|
5MM ALLEN WRENCH
|
Facility
|
OP
|
$57.55
|
|
| Hospital Charge Code |
270656630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$28.77 |
| Rate for Payer: Aetna Commercial |
$17.27
|
| Rate for Payer: Aetna Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.68
|
| Rate for Payer: Cigna Commercial |
$28.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.63
|
|
|
5MM ALLEN WRENCH
|
Facility
|
IP
|
$57.55
|
|
| Hospital Charge Code |
270656630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$13.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.63
|
|
|
5MM CAGE
|
Facility
|
IP
|
$6,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$1,573.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,573.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$975.00
|
|
|
5MM CAGE
|
Facility
|
OP
|
$6,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$3,250.00 |
| Rate for Payer: Aetna Commercial |
$1,950.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,657.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,657.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,657.50
|
| Rate for Payer: Cigna Commercial |
$3,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,573.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$975.00
|
|
|
5MM LARGE CAGE
|
Facility
|
IP
|
$6,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$1,573.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,573.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$975.00
|
|
|
5MM LARGE CAGE
|
Facility
|
OP
|
$6,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$3,250.00 |
| Rate for Payer: Aetna Commercial |
$1,950.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,657.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,657.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,657.50
|
| Rate for Payer: Cigna Commercial |
$3,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,573.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$975.00
|
|
|
5MM SCREW
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
270339471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Medicare Advantage |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$198.90
|
| Rate for Payer: Cigna Commercial |
$390.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$188.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$117.00
|
|
|
5MM SCREW
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
270339471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$188.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$156.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$188.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$117.00
|
|
|
5MM SINGLE-SITE WRISTED NEEDLE
|
Facility
|
IP
|
$6,250.00
|
|
| Hospital Charge Code |
270673361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$937.50
|
|
|
5MM SINGLE-SITE WRISTED NEEDLE
|
Facility
|
OP
|
$6,250.00
|
|
| Hospital Charge Code |
270673361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.50 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna Commercial |
$1,875.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,875.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,593.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,593.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,593.75
|
| Rate for Payer: Cigna Commercial |
$3,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$812.50
|
| Rate for Payer: Oxford Commercial |
$3,125.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$937.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,125.00
|
|
|
5MM TRANSHING PIN
|
Facility
|
IP
|
$660.00
|
|
| Hospital Charge Code |
270339497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
5MM TRANSHING PIN
|
Facility
|
OP
|
$660.00
|
|
| Hospital Charge Code |
270339497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.80
|
| Rate for Payer: Oxford Commercial |
$330.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$330.00
|
|
|
5 MM TRANSTING PIN
|
Facility
|
OP
|
$660.00
|
|
| Hospital Charge Code |
270656631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
5 MM TRANSTING PIN
|
Facility
|
IP
|
$660.00
|
|
| Hospital Charge Code |
270656631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$159.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
5 NUCLEOTIDASE
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
3011970
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$10.50
|
| Rate for Payer: Aetna Medicare Advantage |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.93
|
| Rate for Payer: Cigna Commercial |
$17.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.55
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
5 NUCLEOTIDASE
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
3011970
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.25
|
|
|
5'NUCLEOTIDASE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 83915
|
| Hospital Charge Code |
39900112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
5'NUCLEOTIDASE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 83915
|
| Hospital Charge Code |
39900112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$36.13
|
| Rate for Payer: Aetna Medicare Advantage |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.85
|
| Rate for Payer: Cigna Commercial |
$11.15
|
| Rate for Payer: Cigna Medicare Advantage |
$5.58
|
| Rate for Payer: Clover Medicare Advantage |
$10.59
|
| Rate for Payer: EmblemHealth Commercial |
$33.45
|
| Rate for Payer: Humana Medicare Advantage |
$11.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.15
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$11.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.15
|
|
|
5' NUCLEOTIDASE
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 83915
|
| Hospital Charge Code |
38472518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$36.13
|
| Rate for Payer: Aetna Medicare Advantage |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.85
|
| Rate for Payer: Cigna Commercial |
$11.15
|
| Rate for Payer: Cigna Medicare Advantage |
$5.58
|
| Rate for Payer: Clover Medicare Advantage |
$10.59
|
| Rate for Payer: EmblemHealth Commercial |
$33.45
|
| Rate for Payer: Humana Medicare Advantage |
$11.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.88
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.15
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$11.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.15
|
|
|
5' NUCLEOTIDASE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 83915
|
| Hospital Charge Code |
38472518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.40
|
|
|
5 NUCLEOTIDASE, BLOOD
|
Facility
|
OP
|
$119.25
|
|
|
Service Code
|
HCPCS 83915
|
| Hospital Charge Code |
3001971
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$36.13
|
| Rate for Payer: Aetna Medicare Advantage |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.85
|
| Rate for Payer: Cigna Commercial |
$11.15
|
| Rate for Payer: Cigna Medicare Advantage |
$5.58
|
| Rate for Payer: Clover Medicare Advantage |
$10.59
|
| Rate for Payer: EmblemHealth Commercial |
$33.45
|
| Rate for Payer: Humana Medicare Advantage |
$11.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.50
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.15
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$11.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.15
|
|
|
5 NUCLEOTIDASE, BLOOD
|
Facility
|
IP
|
$119.25
|
|
|
Service Code
|
HCPCS 83915
|
| Hospital Charge Code |
3001971
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.89
|
|
|
5X200 APEX S/D HALF PIN 60 THR
|
Facility
|
IP
|
$1,043.85
|
|
| Hospital Charge Code |
270700236
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$156.58 |
| Max. Negotiated Rate |
$156.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$156.58
|
|
|
5X200 APEX S/D HALF PIN 60 THR
|
Facility
|
OP
|
$1,043.85
|
|
| Hospital Charge Code |
270700236
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$135.70 |
| Max. Negotiated Rate |
$521.92 |
| Rate for Payer: Aetna Commercial |
$313.15
|
| Rate for Payer: Aetna Medicare Advantage |
$313.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$266.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$266.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$266.18
|
| Rate for Payer: Cigna Commercial |
$521.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.70
|
| Rate for Payer: Oxford Commercial |
$521.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$156.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$521.92
|
|
|
5X23MM VARIABLE SCREW
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|