|
NAIL SHF GAMMA16/125 33700625*
|
Facility
|
IP
|
$2,193.00
|
|
| Hospital Charge Code |
1605526
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.95 |
| Max. Negotiated Rate |
$530.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$438.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$530.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.95
|
|
|
NAIL SHF GAMMA16/125 33700625*
|
Facility
|
OP
|
$2,193.00
|
|
| Hospital Charge Code |
1605526
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.95 |
| Max. Negotiated Rate |
$1,096.50 |
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Medicare Advantage |
$657.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$559.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$559.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$559.22
|
| Rate for Payer: Cigna Commercial |
$1,096.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$530.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.95
|
|
|
NAIL SHF GAMMA16/130 33700063*
|
Facility
|
IP
|
$2,193.00
|
|
| Hospital Charge Code |
1605534
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.95 |
| Max. Negotiated Rate |
$530.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$438.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$530.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.95
|
|
|
NAIL SHF GAMMA16/130 33700063*
|
Facility
|
OP
|
$2,193.00
|
|
| Hospital Charge Code |
1605534
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.95 |
| Max. Negotiated Rate |
$1,096.50 |
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Medicare Advantage |
$657.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$559.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$559.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$559.22
|
| Rate for Payer: Cigna Commercial |
$1,096.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$530.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.95
|
|
|
NAIL SHF GAMMA16/135 33700635*
|
Facility
|
IP
|
$2,193.00
|
|
| Hospital Charge Code |
1605542
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.95 |
| Max. Negotiated Rate |
$530.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$438.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$530.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.95
|
|
|
NAIL SHF GAMMA16/135 33700635*
|
Facility
|
OP
|
$2,193.00
|
|
| Hospital Charge Code |
1605542
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.95 |
| Max. Negotiated Rate |
$1,096.50 |
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Medicare Advantage |
$657.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$559.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$559.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$559.22
|
| Rate for Payer: Cigna Commercial |
$1,096.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$530.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.95
|
|
|
NAIL SHF GAMMA 16/140 ******
|
Facility
|
IP
|
$2,193.00
|
|
| Hospital Charge Code |
1605559
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.95 |
| Max. Negotiated Rate |
$530.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$438.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$530.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.95
|
|
|
NAIL SHF GAMMA 16/140 ******
|
Facility
|
OP
|
$2,193.00
|
|
| Hospital Charge Code |
1605559
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.95 |
| Max. Negotiated Rate |
$1,096.50 |
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Medicare Advantage |
$657.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$559.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$559.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$559.22
|
| Rate for Payer: Cigna Commercial |
$1,096.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$530.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.95
|
|
|
NAIL SHORT TROCH 11mm DC28811
|
Facility
|
IP
|
$4,752.00
|
|
| Hospital Charge Code |
270635346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.80 |
| Max. Negotiated Rate |
$1,149.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$950.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,149.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.80
|
|
|
NAIL SHORT TROCH 11mm DC28811
|
Facility
|
OP
|
$4,752.00
|
|
| Hospital Charge Code |
270635346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.80 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,425.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,211.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,211.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$950.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,211.76
|
| Rate for Payer: Cigna Commercial |
$2,376.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,149.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.80
|
|
|
NAIL SMN IM HIP 10 38 7116308L
|
Facility
|
OP
|
$5,609.65
|
|
| Hospital Charge Code |
270621500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.45 |
| Max. Negotiated Rate |
$2,804.82 |
| Rate for Payer: Aetna Commercial |
$1,682.89
|
| Rate for Payer: Aetna Medicare Advantage |
$1,682.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,430.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,430.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,121.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,430.46
|
| Rate for Payer: Cigna Commercial |
$2,804.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,357.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$841.45
|
|
|
NAIL SMN IM HIP 10 38 7116308L
|
Facility
|
IP
|
$5,609.65
|
|
| Hospital Charge Code |
270621500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.45 |
| Max. Negotiated Rate |
$1,357.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,121.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,357.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$841.45
|
|
|
NAIL SMN TIB/HUM 3.5 22 223522
|
Facility
|
OP
|
$1,016.85
|
|
| Hospital Charge Code |
270622928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.53 |
| Max. Negotiated Rate |
$508.43 |
| Rate for Payer: Aetna Commercial |
$305.06
|
| Rate for Payer: Aetna Medicare Advantage |
$305.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$259.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$259.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$203.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$259.30
|
| Rate for Payer: Cigna Commercial |
$508.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$152.53
|
|
|
NAIL SMN TIB/HUM 3.5 22 223522
|
Facility
|
IP
|
$1,016.85
|
|
| Hospital Charge Code |
270622928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.53 |
| Max. Negotiated Rate |
$246.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$203.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$152.53
|
|
|
NAIL SMN TIB/HUM 3.5 25 223525
|
Facility
|
OP
|
$724.00
|
|
| Hospital Charge Code |
270622766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$362.00 |
| Rate for Payer: Aetna Commercial |
$217.20
|
| Rate for Payer: Aetna Medicare Advantage |
$217.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.62
|
| Rate for Payer: Cigna Commercial |
$362.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.60
|
|
|
NAIL SMN TIB/HUM 3.5 25 223525
|
Facility
|
IP
|
$724.00
|
|
| Hospital Charge Code |
270622766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$175.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.60
|
|
|
NAIL SMN TIB/HUM 3.5 26 223526
|
Facility
|
IP
|
$724.00
|
|
| Hospital Charge Code |
270622767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$175.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.60
|
|
|
NAIL SMN TIB/HUM 3.5 26 223526
|
Facility
|
OP
|
$724.00
|
|
| Hospital Charge Code |
270622767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$362.00 |
| Rate for Payer: Aetna Commercial |
$217.20
|
| Rate for Payer: Aetna Medicare Advantage |
$217.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.62
|
| Rate for Payer: Cigna Commercial |
$362.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.60
|
|
|
NAIL SNR IM SPC 13 25 71122397
|
Facility
|
OP
|
$3,528.00
|
|
| Hospital Charge Code |
270613593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.20 |
| Max. Negotiated Rate |
$1,764.00 |
| Rate for Payer: Aetna Commercial |
$1,058.40
|
| Rate for Payer: Aetna Medicare Advantage |
$1,058.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$899.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$899.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$899.64
|
| Rate for Payer: Cigna Commercial |
$1,764.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$853.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$529.20
|
|
|
NAIL SNR IM SPC 13 25 71122397
|
Facility
|
IP
|
$3,528.00
|
|
| Hospital Charge Code |
270613593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.20 |
| Max. Negotiated Rate |
$853.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$705.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$853.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$529.20
|
|
|
NAIL STRY GAMMA 11 340 3370703
|
Facility
|
OP
|
$5,460.00
|
|
| Hospital Charge Code |
270627180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.00 |
| Max. Negotiated Rate |
$2,730.00 |
| Rate for Payer: Aetna Commercial |
$1,638.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,638.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,392.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,392.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,092.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,392.30
|
| Rate for Payer: Cigna Commercial |
$2,730.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,321.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$819.00
|
|
|
NAIL STRY GAMMA 11 340 3370703
|
Facility
|
IP
|
$5,460.00
|
|
| Hospital Charge Code |
270627180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.00 |
| Max. Negotiated Rate |
$1,321.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,092.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,321.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$819.00
|
|
|
NAIL SUPRACONDYLAR 10x320mm
|
Facility
|
IP
|
$10,692.20
|
|
| Hospital Charge Code |
270675726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,603.83 |
| Max. Negotiated Rate |
$2,587.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,138.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,587.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,603.83
|
|
|
NAIL SUPRACONDYLAR 10x320mm
|
Facility
|
OP
|
$10,692.20
|
|
| Hospital Charge Code |
270675726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,603.83 |
| Max. Negotiated Rate |
$5,346.10 |
| Rate for Payer: Aetna Commercial |
$3,207.66
|
| Rate for Payer: Aetna Medicare Advantage |
$3,207.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,726.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,726.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,138.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,726.51
|
| Rate for Payer: Cigna Commercial |
$5,346.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,587.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,603.83
|
|
|
NAIL SUPRACONDYLAR 11x300MM
|
Facility
|
IP
|
$15,885.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,382.75 |
| Max. Negotiated Rate |
$3,844.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,177.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,844.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,382.75
|
|