|
PLATE CLAVICAL ANTERIOR 10 HO
|
Facility
|
OP
|
$5,830.00
|
|
| Hospital Charge Code |
270669425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: Aetna Commercial |
$1,749.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,749.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,486.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,486.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,166.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,486.65
|
| Rate for Payer: Cigna Commercial |
$2,915.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,410.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$874.50
|
|
|
PLATE CLAVICAL ANTERIOR 10 HO
|
Facility
|
IP
|
$5,830.00
|
|
| Hospital Charge Code |
270669425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.50 |
| Max. Negotiated Rate |
$1,410.86 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,166.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,410.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$874.50
|
|
|
PLATE CLAVICAL LEFT 8 HOLE
|
Facility
|
IP
|
$2,750.00
|
|
| Hospital Charge Code |
270668043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$665.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$665.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
|
|
PLATE CLAVICAL LEFT 8 HOLE
|
Facility
|
OP
|
$2,750.00
|
|
| Hospital Charge Code |
270668043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$825.00
|
| Rate for Payer: Aetna Medicare Advantage |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$701.25
|
| Rate for Payer: Cigna Commercial |
$1,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$665.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
|
|
PLATE CLAVICAL SYSTEM
|
Facility
|
IP
|
$11,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,687.50 |
| Max. Negotiated Rate |
$2,722.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,722.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,687.50
|
|
|
PLATE CLAVICAL SYSTEM
|
Facility
|
OP
|
$11,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,687.50 |
| Max. Negotiated Rate |
$5,625.00 |
| Rate for Payer: Aetna Commercial |
$3,375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,868.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,868.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,868.75
|
| Rate for Payer: Cigna Commercial |
$5,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,722.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,687.50
|
|
|
PLATE CLAVICLA ANT 7 HOLE
|
Facility
|
IP
|
$4,274.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.15 |
| Max. Negotiated Rate |
$1,034.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$854.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,034.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$641.15
|
|
|
PLATE CLAVICLA ANT 7 HOLE
|
Facility
|
OP
|
$4,274.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.15 |
| Max. Negotiated Rate |
$2,137.18 |
| Rate for Payer: Aetna Commercial |
$1,282.31
|
| Rate for Payer: Aetna Medicare Advantage |
$1,282.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,089.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,089.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$854.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,089.96
|
| Rate for Payer: Cigna Commercial |
$2,137.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,034.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$641.15
|
|
|
PLATE CLAVICLE 2.7MM LT CS2
|
Facility
|
IP
|
$4,919.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.88 |
| Max. Negotiated Rate |
$1,190.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$983.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,190.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$737.88
|
|
|
PLATE CLAVICLE 2.7MM LT CS2
|
Facility
|
OP
|
$4,919.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.88 |
| Max. Negotiated Rate |
$2,459.60 |
| Rate for Payer: Aetna Commercial |
$1,475.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,475.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,254.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,254.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$983.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,254.40
|
| Rate for Payer: Cigna Commercial |
$2,459.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,190.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$737.88
|
|
|
PLATECLAVICLE3.5MMLCP5HRT94MM
|
Facility
|
IP
|
$5,721.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.17 |
| Max. Negotiated Rate |
$1,384.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,144.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,384.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$858.17
|
|
|
PLATECLAVICLE3.5MMLCP5HRT94MM
|
Facility
|
OP
|
$5,721.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.17 |
| Max. Negotiated Rate |
$2,860.57 |
| Rate for Payer: Aetna Commercial |
$1,716.35
|
| Rate for Payer: Aetna Medicare Advantage |
$1,716.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,458.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,458.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,144.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,458.89
|
| Rate for Payer: Cigna Commercial |
$2,860.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,384.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$858.17
|
|
|
PLATE CLAVICLE 6 HOLE
|
Facility
|
IP
|
$9,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,377.00 |
| Max. Negotiated Rate |
$2,221.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,836.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,221.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,377.00
|
|
|
PLATE CLAVICLE 6 HOLE
|
Facility
|
OP
|
$9,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,377.00 |
| Max. Negotiated Rate |
$4,590.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,754.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,340.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,340.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,836.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,340.90
|
| Rate for Payer: Cigna Commercial |
$4,590.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,221.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,377.00
|
|
|
PLATE CLAVICLE SUPER 3.5MM 8 H
|
Facility
|
OP
|
$4,460.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270689730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.04 |
| Max. Negotiated Rate |
$2,230.15 |
| Rate for Payer: Aetna Commercial |
$1,338.09
|
| Rate for Payer: Aetna Medicare Advantage |
$1,338.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,137.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,137.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$892.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,137.38
|
| Rate for Payer: Cigna Commercial |
$2,230.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,079.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$669.04
|
|
|
PLATE CLAVICLE SUPER 3.5MM 8 H
|
Facility
|
IP
|
$4,460.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270689730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.04 |
| Max. Negotiated Rate |
$1,079.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$892.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,079.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$669.04
|
|
|
PLATE CLAVICLE WITH LAT EXT
|
Facility
|
OP
|
$4,904.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$735.67 |
| Max. Negotiated Rate |
$2,452.22 |
| Rate for Payer: Aetna Commercial |
$1,471.34
|
| Rate for Payer: Aetna Medicare Advantage |
$1,471.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,250.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,250.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$980.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,250.63
|
| Rate for Payer: Cigna Commercial |
$2,452.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,186.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$735.67
|
|
|
PLATE CLAVICLE WITH LAT EXT
|
Facility
|
IP
|
$4,904.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$735.67 |
| Max. Negotiated Rate |
$1,186.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$980.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,186.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$735.67
|
|
|
PLATE CLAV LT MED LOCK PLCL8ML
|
Facility
|
OP
|
$3,475.00
|
|
| Hospital Charge Code |
270638666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$1,737.50 |
| Rate for Payer: Aetna Commercial |
$1,042.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,042.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$695.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$886.12
|
| Rate for Payer: Cigna Commercial |
$1,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$840.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
|
|
PLATE CLAV LT MED LOCK PLCL8ML
|
Facility
|
IP
|
$3,475.00
|
|
| Hospital Charge Code |
270638666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$840.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$695.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$840.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
|
|
PLATE CLAW II 2HOLE 20MM
|
Facility
|
IP
|
$10,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.25 |
| Max. Negotiated Rate |
$2,583.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,583.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,601.25
|
|
|
PLATE CLAW II 2HOLE 20MM
|
Facility
|
OP
|
$10,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.25 |
| Max. Negotiated Rate |
$5,337.50 |
| Rate for Payer: Aetna Commercial |
$3,202.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,202.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,722.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,722.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,722.12
|
| Rate for Payer: Cigna Commercial |
$5,337.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,583.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,601.25
|
|
|
PLATE CLC FRAC PERIMETER SM
|
Facility
|
IP
|
$6,620.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.00 |
| Max. Negotiated Rate |
$1,602.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,602.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.00
|
|
|
PLATE CLC FRAC PERIMETER SM
|
Facility
|
OP
|
$6,620.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.00 |
| Max. Negotiated Rate |
$3,310.00 |
| Rate for Payer: Aetna Commercial |
$1,986.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,986.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,688.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,688.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,688.10
|
| Rate for Payer: Cigna Commercial |
$3,310.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,602.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.00
|
|
|
PLATE CLC FRAC STD X-SM/SM
|
Facility
|
OP
|
$6,620.00
|
|
| Hospital Charge Code |
270656830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.00 |
| Max. Negotiated Rate |
$3,310.00 |
| Rate for Payer: Aetna Commercial |
$1,986.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,986.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,688.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,688.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,688.10
|
| Rate for Payer: Cigna Commercial |
$3,310.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,602.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.00
|
|