|
75 - 5.0 CANN.LOCKING SAW II
|
Facility
|
OP
|
$1,190.25
|
|
| Hospital Charge Code |
270656666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.73 |
| Max. Negotiated Rate |
$595.12 |
| Rate for Payer: Aetna Commercial |
$357.07
|
| Rate for Payer: Aetna Medicare Advantage |
$357.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$303.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$303.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$303.51
|
| Rate for Payer: Cigna Commercial |
$595.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$154.73
|
| Rate for Payer: Oxford Commercial |
$595.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$178.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$595.12
|
|
|
75 - 5.0 CANN.LOCKING SAW II
|
Facility
|
IP
|
$1,190.25
|
|
| Hospital Charge Code |
270656666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.54 |
| Max. Negotiated Rate |
$178.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$178.54
|
|
|
7.5X35MM SCREW
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
7.5X35MM SCREW
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare Advantage |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$337.88
|
| Rate for Payer: Cigna Commercial |
$662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
7.5X40MM POLYSCREW
|
Facility
|
IP
|
$4,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.50 |
| Max. Negotiated Rate |
$1,076.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$890.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,076.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$667.50
|
|
|
7.5X40MM POLYSCREW
|
Facility
|
OP
|
$4,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.50 |
| Max. Negotiated Rate |
$2,225.00 |
| Rate for Payer: Aetna Commercial |
$1,335.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,335.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,134.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,134.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$890.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,134.75
|
| Rate for Payer: Cigna Commercial |
$2,225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,076.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$667.50
|
|
|
7.5X45MM LUMBAR SCREW
|
Facility
|
OP
|
$4,275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.25 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,282.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,090.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,090.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$855.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,090.12
|
| Rate for Payer: Cigna Commercial |
$2,137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,034.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$641.25
|
|
|
7.5X45MM LUMBAR SCREW
|
Facility
|
IP
|
$4,275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.25 |
| Max. Negotiated Rate |
$1,034.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,034.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$641.25
|
|
|
7.5X45MM MIS MOD SCREW SHANK
|
Facility
|
OP
|
$2,900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$870.00
|
| Rate for Payer: Aetna Medicare Advantage |
$870.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$739.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$739.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$739.50
|
| Rate for Payer: Cigna Commercial |
$1,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$701.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.00
|
|
|
7.5X45MM MIS MOD SCREW SHANK
|
Facility
|
IP
|
$2,900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$701.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$701.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.00
|
|
|
7.5X45MM REDUCTION SCREWS
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$1,650.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
7.5X45MM REDUCTION SCREWS
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
7.5X50MM MIS MOD SCREW SHANK
|
Facility
|
IP
|
$2,900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$701.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$701.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.00
|
|
|
7.5X50MM MIS MOD SCREW SHANK
|
Facility
|
OP
|
$2,900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$870.00
|
| Rate for Payer: Aetna Medicare Advantage |
$870.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$739.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$739.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$739.50
|
| Rate for Payer: Cigna Commercial |
$1,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$701.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.00
|
|
|
7.5X50MM MODULAR SCREW
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$907.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
|
|
7.5X50MM MODULAR SCREW
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$956.25
|
| Rate for Payer: Cigna Commercial |
$1,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$907.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
|
|
7CC TORNADO BIO COLLAGEN
|
Facility
|
IP
|
$11,695.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270704245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,754.33 |
| Max. Negotiated Rate |
$2,830.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,339.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,830.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,754.33
|
|
|
7CC TORNADO BIO COLLAGEN
|
Facility
|
OP
|
$11,695.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270704245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,754.33 |
| Max. Negotiated Rate |
$5,847.75 |
| Rate for Payer: Aetna Commercial |
$3,508.65
|
| Rate for Payer: Aetna Medicare Advantage |
$3,508.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,982.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,982.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,339.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,982.35
|
| Rate for Payer: Cigna Commercial |
$5,847.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,830.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,754.33
|
|
|
7 FRENCH 27MM ENSNARE
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
270659155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$561.00
|
| Rate for Payer: Cigna Commercial |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
|
|
7 FRENCH 27MM ENSNARE
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
270659155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$532.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
|
|
7 FR XB 3-0 INTERVENTIONAL CAT
|
Facility
|
OP
|
$274.75
|
|
| Hospital Charge Code |
2709002920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$137.38 |
| Rate for Payer: Aetna Commercial |
$82.42
|
| Rate for Payer: Aetna Medicare Advantage |
$82.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.06
|
| Rate for Payer: Cigna Commercial |
$137.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.72
|
| Rate for Payer: Oxford Commercial |
$137.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$137.38
|
|
|
7 FR XB 3-0 INTERVENTIONAL CAT
|
Facility
|
IP
|
$274.75
|
|
| Hospital Charge Code |
2709002920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$41.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.21
|
|
|
7 HOLE 1/3 TUBULAR PLATE
|
Facility
|
IP
|
$804.65
|
|
| Hospital Charge Code |
270657751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$194.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.70
|
|
|
7 HOLE 1/3 TUBULAR PLATE
|
Facility
|
OP
|
$804.65
|
|
| Hospital Charge Code |
270657751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$402.32 |
| Rate for Payer: Aetna Commercial |
$241.40
|
| Rate for Payer: Aetna Medicare Advantage |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$205.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$205.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$205.19
|
| Rate for Payer: Cigna Commercial |
$402.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.70
|
|
|
7 HOLE REINFORCED STRAIGHT PLA
|
Facility
|
IP
|
$2,703.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.56 |
| Max. Negotiated Rate |
$654.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$540.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$654.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$405.56
|
|