|
PLATE 5 HOLE Utility pole
|
Facility
|
IP
|
$8,100.00
|
|
| Hospital Charge Code |
270669406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.00 |
| Max. Negotiated Rate |
$1,960.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,620.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,960.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,215.00
|
|
|
PLATE 5 HOLE Utility pole
|
Facility
|
OP
|
$8,100.00
|
|
| Hospital Charge Code |
270669406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.00 |
| Max. Negotiated Rate |
$4,050.00 |
| Rate for Payer: Aetna Commercial |
$2,430.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,430.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,065.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,065.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,620.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,065.50
|
| Rate for Payer: Cigna Commercial |
$4,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,960.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,215.00
|
|
|
PLATE 5TH HOOK MET
|
Facility
|
IP
|
$5,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$1,306.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,080.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,306.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$810.00
|
|
|
PLATE 5TH HOOK MET
|
Facility
|
OP
|
$5,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,620.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,620.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,377.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,377.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,080.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,377.00
|
| Rate for Payer: Cigna Commercial |
$2,700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,306.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$810.00
|
|
|
PLATE 60 MM
|
Facility
|
OP
|
$5,500.00
|
|
| Hospital Charge Code |
270703447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$1,650.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
PLATE 60 MM
|
Facility
|
IP
|
$5,500.00
|
|
| Hospital Charge Code |
270703447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
PLATE 63MM
|
Facility
|
IP
|
$5,150.00
|
|
| Hospital Charge Code |
270703362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$772.50 |
| Max. Negotiated Rate |
$1,246.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,030.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,246.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$772.50
|
|
|
PLATE 63MM
|
Facility
|
OP
|
$5,150.00
|
|
| Hospital Charge Code |
270703362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$772.50 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,545.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,545.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,313.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,313.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,030.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,313.25
|
| Rate for Payer: Cigna Commercial |
$2,575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,246.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$772.50
|
|
|
PLATE 64MM
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$1,650.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
PLATE 64MM
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
PLATE 65MM 4 LEVEL CURE
|
Facility
|
IP
|
$16,747.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,512.12 |
| Max. Negotiated Rate |
$4,052.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,349.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,052.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,512.12
|
|
|
PLATE 65MM 4 LEVEL CURE
|
Facility
|
OP
|
$16,747.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,512.12 |
| Max. Negotiated Rate |
$8,373.75 |
| Rate for Payer: Aetna Commercial |
$5,024.25
|
| Rate for Payer: Aetna Medicare Advantage |
$5,024.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,349.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,270.61
|
| Rate for Payer: Cigna Commercial |
$8,373.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,052.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,512.12
|
|
|
PLATE 6.5MMX30MM
|
Facility
|
OP
|
$6,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna Commercial |
$1,875.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,875.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,593.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,593.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,593.75
|
| Rate for Payer: Cigna Commercial |
$3,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,512.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$937.50
|
|
|
PLATE 6.5MMX30MM
|
Facility
|
IP
|
$6,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$1,512.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,512.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$937.50
|
|
|
PLATE 6H 76MM
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.50 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$1,395.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,185.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,185.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$930.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,185.75
|
| Rate for Payer: Cigna Commercial |
$2,325.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,125.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$697.50
|
|
|
PLATE 6H 76MM
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.50 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$930.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,125.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$697.50
|
|
|
PLATE 6H LT ULNADORL 234801006
|
Facility
|
OP
|
$3,085.75
|
|
| Hospital Charge Code |
270633304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.86 |
| Max. Negotiated Rate |
$1,542.88 |
| Rate for Payer: Aetna Commercial |
$925.73
|
| Rate for Payer: Aetna Medicare Advantage |
$925.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$786.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$786.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$617.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$786.87
|
| Rate for Payer: Cigna Commercial |
$1,542.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$746.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.86
|
|
|
PLATE 6H LT ULNADORL 234801006
|
Facility
|
IP
|
$3,085.75
|
|
| Hospital Charge Code |
270633304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.86 |
| Max. Negotiated Rate |
$746.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$617.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$746.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$462.86
|
|
|
PLATE 6 HOLE
|
Facility
|
IP
|
$3,205.00
|
|
| Hospital Charge Code |
270702597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$480.75 |
| Max. Negotiated Rate |
$775.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$641.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$775.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$480.75
|
|
|
PLATE 6 HOLE
|
Facility
|
OP
|
$3,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.25 |
| Max. Negotiated Rate |
$1,987.50 |
| Rate for Payer: Aetna Commercial |
$1,192.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,192.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,013.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,013.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$795.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,013.62
|
| Rate for Payer: Cigna Commercial |
$1,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$961.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$596.25
|
|
|
PLATE 6 HOLE
|
Facility
|
IP
|
$3,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.25 |
| Max. Negotiated Rate |
$961.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$795.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$961.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$596.25
|
|
|
PLATE 6 HOLE
|
Facility
|
OP
|
$3,205.00
|
|
| Hospital Charge Code |
270702597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$480.75 |
| Max. Negotiated Rate |
$1,602.50 |
| Rate for Payer: Aetna Commercial |
$961.50
|
| Rate for Payer: Aetna Medicare Advantage |
$961.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$817.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$817.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$641.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$817.27
|
| Rate for Payer: Cigna Commercial |
$1,602.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$775.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$480.75
|
|
|
PLATE 6 HOLE 1/3
|
Facility
|
OP
|
$445.00
|
|
| Hospital Charge Code |
270661843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$222.50 |
| Rate for Payer: Aetna Commercial |
$133.50
|
| Rate for Payer: Aetna Medicare Advantage |
$133.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$113.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$113.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$89.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$113.47
|
| Rate for Payer: Cigna Commercial |
$222.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.75
|
|
|
PLATE 6 HOLE 1/3
|
Facility
|
IP
|
$445.00
|
|
| Hospital Charge Code |
270661843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$89.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.75
|
|
|
PLATE 6HOLE 2.7X3 5MM LCP LEFT
|
Facility
|
OP
|
$6,740.00
|
|
| Hospital Charge Code |
270648927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$3,370.00 |
| Rate for Payer: Aetna Commercial |
$2,022.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,022.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$3,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|