|
NAIL OST IKA KNEE 14/30 150MM
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$3,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,550.00
|
| Rate for Payer: Cigna Commercial |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
NAIL OST IKA KNEE 14/30 150MM
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
NAIL OST IKA KNEE 16/30 150MM
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$3,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,550.00
|
| Rate for Payer: Cigna Commercial |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
NAIL OST IKA KNEE 16/30 150MM
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
NAIL PANTA 11LGx180MM
|
Facility
|
IP
|
$16,651.80
|
|
| Hospital Charge Code |
270666222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.77 |
| Max. Negotiated Rate |
$4,029.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,330.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,029.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,497.77
|
|
|
NAIL PANTA 11LGx180MM
|
Facility
|
OP
|
$16,651.80
|
|
| Hospital Charge Code |
270666222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.77 |
| Max. Negotiated Rate |
$8,325.90 |
| Rate for Payer: Aetna Commercial |
$4,995.54
|
| Rate for Payer: Aetna Medicare Advantage |
$4,995.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,246.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,246.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,330.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,246.21
|
| Rate for Payer: Cigna Commercial |
$8,325.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,029.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,497.77
|
|
|
NAIL PHOENIX 12MM 300MM
|
Facility
|
OP
|
$13,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,966.50 |
| Max. Negotiated Rate |
$6,555.00 |
| Rate for Payer: Aetna Commercial |
$3,933.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,933.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,343.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,343.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,622.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,343.05
|
| Rate for Payer: Cigna Commercial |
$6,555.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,172.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,966.50
|
|
|
NAIL PHOENIX 12MM 300MM
|
Facility
|
IP
|
$13,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,966.50 |
| Max. Negotiated Rate |
$3,172.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,622.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,172.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,966.50
|
|
|
NAIL PHOENIX RET SYSTEM
|
Facility
|
OP
|
$8,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.25 |
| Max. Negotiated Rate |
$4,087.50 |
| Rate for Payer: Aetna Commercial |
$2,452.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,452.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,084.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,084.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,635.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,084.62
|
| Rate for Payer: Cigna Commercial |
$4,087.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,978.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,226.25
|
|
|
NAIL PHOENIX RET SYSTEM
|
Facility
|
IP
|
$8,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.25 |
| Max. Negotiated Rate |
$1,978.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,635.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,978.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,226.25
|
|
|
NAIL PHOENIX TIBIAL 10.5x370mm
|
Facility
|
OP
|
$8,240.00
|
|
| Hospital Charge Code |
270665516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.00 |
| Max. Negotiated Rate |
$4,120.00 |
| Rate for Payer: Aetna Commercial |
$2,472.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,472.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,101.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,101.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,648.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,101.20
|
| Rate for Payer: Cigna Commercial |
$4,120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,994.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,236.00
|
|
|
NAIL PHOENIX TIBIAL 10.5x370mm
|
Facility
|
IP
|
$8,240.00
|
|
| Hospital Charge Code |
270665516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.00 |
| Max. Negotiated Rate |
$1,994.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,648.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,994.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,236.00
|
|
|
NAILR/A GRDFEM10X340TI CA
|
Facility
|
OP
|
$7,054.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,058.17 |
| Max. Negotiated Rate |
$3,527.22 |
| Rate for Payer: Aetna Commercial |
$2,116.34
|
| Rate for Payer: Aetna Medicare Advantage |
$2,116.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,798.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,798.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,410.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,798.88
|
| Rate for Payer: Cigna Commercial |
$3,527.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,707.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,058.17
|
|
|
NAILR/A GRDFEM10X340TI CA
|
Facility
|
IP
|
$7,054.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,058.17 |
| Max. Negotiated Rate |
$1,707.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,410.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,707.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,058.17
|
|
|
NAIL RECON TI FEMORAL 10x380MM
|
Facility
|
IP
|
$6,645.00
|
|
| Hospital Charge Code |
270677439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.75 |
| Max. Negotiated Rate |
$1,608.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,329.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,608.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$996.75
|
|
|
NAIL RECON TI FEMORAL 10x380MM
|
Facility
|
OP
|
$6,645.00
|
|
| Hospital Charge Code |
270677439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.75 |
| Max. Negotiated Rate |
$3,322.50 |
| Rate for Payer: Aetna Commercial |
$1,993.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,993.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,694.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,694.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,329.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,694.47
|
| Rate for Payer: Cigna Commercial |
$3,322.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,608.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$996.75
|
|
|
NAIL RETRO 12MM X 320MM
|
Facility
|
IP
|
$16,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,452.50 |
| Max. Negotiated Rate |
$3,956.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,270.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,956.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,452.50
|
|
|
NAIL RETRO 12MM X 320MM
|
Facility
|
OP
|
$16,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,452.50 |
| Max. Negotiated Rate |
$8,175.00 |
| Rate for Payer: Aetna Commercial |
$4,905.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,905.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,169.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,169.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,169.25
|
| Rate for Payer: Cigna Commercial |
$8,175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,956.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,452.50
|
|
|
NAIL RETRO FEMORAL TI 10x360MM
|
Facility
|
OP
|
$7,054.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,058.17 |
| Max. Negotiated Rate |
$3,527.22 |
| Rate for Payer: Aetna Commercial |
$2,116.34
|
| Rate for Payer: Aetna Medicare Advantage |
$2,116.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,798.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,798.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,410.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,798.88
|
| Rate for Payer: Cigna Commercial |
$3,527.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,707.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,058.17
|
|
|
NAIL RETRO FEMORAL TI 10x360MM
|
Facility
|
IP
|
$7,054.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,058.17 |
| Max. Negotiated Rate |
$1,707.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,410.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,707.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,058.17
|
|
|
NAIL RETRO FEMORAL TI 11x320MM
|
Facility
|
OP
|
$6,849.00
|
|
| Hospital Charge Code |
270676886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.35 |
| Max. Negotiated Rate |
$3,424.50 |
| Rate for Payer: Aetna Commercial |
$2,054.70
|
| Rate for Payer: Aetna Medicare Advantage |
$2,054.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,746.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,746.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,369.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,746.49
|
| Rate for Payer: Cigna Commercial |
$3,424.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,657.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,027.35
|
|
|
NAIL RETRO FEMORAL TI 11x320MM
|
Facility
|
IP
|
$6,849.00
|
|
| Hospital Charge Code |
270676886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.35 |
| Max. Negotiated Rate |
$1,657.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,369.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,657.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,027.35
|
|
|
NAIL RETRO FEMORAL TI 11x340mm
|
Facility
|
OP
|
$6,849.00
|
|
| Hospital Charge Code |
270671809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.35 |
| Max. Negotiated Rate |
$3,424.50 |
| Rate for Payer: Aetna Commercial |
$2,054.70
|
| Rate for Payer: Aetna Medicare Advantage |
$2,054.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,746.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,746.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,369.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,746.49
|
| Rate for Payer: Cigna Commercial |
$3,424.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,657.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,027.35
|
|
|
NAIL RETRO FEMORAL TI 11x340mm
|
Facility
|
IP
|
$6,849.00
|
|
| Hospital Charge Code |
270671809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.35 |
| Max. Negotiated Rate |
$1,657.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,369.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,657.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,027.35
|
|
|
NAIL RETRO FEMORAL TI 11x360mm
|
Facility
|
IP
|
$6,849.00
|
|
| Hospital Charge Code |
270675112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.35 |
| Max. Negotiated Rate |
$1,657.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,369.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,657.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,027.35
|
|