|
NAIL TIBIAL M/D10x26 225326009
|
Facility
|
IP
|
$3,743.20
|
|
| Hospital Charge Code |
270639118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.48 |
| Max. Negotiated Rate |
$905.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$748.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$905.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$561.48
|
|
|
NAIL TIBIAL M/D10x26 225326009
|
Facility
|
OP
|
$3,743.20
|
|
| Hospital Charge Code |
270639118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.48 |
| Max. Negotiated Rate |
$1,871.60 |
| Rate for Payer: Aetna Commercial |
$1,122.96
|
| Rate for Payer: Aetna Medicare Advantage |
$1,122.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$954.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$954.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$748.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$954.52
|
| Rate for Payer: Cigna Commercial |
$1,871.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$905.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$561.48
|
|
|
NAIL TIBIAL PHOENIX 9X350MM
|
Facility
|
OP
|
$6,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.50 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna Commercial |
$2,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,085.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,772.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,772.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,772.25
|
| Rate for Payer: Cigna Commercial |
$3,475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,681.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,042.50
|
|
|
NAIL TIBIAL PHOENIX 9X350MM
|
Facility
|
IP
|
$6,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.50 |
| Max. Negotiated Rate |
$1,681.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,390.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,681.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,042.50
|
|
|
NAIL TIBIAL PROX BEND 9x315mm
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
NAIL TIBIAL PROX BEND 9x315mm
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671293
|
|
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
|
|
|
NAIL TIBIAL PROX BEND 9x330mm
|
Facility
|
IP
|
$6,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.00 |
| Max. Negotiated Rate |
$1,495.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,236.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,495.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$927.00
|
|
|
NAIL TIBIAL PROX BEND 9x330mm
|
Facility
|
OP
|
$6,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.00 |
| Max. Negotiated Rate |
$3,090.00 |
| Rate for Payer: Aetna Commercial |
$1,854.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,854.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,575.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,575.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,236.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,575.90
|
| Rate for Payer: Cigna Commercial |
$3,090.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,495.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$927.00
|
|
|
NAIL TIBIAL STANDARD 9X345MM
|
Facility
|
IP
|
$11,410.00
|
|
| Hospital Charge Code |
270668416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,711.50 |
| Max. Negotiated Rate |
$2,761.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,282.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,761.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,711.50
|
|
|
NAIL TIBIAL STANDARD 9X345MM
|
Facility
|
OP
|
$11,410.00
|
|
| Hospital Charge Code |
270668416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,711.50 |
| Max. Negotiated Rate |
$5,705.00 |
| Rate for Payer: Aetna Commercial |
$3,423.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,423.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,909.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,909.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,282.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,909.55
|
| Rate for Payer: Cigna Commercial |
$5,705.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,761.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,711.50
|
|
|
NAIL TIBIAL STRD 9x285mm
|
Facility
|
IP
|
$7,913.50
|
|
| Hospital Charge Code |
270671681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.03 |
| Max. Negotiated Rate |
$1,915.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,582.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,915.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.03
|
|
|
NAIL TIBIAL STRD 9x285mm
|
Facility
|
OP
|
$7,913.50
|
|
| Hospital Charge Code |
270671681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.03 |
| Max. Negotiated Rate |
$3,956.75 |
| Rate for Payer: Aetna Commercial |
$2,374.05
|
| Rate for Payer: Aetna Medicare Advantage |
$2,374.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,017.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,017.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,582.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,017.94
|
| Rate for Payer: Cigna Commercial |
$3,956.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,915.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,187.03
|
|
|
NAIL TIBIAL T2 ALPHA 10X255MM
|
Facility
|
OP
|
$12,079.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,811.89 |
| Max. Negotiated Rate |
$6,039.65 |
| Rate for Payer: Aetna Commercial |
$3,623.79
|
| Rate for Payer: Aetna Medicare Advantage |
$3,623.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,080.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,080.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,415.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,080.22
|
| Rate for Payer: Cigna Commercial |
$6,039.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,923.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,811.89
|
|
|
NAIL TIBIAL T2 ALPHA 10X255MM
|
Facility
|
IP
|
$12,079.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,811.89 |
| Max. Negotiated Rate |
$2,923.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,415.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,923.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,811.89
|
|
|
NAIL TIBIAL TI CANN 10x330mm
|
Facility
|
OP
|
$6,000.00
|
|
| Hospital Charge Code |
270656596
|
|
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
|
|
|
NAIL TIBIAL TI CANN 10x330mm
|
Facility
|
IP
|
$6,000.00
|
|
| Hospital Charge Code |
270656596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
NAIL TIBIAL TI CANN 11x315mm
|
Facility
|
OP
|
$6,000.00
|
|
| Hospital Charge Code |
270656598
|
|
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
|
|
|
NAIL TIBIAL TI CANN 11x315mm
|
Facility
|
IP
|
$6,000.00
|
|
| Hospital Charge Code |
270656598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
NAIL TIBIAL TI CANN 11x405mm
|
Facility
|
OP
|
$6,000.00
|
|
| Hospital Charge Code |
270665479
|
|
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
|
|
|
NAIL TIBIAL TI CANN 11x405mm
|
Facility
|
IP
|
$6,000.00
|
|
| Hospital Charge Code |
270665479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
NAIL TIBIAL TI CANN 8X300mm
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
NAIL TIBIAL TI CANN 8X300mm
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669790
|
|
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
|
|
|
NAIL TIBIAL TI CANN 9x270mm
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
NAIL TIBIAL TI CANN 9x270mm
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659947
|
|
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
|
|
|
NAILTIBIALWPROXBEND9MM345MM
|
Facility
|
OP
|
$6,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.00 |
| Max. Negotiated Rate |
$3,090.00 |
| Rate for Payer: Aetna Commercial |
$1,854.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,854.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,575.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,575.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,236.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,575.90
|
| Rate for Payer: Cigna Commercial |
$3,090.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,495.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$927.00
|
|