|
4.5X50MM BONE SCREW
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
270656733
|
|
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
|
|
|
4.5X50MM BONE SCREW
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
270656733
|
|
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
|
|
|
4.5 X 50MM BONE SCREW TORNIER
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
270339521
|
|
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
|
|
|
4.5 X 50MM BONE SCREW TORNIER
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
270339521
|
|
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
|
|
|
4.75 KNOTLESSBC LOOP N TACK SY
|
Facility
|
IP
|
$4,429.00
|
|
| Hospital Charge Code |
270703222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.35 |
| Max. Negotiated Rate |
$1,071.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$885.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,071.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$664.35
|
|
|
4.75 KNOTLESSBC LOOP N TACK SY
|
Facility
|
OP
|
$4,429.00
|
|
| Hospital Charge Code |
270703222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.35 |
| Max. Negotiated Rate |
$2,214.50 |
| Rate for Payer: Aetna Commercial |
$1,328.70
|
| Rate for Payer: Aetna Medicare Advantage |
$1,328.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,129.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,129.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$885.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,129.39
|
| Rate for Payer: Cigna Commercial |
$2,214.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,071.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$664.35
|
|
|
4.75 KNOTLESS BC LOOP N TACK T
|
Facility
|
IP
|
$4,075.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.25 |
| Max. Negotiated Rate |
$986.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$815.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$986.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$611.25
|
|
|
4.75 KNOTLESS BC LOOP N TACK T
|
Facility
|
OP
|
$4,075.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.25 |
| Max. Negotiated Rate |
$2,037.50 |
| Rate for Payer: Aetna Commercial |
$1,222.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,222.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,039.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,039.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$815.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,039.12
|
| Rate for Payer: Cigna Commercial |
$2,037.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$986.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$611.25
|
|
|
4.75MM KNOTLESSSWIVEL ANCHOR
|
Facility
|
OP
|
$2,549.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$382.39 |
| Max. Negotiated Rate |
$1,274.62 |
| Rate for Payer: Aetna Commercial |
$764.77
|
| Rate for Payer: Aetna Medicare Advantage |
$764.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$650.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$650.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$509.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$650.06
|
| Rate for Payer: Cigna Commercial |
$1,274.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$616.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$382.39
|
|
|
4.75MM KNOTLESSSWIVEL ANCHOR
|
Facility
|
IP
|
$2,549.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$382.39 |
| Max. Negotiated Rate |
$616.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$509.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$616.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$382.39
|
|
|
480MM ROD
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
480MM ROD
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$726.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
4.8 DRILL BIT
|
Facility
|
OP
|
$625.00
|
|
| Hospital Charge Code |
270339502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$312.50 |
| Rate for Payer: Aetna Commercial |
$187.50
|
| Rate for Payer: Aetna Medicare Advantage |
$187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$159.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$159.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$159.38
|
| Rate for Payer: Cigna Commercial |
$312.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.25
|
| Rate for Payer: Oxford Commercial |
$312.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$312.50
|
|
|
4.8 DRILL BIT
|
Facility
|
IP
|
$625.00
|
|
| Hospital Charge Code |
270339502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.75
|
|
|
4.8MM CANC SCRW NONSTRL 32MM
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
4.8MM CANC SCRW NONSTRL 32MM
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$172.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
4 COLOSTOMY FLANGE
|
Facility
|
OP
|
$11.04
|
|
| Hospital Charge Code |
270650996
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna Medicare Advantage |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.82
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.44
|
| Rate for Payer: Oxford Commercial |
$5.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.52
|
|
|
4 COLOSTOMY FLANGE
|
Facility
|
IP
|
$11.04
|
|
| Hospital Charge Code |
270650996
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.66
|
|
|
4 HOLE DISTAL LATERAL PLATE
|
Facility
|
OP
|
$17,345.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,601.75 |
| Max. Negotiated Rate |
$8,672.50 |
| Rate for Payer: Aetna Commercial |
$5,203.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,203.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,422.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,422.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,469.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,422.98
|
| Rate for Payer: Cigna Commercial |
$8,672.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,197.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,601.75
|
|
|
4 HOLE DISTAL LATERAL PLATE
|
Facility
|
IP
|
$17,345.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,601.75 |
| Max. Negotiated Rate |
$4,197.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,469.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,197.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,601.75
|
|
|
4-HOLE PROX LATERAL TIBIA PLAT
|
Facility
|
IP
|
$9,190.00
|
|
| Hospital Charge Code |
270656449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.50 |
| Max. Negotiated Rate |
$2,223.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,838.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,223.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,378.50
|
|
|
4-HOLE PROX LATERAL TIBIA PLAT
|
Facility
|
OP
|
$9,190.00
|
|
| Hospital Charge Code |
270656449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.50 |
| Max. Negotiated Rate |
$4,595.00 |
| Rate for Payer: Aetna Commercial |
$2,757.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,757.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,343.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,343.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,838.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,343.45
|
| Rate for Payer: Cigna Commercial |
$4,595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,223.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,378.50
|
|
|
4-HOLE PROX.LAT.TIBIA PLT.
|
Facility
|
OP
|
$6,860.00
|
|
| Hospital Charge Code |
270656451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna Commercial |
$2,058.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,058.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,749.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,749.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,372.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$3,430.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,660.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,029.00
|
|
|
4-HOLE PROX.LAT.TIBIA PLT.
|
Facility
|
IP
|
$6,860.00
|
|
| Hospital Charge Code |
270656451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$1,660.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,372.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,660.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,029.00
|
|
|
4 HOLE UDR PLATE NARROW (L)
|
Facility
|
IP
|
$9,075.00
|
|
| Hospital Charge Code |
270703216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,361.25 |
| Max. Negotiated Rate |
$2,196.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,815.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,196.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,361.25
|
|