,947.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,505.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,505.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,965.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,505.38
|
| Rate for Payer: Cigna Commercial |
$4,912.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,377.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,473.75
|
|
|
NAIL FEMUR TFNA TI 11X235MM RT
|
Facility
|
OP
|
$20,995.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,149.25 |
| Max. Negotiated Rate |
$10,497.50 |
| Rate for Payer: Aetna Commercial |
$6,298.50
|
| Rate for Payer: Aetna Medicare Advantage |
$6,298.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,353.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,353.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,199.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,353.73
|
| Rate for Payer: Cigna Commercial |
$10,497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,080.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,149.25
|
|