|
3.5MM CRTX SCREW LOW PROF 36MM
|
Facility
|
IP
|
$157.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.63 |
| Max. Negotiated Rate |
$38.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.63
|
|
|
3.5MM CRTX SCREW LOW PROF 75MM
|
Facility
|
IP
|
$152.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.94
|
|
|
3.5MM CRTX SCREW LOW PROF 75MM
|
Facility
|
OP
|
$152.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$76.47 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: Aetna Medicare Advantage |
$45.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.00
|
| Rate for Payer: Cigna Commercial |
$76.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.94
|
|
|
3.5MM LCP MED PROX TIB PLATE 1
|
Facility
|
OP
|
$6,635.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.39 |
| Max. Negotiated Rate |
$3,317.97 |
| Rate for Payer: Aetna Commercial |
$1,990.79
|
| Rate for Payer: Aetna Medicare Advantage |
$1,990.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,692.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,692.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,327.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,692.17
|
| Rate for Payer: Cigna Commercial |
$3,317.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,605.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$995.39
|
|
|
3.5MM LCP MED PROX TIB PLATE 1
|
Facility
|
IP
|
$6,635.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.39 |
| Max. Negotiated Rate |
$1,605.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,327.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,605.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$995.39
|
|
|
3.5MM LOCK COM PLATE 12 HOLE
|
Facility
|
OP
|
$2,380.00
|
|
| Hospital Charge Code |
270702051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna Commercial |
$714.00
|
| Rate for Payer: Aetna Medicare Advantage |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$606.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$606.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$476.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$606.90
|
| Rate for Payer: Cigna Commercial |
$1,190.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$575.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$357.00
|
|
|
3.5MM LOCK COM PLATE 12 HOLE
|
Facility
|
IP
|
$2,380.00
|
|
| Hospital Charge Code |
270702051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$575.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$476.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$575.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$357.00
|
|
|
3.5MM LOW PROF CORT 22MM
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
270702053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Medicare Advantage |
$157.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.88
|
| Rate for Payer: Cigna Commercial |
$262.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
|
|
3.5MM LOW PROF CORT 22MM
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
270702053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$127.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
|
|
3.5MM LOW PROFILE CORT 32MM
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna Commercial |
$111.00
|
| Rate for Payer: Aetna Medicare Advantage |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.35
|
| Rate for Payer: Cigna Commercial |
$185.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$89.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.50
|
|
|
3.5MM LOW PROFILE CORT 32MM
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$89.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$89.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.50
|
|
|
3.5MM LOW PROFILE CORT 40MM
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.32
|
| Rate for Payer: Cigna Commercial |
$132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.60
|
|
|
3.5MM LOW PROFILE CORT 40MM
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$63.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.60
|
|
|
3.5MM LOW PROFILE CORT 50MM
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270658889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$69.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$69.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.90
|
|
|
3.5MM LOW PROFILE CORT 50MM
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270658889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna Commercial |
$85.80
|
| Rate for Payer: Aetna Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.93
|
| Rate for Payer: Cigna Commercial |
$143.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$69.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.90
|
|
|
3.5 MM MULTIDIRECT SCREW 14MM
|
Facility
|
OP
|
$832.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$249.60
|
| Rate for Payer: Aetna Medicare Advantage |
$249.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.16
|
| Rate for Payer: Cigna Commercial |
$416.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.80
|
|
|
3.5 MM MULTIDIRECT SCREW 14MM
|
Facility
|
IP
|
$832.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$201.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.80
|
|
|
3.5MM MULTI DIRECT SCREW 16MM
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$264.00
|
| Rate for Payer: Aetna Medicare Advantage |
$264.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$176.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.40
|
| Rate for Payer: Cigna Commercial |
$440.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$212.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.00
|
|
|
3.5MM MULTI DIRECT SCREW 16MM
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$212.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$176.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$212.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.00
|
|
|
3.5MM MULTIDIRECT SCREW 20MM
|
Facility
|
OP
|
$832.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$249.60
|
| Rate for Payer: Aetna Medicare Advantage |
$249.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.16
|
| Rate for Payer: Cigna Commercial |
$416.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.80
|
|
|
3.5MM MULTIDIRECT SCREW 20MM
|
Facility
|
IP
|
$832.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$201.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.80
|
|
|
3.5MM MULTIDIRECT SCREW 70MM
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$185.86 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$153.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$185.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.20
|
|
|
3.5MM MULTIDIRECT SCREW 70MM
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Medicare Advantage |
$230.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$195.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$195.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$153.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$195.84
|
| Rate for Payer: Cigna Commercial |
$384.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$185.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.20
|
|
|
3.5M MPROXIMAL TIBIAL PLATE
|
Facility
|
OP
|
$6,699.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.94 |
| Max. Negotiated Rate |
$3,349.80 |
| Rate for Payer: Aetna Commercial |
$2,009.88
|
| Rate for Payer: Aetna Medicare Advantage |
$2,009.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,708.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,708.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,339.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,708.40
|
| Rate for Payer: Cigna Commercial |
$3,349.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,621.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,004.94
|
|
|
3.5M MPROXIMAL TIBIAL PLATE
|
Facility
|
IP
|
$6,699.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.94 |
| Max. Negotiated Rate |
$1,621.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,339.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,621.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,004.94
|
|