|
35MM ROD
|
Facility
|
IP
|
$1,690.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.60 |
| Max. Negotiated Rate |
$409.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$338.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$409.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$253.60
|
|
|
35MM ROD
|
Facility
|
OP
|
$1,690.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.60 |
| Max. Negotiated Rate |
$845.33 |
| Rate for Payer: Aetna Commercial |
$507.19
|
| Rate for Payer: Aetna Medicare Advantage |
$507.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$431.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$431.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$338.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$431.12
|
| Rate for Payer: Cigna Commercial |
$845.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$409.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$253.60
|
|
|
3.5MM TROCAR, SHORT
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
270703299
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
3.5MM TROCAR, SHORT
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
270703299
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$450.00
|
|
|
3.5MM ULS T-PLT 4H HEAD 6H SHA
|
Facility
|
IP
|
$1,772.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.88 |
| Max. Negotiated Rate |
$428.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$354.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$428.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.88
|
|
|
3.5MM ULS T-PLT 4H HEAD 6H SHA
|
Facility
|
OP
|
$1,772.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.88 |
| Max. Negotiated Rate |
$886.25 |
| Rate for Payer: Aetna Commercial |
$531.75
|
| Rate for Payer: Aetna Medicare Advantage |
$531.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$451.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$451.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$354.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$451.99
|
| Rate for Payer: Cigna Commercial |
$886.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$428.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$265.88
|
|
|
3.5MM VAR ANGLE LOCKING 54MM
|
Facility
|
IP
|
$73.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$17.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.02
|
|
|
3.5MM VAR ANGLE LOCKING 54MM
|
Facility
|
OP
|
$73.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$36.73 |
| Rate for Payer: Aetna Commercial |
$22.04
|
| Rate for Payer: Aetna Medicare Advantage |
$22.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.73
|
| Rate for Payer: Cigna Commercial |
$36.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.02
|
|
|
3.5MM X 12MM CORTICAL SCREW
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$52.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
3.5MM X 12MM CORTICAL SCREW
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$42.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
3.5MM X 14MM TI LOCKING SCREW
|
Facility
|
OP
|
$433.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare Advantage |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$110.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$110.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$110.54
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.03
|
|
|
3.5MM X 14MM TI LOCKING SCREW
|
Facility
|
IP
|
$433.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$104.91 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.03
|
|
|
3.5MM X 16MM TI LOCKING SCREW
|
Facility
|
OP
|
$433.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare Advantage |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$110.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$110.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$110.54
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.03
|
|
|
3.5MM X 16MM TI LOCKING SCREW
|
Facility
|
IP
|
$433.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$104.91 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.03
|
|
|
3.5MM X 40MM TI LOCKING SCREW
|
Facility
|
IP
|
$433.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$104.91 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.03
|
|
|
3.5MM X 40MM TI LOCKING SCREW
|
Facility
|
OP
|
$433.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare Advantage |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$110.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$110.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$110.54
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.03
|
|
|
35MM X 42MM HEADLESS CANN SCRE
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
35MM X 42MM HEADLESS CANN SCRE
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
3.5MM X 60MM TI LOCKING SCREW
|
Facility
|
IP
|
$433.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$104.91 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.03
|
|
|
3.5MM X 60MM TI LOCKING SCREW
|
Facility
|
OP
|
$433.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare Advantage |
$130.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$110.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$110.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$110.54
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$65.03
|
|
|
3.5 RIGHT OPEN WEDGE PLATE
|
Facility
|
IP
|
$3,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656453
|
|
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
|
|
|
3.5 RIGHT OPEN WEDGE PLATE
|
Facility
|
OP
|
$3,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656453
|
|
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
|
|
|
3.5 SCREW LOCKING 12MM
|
Facility
|
IP
|
$480.25
|
|
| Hospital Charge Code |
270656885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$116.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$96.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$116.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.04
|
|
|
3.5 SCREW LOCKING 12MM
|
Facility
|
OP
|
$480.25
|
|
| Hospital Charge Code |
270656885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$144.07
|
| Rate for Payer: Aetna Medicare Advantage |
$144.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$122.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$122.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$96.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$122.46
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$116.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.04
|
|
|
3.5 X 14 F.A. SCREW
|
Facility
|
OP
|
$5,815.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.25 |
| Max. Negotiated Rate |
$2,907.50 |
| Rate for Payer: Aetna Commercial |
$1,744.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,744.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,482.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,482.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,163.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,482.83
|
| Rate for Payer: Cigna Commercial |
$2,907.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,407.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$872.25
|
|