|
ROD SYN REAMING 3 950 355.041S
|
Facility
|
IP
|
$498.50
|
|
| Hospital Charge Code |
270627051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.78 |
| Max. Negotiated Rate |
$120.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$120.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.78
|
|
|
ROD SYN REAMING 3 950 355.041S
|
Facility
|
OP
|
$498.50
|
|
| Hospital Charge Code |
270627051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.78 |
| Max. Negotiated Rate |
$249.25 |
| Rate for Payer: Aetna Commercial |
$149.55
|
| Rate for Payer: Aetna Medicare Advantage |
$149.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.12
|
| Rate for Payer: Cigna Commercial |
$249.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$120.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.78
|
|
|
ROD SYST SMALL BONE 3x110MM
|
Facility
|
IP
|
$7,515.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,127.25 |
| Max. Negotiated Rate |
$1,818.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,503.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,818.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,127.25
|
|
|
ROD SYST SMALL BONE 3x110MM
|
Facility
|
OP
|
$7,515.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,127.25 |
| Max. Negotiated Rate |
$3,757.50 |
| Rate for Payer: Aetna Commercial |
$2,254.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,254.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,916.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,916.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,503.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,916.33
|
| Rate for Payer: Cigna Commercial |
$3,757.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,818.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,127.25
|
|
|
ROD SYST SMALL BONE 3x145MM
|
Facility
|
OP
|
$7,515.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,127.25 |
| Max. Negotiated Rate |
$3,757.50 |
| Rate for Payer: Aetna Commercial |
$2,254.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,254.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,916.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,916.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,503.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,916.33
|
| Rate for Payer: Cigna Commercial |
$3,757.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,818.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,127.25
|
|
|
ROD SYST SMALL BONE 3x145MM
|
Facility
|
IP
|
$7,515.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,127.25 |
| Max. Negotiated Rate |
$1,818.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,503.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,818.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,127.25
|
|
|
RODS Z
|
Facility
|
OP
|
$6,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: Aetna Commercial |
$1,890.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,890.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,606.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,606.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,260.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,606.50
|
| Rate for Payer: Cigna Commercial |
$3,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,524.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$945.00
|
|
|
RODS Z
|
Facility
|
IP
|
$6,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$1,524.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,524.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$945.00
|
|
|
ROD TBOLT PREBENT 5.5X45MM
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
ROD TBOLT PREBENT 5.5X45MM
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
ROD THRD 100MM LNG/SLOTTED
|
Facility
|
IP
|
$299.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.96 |
| Max. Negotiated Rate |
$72.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$59.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.96
|
|
|
ROD THRD 100MM LNG/SLOTTED
|
Facility
|
OP
|
$299.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.96 |
| Max. Negotiated Rate |
$149.88 |
| Rate for Payer: Aetna Commercial |
$89.92
|
| Rate for Payer: Aetna Medicare Advantage |
$89.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$59.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.44
|
| Rate for Payer: Cigna Commercial |
$149.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.96
|
|
|
ROD THRD 300MM LNG/SLOTTED
|
Facility
|
OP
|
$377.00
|
|
| Hospital Charge Code |
270678153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Aetna Commercial |
$113.10
|
| Rate for Payer: Aetna Medicare Advantage |
$113.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$96.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$96.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$96.14
|
| Rate for Payer: Cigna Commercial |
$188.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$91.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.55
|
|
|
ROD THRD 300MM LNG/SLOTTED
|
Facility
|
IP
|
$377.00
|
|
| Hospital Charge Code |
270678153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$91.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$91.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.55
|
|
|
ROD THREADED 250MM LONG
|
Facility
|
OP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$168.70 |
| Rate for Payer: Aetna Commercial |
$101.22
|
| Rate for Payer: Aetna Medicare Advantage |
$101.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.04
|
| Rate for Payer: Cigna Commercial |
$168.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
ROD THREADED 250MM LONG
|
Facility
|
IP
|
$337.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
ROD THREADED 6x300MM
|
Facility
|
IP
|
$460.00
|
|
| Hospital Charge Code |
270674292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.00
|
|
|
ROD THREADED 6x300MM
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
270674292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$138.00
|
| Rate for Payer: Aetna Medicare Advantage |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$117.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$117.30
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.80
|
| Rate for Payer: Oxford Commercial |
$230.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$230.00
|
|
|
ROD THREADED EXT FIX 150MM
|
Facility
|
OP
|
$319.10
|
|
| Hospital Charge Code |
270693743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$159.55 |
| Rate for Payer: Aetna Commercial |
$95.73
|
| Rate for Payer: Aetna Medicare Advantage |
$95.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.37
|
| Rate for Payer: Cigna Commercial |
$159.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.48
|
| Rate for Payer: Oxford Commercial |
$159.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.55
|
|
|
ROD THREADED EXT FIX 150MM
|
Facility
|
IP
|
$319.10
|
|
| Hospital Charge Code |
270693743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$47.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.87
|
|
|
ROD THREADED EXT FIX 200MM
|
Facility
|
OP
|
$349.05
|
|
| Hospital Charge Code |
270693742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.38 |
| Max. Negotiated Rate |
$174.53 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Aetna Medicare Advantage |
$104.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.01
|
| Rate for Payer: Cigna Commercial |
$174.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.38
|
| Rate for Payer: Oxford Commercial |
$174.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$174.53
|
|
|
ROD THREADED EXT FIX 200MM
|
Facility
|
IP
|
$349.05
|
|
| Hospital Charge Code |
270693742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$52.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.36
|
|
|
ROD THREADED LRF 200MM
|
Facility
|
OP
|
$408.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$204.35 |
| Rate for Payer: Aetna Commercial |
$122.61
|
| Rate for Payer: Aetna Medicare Advantage |
$122.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$104.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$104.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$81.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$104.22
|
| Rate for Payer: Cigna Commercial |
$204.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.30
|
|
|
ROD THREADED LRF 200MM
|
Facility
|
IP
|
$408.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$98.91 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$81.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.30
|
|
|
ROD TI 5.5X40MM
|
Facility
|
IP
|
$2,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.50 |
| Max. Negotiated Rate |
$578.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$478.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$578.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$358.50
|
|