|
OSSIMATRIX SMALL PRFM
|
Facility
|
IP
|
$6,475.00
|
|
| Hospital Charge Code |
270702458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$1,566.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
|
|
OSS IM STEM WITH SCREW 10MM X
|
Facility
|
IP
|
$9,210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.50 |
| Max. Negotiated Rate |
$2,228.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,842.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,228.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,381.50
|
|
|
OSS IM STEM WITH SCREW 10MM X
|
Facility
|
OP
|
$9,210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.50 |
| Max. Negotiated Rate |
$4,605.00 |
| Rate for Payer: Aetna Commercial |
$2,763.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,763.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,348.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,348.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,842.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,348.55
|
| Rate for Payer: Cigna Commercial |
$4,605.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,228.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,381.50
|
|
|
OSS IM STEM WITH SCREW 11MM X
|
Facility
|
IP
|
$9,210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.50 |
| Max. Negotiated Rate |
$2,228.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,842.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,228.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,381.50
|
|
|
OSS IM STEM WITH SCREW 11MM X
|
Facility
|
OP
|
$9,210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.50 |
| Max. Negotiated Rate |
$4,605.00 |
| Rate for Payer: Aetna Commercial |
$2,763.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,763.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,348.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,348.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,842.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,348.55
|
| Rate for Payer: Cigna Commercial |
$4,605.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,228.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,381.50
|
|
|
OSSIO PUNCH PK 4.75MM
|
Facility
|
IP
|
$2,475.00
|
|
| Hospital Charge Code |
270700791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$371.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
OSSIO PUNCH PK 4.75MM
|
Facility
|
OP
|
$2,475.00
|
|
| Hospital Charge Code |
270700791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$742.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$321.75
|
| Rate for Payer: Oxford Commercial |
$1,237.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,237.50
|
|
|
OSSIO TAP PK 4.75MM
|
Facility
|
IP
|
$2,475.00
|
|
| Hospital Charge Code |
270700790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$371.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
OSSIO TAP PK 4.75MM
|
Facility
|
OP
|
$2,475.00
|
|
| Hospital Charge Code |
270700790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$742.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$321.75
|
| Rate for Payer: Oxford Commercial |
$1,237.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,237.50
|
|
|
OSS MOLDABLE 3CC
|
Facility
|
OP
|
$7,125.00
|
|
| Hospital Charge Code |
270702345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.75 |
| Max. Negotiated Rate |
$3,562.50 |
| Rate for Payer: Aetna Commercial |
$2,137.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,816.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,816.88
|
| Rate for Payer: Cigna Commercial |
$3,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
|
|
OSS MOLDABLE 3CC
|
Facility
|
IP
|
$7,125.00
|
|
| Hospital Charge Code |
270702345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.75 |
| Max. Negotiated Rate |
$1,724.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,724.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,068.75
|
|
|
OSS NON-MOD TIB PLATE LONG 71
|
Facility
|
OP
|
$30,550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,582.50 |
| Max. Negotiated Rate |
$15,275.00 |
| Rate for Payer: Aetna Commercial |
$9,165.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,790.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,790.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,790.25
|
| Rate for Payer: Cigna Commercial |
$15,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,393.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,582.50
|
|
|
OSS NON-MOD TIB PLATE LONG 71
|
Facility
|
IP
|
$30,550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,582.50 |
| Max. Negotiated Rate |
$7,393.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,393.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,582.50
|
|
|
OSS RS 8.5CM ELLIP SEG FMRL-LT
|
Facility
|
IP
|
$63,900.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270689984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,585.00 |
| Max. Negotiated Rate |
$15,463.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12,780.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,463.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,585.00
|
|
|
OSS RS 8.5CM ELLIP SEG FMRL-LT
|
Facility
|
OP
|
$63,900.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270689984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,585.00 |
| Max. Negotiated Rate |
$31,950.00 |
| Rate for Payer: Aetna Commercial |
$19,170.00
|
| Rate for Payer: Aetna Medicare Advantage |
$19,170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16,294.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16,294.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12,780.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16,294.50
|
| Rate for Payer: Cigna Commercial |
$31,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15,463.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,585.00
|
|
|
OSS STAPLE
|
Facility
|
IP
|
$4,475.00
|
|
| Hospital Charge Code |
270656969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$1,082.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$895.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,082.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
|
|
OSS STAPLE
|
Facility
|
OP
|
$4,475.00
|
|
| Hospital Charge Code |
270656969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.25 |
| Max. Negotiated Rate |
$2,237.50 |
| Rate for Payer: Aetna Commercial |
$1,342.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,342.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,141.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$895.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,141.12
|
| Rate for Payer: Cigna Commercial |
$2,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,082.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$671.25
|
|
|
OS STAPLE
|
Facility
|
OP
|
$6,975.00
|
|
| Hospital Charge Code |
270657017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$3,487.50 |
| Rate for Payer: Aetna Commercial |
$2,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,778.62
|
| Rate for Payer: Cigna Commercial |
$3,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
OS STAPLE
|
Facility
|
IP
|
$6,975.00
|
|
| Hospital Charge Code |
270657017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$1,687.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
OSS TI 5CM DSTL FEMUR RT
|
Facility
|
IP
|
$37,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270684636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,625.00 |
| Max. Negotiated Rate |
$9,075.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,075.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,625.00
|
|
|
OSS TI 5CM DSTL FEMUR RT
|
Facility
|
OP
|
$37,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270684636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,625.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Aetna Commercial |
$11,250.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,562.50
|
| Rate for Payer: Cigna Commercial |
$18,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,075.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,625.00
|
|
|
OSS TI AXLE W CAP AND SCR
|
Facility
|
IP
|
$6,900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.00 |
| Max. Negotiated Rate |
$1,669.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,380.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,669.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,035.00
|
|
|
OSS TI AXLE W CAP AND SCR
|
Facility
|
OP
|
$6,900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.00 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: Aetna Commercial |
$2,070.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,070.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,759.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,759.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,380.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,759.50
|
| Rate for Payer: Cigna Commercial |
$3,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,669.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,035.00
|
|
|
OSS TIBIAL POLY BEARING 20MM
|
Facility
|
IP
|
$8,952.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.80 |
| Max. Negotiated Rate |
$2,166.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,790.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,166.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,342.80
|
|
|
OSS TIBIAL POLY BEARING 20MM
|
Facility
|
OP
|
$8,952.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270691629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.80 |
| Max. Negotiated Rate |
$4,476.00 |
| Rate for Payer: Aetna Commercial |
$2,685.60
|
| Rate for Payer: Aetna Medicare Advantage |
$2,685.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,282.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,282.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,790.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,282.76
|
| Rate for Payer: Cigna Commercial |
$4,476.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,166.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,342.80
|
|