|
6Fr Neuron Max sheath 90 Str
|
Facility
|
OP
|
$2,475.00
|
|
| Hospital Charge Code |
270685062N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$742.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$321.75
|
| Rate for Payer: Oxford Commercial |
$1,237.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,237.50
|
|
|
6Fr Neuron Max sheath 90 Str
|
Facility
|
IP
|
$2,475.00
|
|
| Hospital Charge Code |
270685062N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$371.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
6Fr Neuron Max sheath 90 Str
|
Facility
|
OP
|
$2,475.00
|
|
| Hospital Charge Code |
270685062S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$742.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$321.75
|
| Rate for Payer: Oxford Commercial |
$1,237.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,237.50
|
|
|
6Fr Neuron Max sheath 90 Str
|
Facility
|
IP
|
$2,475.00
|
|
| Hospital Charge Code |
270685062S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$371.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
6F STRAIGHT PIGTAIL
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2709000324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.20
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
|
|
6F STRAIGHT PIGTAIL
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2709000324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
6 HOLE CLAVICLE PLATE
|
Facility
|
IP
|
$5,610.00
|
|
| Hospital Charge Code |
270656020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.50 |
| Max. Negotiated Rate |
$1,357.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,122.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,357.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$841.50
|
|
|
6 HOLE CLAVICLE PLATE
|
Facility
|
OP
|
$5,610.00
|
|
| Hospital Charge Code |
270656020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.50 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Aetna Commercial |
$1,683.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,683.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,430.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,430.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,122.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,430.55
|
| Rate for Payer: Cigna Commercial |
$2,805.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,357.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$841.50
|
|
|
6 HOLE COMPRESSION PLATE
|
Facility
|
IP
|
$1,315.00
|
|
| Hospital Charge Code |
270664729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.25 |
| Max. Negotiated Rate |
$318.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$263.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.25
|
|
|
6 HOLE COMPRESSION PLATE
|
Facility
|
OP
|
$1,315.00
|
|
| Hospital Charge Code |
270664729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.25 |
| Max. Negotiated Rate |
$657.50 |
| Rate for Payer: Aetna Commercial |
$394.50
|
| Rate for Payer: Aetna Medicare Advantage |
$394.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$335.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$335.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$263.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$335.32
|
| Rate for Payer: Cigna Commercial |
$657.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.25
|
|
|
6 HOLE DISTAL FIBULA PLATE
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.25 |
| Max. Negotiated Rate |
$1,937.50 |
| Rate for Payer: Aetna Commercial |
$1,162.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,162.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$988.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$988.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$775.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$988.12
|
| Rate for Payer: Cigna Commercial |
$1,937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$937.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$581.25
|
|
|
6 HOLE DISTAL FIBULA PLATE
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.25 |
| Max. Negotiated Rate |
$937.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$775.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$937.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$581.25
|
|
|
6 HOLE DUAL COMPRESSION PLATE
|
Facility
|
OP
|
$1,533.45
|
|
| Hospital Charge Code |
270656917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.02 |
| Max. Negotiated Rate |
$766.73 |
| Rate for Payer: Aetna Commercial |
$460.04
|
| Rate for Payer: Aetna Medicare Advantage |
$460.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$391.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$391.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$306.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$391.03
|
| Rate for Payer: Cigna Commercial |
$766.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$371.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$230.02
|
|
|
6 HOLE DUAL COMPRESSION PLATE
|
Facility
|
IP
|
$1,533.45
|
|
| Hospital Charge Code |
270656917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.02 |
| Max. Negotiated Rate |
$371.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$306.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$371.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$230.02
|
|
|
6 HOLE HEAD 2 SHAFT 2 COL PLAT
|
Facility
|
OP
|
$6,983.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.51 |
| Max. Negotiated Rate |
$3,491.70 |
| Rate for Payer: Aetna Commercial |
$2,095.02
|
| Rate for Payer: Aetna Medicare Advantage |
$2,095.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,780.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,780.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,396.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,780.77
|
| Rate for Payer: Cigna Commercial |
$3,491.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,689.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,047.51
|
|
|
6 HOLE HEAD 2 SHAFT 2 COL PLAT
|
Facility
|
IP
|
$6,983.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.51 |
| Max. Negotiated Rate |
$1,689.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,396.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,689.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,047.51
|
|
|
6 HOLE PROXIMAL HUMERAL PLATE
|
Facility
|
IP
|
$7,428.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.26 |
| Max. Negotiated Rate |
$1,797.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,485.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,797.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,114.26
|
|
|
6 HOLE PROXIMAL HUMERAL PLATE
|
Facility
|
OP
|
$7,428.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.26 |
| Max. Negotiated Rate |
$3,714.20 |
| Rate for Payer: Aetna Commercial |
$2,228.52
|
| Rate for Payer: Aetna Medicare Advantage |
$2,228.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,894.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,894.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,485.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,894.24
|
| Rate for Payer: Cigna Commercial |
$3,714.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,797.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,114.26
|
|
|
6 HOLE STRAIGHT PLATE
|
Facility
|
IP
|
$2,920.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.00 |
| Max. Negotiated Rate |
$706.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$584.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$706.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$438.00
|
|
|
6 HOLE STRAIGHT PLATE
|
Facility
|
OP
|
$2,920.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.00 |
| Max. Negotiated Rate |
$1,460.00 |
| Rate for Payer: Aetna Commercial |
$876.00
|
| Rate for Payer: Aetna Medicare Advantage |
$876.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$744.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$744.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$584.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$744.60
|
| Rate for Payer: Cigna Commercial |
$1,460.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$706.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$438.00
|
|
|
#6 MATRIX CONNECTOR
|
Facility
|
OP
|
$5,926.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$888.94 |
| Max. Negotiated Rate |
$2,963.12 |
| Rate for Payer: Aetna Medicare Advantage |
$1,777.88
|
| Rate for Payer: Aetna Commercial |
$1,777.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,511.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,511.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,185.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,511.19
|
| Rate for Payer: Cigna Commercial |
$2,963.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,434.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$888.94
|
|
|
#6 MATRIX CONNECTOR
|
Facility
|
IP
|
$5,926.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$888.94 |
| Max. Negotiated Rate |
$1,434.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,185.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,434.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$888.94
|
|
|
6MM DRILL BIT
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
270680775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.00 |
| 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) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Oxford Commercial |
$750.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$750.00
|
|
|
6MM DRILL BIT
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
270680775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
6MM SMALL SPIRA C
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270703918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Aetna Commercial |
$2,625.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,625.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,231.25
|
| Rate for Payer: Cigna Commercial |
$4,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
|