|
1.25 WIRE
|
Facility
|
OP
|
$356.50
|
|
| Hospital Charge Code |
270683435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$178.25 |
| Rate for Payer: Aetna Commercial |
$106.95
|
| Rate for Payer: Aetna Medicare Advantage |
$106.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.91
|
| Rate for Payer: Cigna Commercial |
$178.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.34
|
| Rate for Payer: Oxford Commercial |
$178.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$178.25
|
|
|
1.25 WIRE
|
Facility
|
OP
|
$6,395.00
|
|
| Hospital Charge Code |
270700450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$831.35 |
| Max. Negotiated Rate |
$3,197.50 |
| Rate for Payer: Aetna Commercial |
$1,918.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,918.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,630.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,630.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,630.72
|
| Rate for Payer: Cigna Commercial |
$3,197.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$831.35
|
| Rate for Payer: Oxford Commercial |
$3,197.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$959.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,197.50
|
|
|
12 CM CIRCLE
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270684329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$718.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$594.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$718.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$445.50
|
|
|
12 CM CIRCLE
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270684329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Aetna Commercial |
$891.00
|
| Rate for Payer: Aetna Medicare Advantage |
$891.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$757.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$757.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$594.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$757.35
|
| Rate for Payer: Cigna Commercial |
$1,485.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$718.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$445.50
|
|
|
12 CM X 15 CM OVAL
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270684333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$705.75 |
| Max. Negotiated Rate |
$1,138.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$941.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,138.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$705.75
|
|
|
12 CM X 15 CM OVAL
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270684333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$705.75 |
| Max. Negotiated Rate |
$2,352.50 |
| Rate for Payer: Aetna Commercial |
$1,411.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,411.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,199.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,199.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$941.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,199.78
|
| Rate for Payer: Cigna Commercial |
$2,352.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,138.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$705.75
|
|
|
12 MM ALIGNMENT TARGET
|
Facility
|
IP
|
$2,500.00
|
|
| Hospital Charge Code |
270664007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
|
|
12 MM ALIGNMENT TARGET
|
Facility
|
OP
|
$2,500.00
|
|
| Hospital Charge Code |
270664007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$325.00
|
| Rate for Payer: Oxford Commercial |
$1,250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,250.00
|
|
|
12MM DRILL BIT
|
Facility
|
OP
|
$986.85
|
|
| Hospital Charge Code |
270688891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.29 |
| Max. Negotiated Rate |
$493.43 |
| Rate for Payer: Aetna Commercial |
$296.06
|
| Rate for Payer: Aetna Medicare Advantage |
$296.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$251.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$251.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$251.65
|
| Rate for Payer: Cigna Commercial |
$493.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.29
|
| Rate for Payer: Oxford Commercial |
$493.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$493.43
|
|
|
12MM DRILL BIT
|
Facility
|
IP
|
$986.85
|
|
| Hospital Charge Code |
270688891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.03 |
| Max. Negotiated Rate |
$148.03 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$148.03
|
|
|
12MM SELF DRILLING RESCUE SCRW
|
Facility
|
OP
|
$382.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: Aetna Medicare Advantage |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.54
|
| Rate for Payer: Cigna Commercial |
$191.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$92.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.38
|
|
|
12MM SELF DRILLING RESCUE SCRW
|
Facility
|
IP
|
$382.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$92.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$76.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$92.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.38
|
|
|
12MMX100MM STEM EXTENSION
|
Facility
|
IP
|
$5,245.85
|
|
| Hospital Charge Code |
27065684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.88 |
| Max. Negotiated Rate |
$1,269.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,049.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,269.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.88
|
|
|
12MMX100MM STEM EXTENSION
|
Facility
|
OP
|
$5,245.85
|
|
| Hospital Charge Code |
27065684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.88 |
| Max. Negotiated Rate |
$2,622.93 |
| Rate for Payer: Aetna Commercial |
$1,573.76
|
| Rate for Payer: Aetna Medicare Advantage |
$1,573.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,337.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,337.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,049.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,337.69
|
| Rate for Payer: Cigna Commercial |
$2,622.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,269.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$786.88
|
|
|
12x12x7 Spaces Peek
|
Facility
|
OP
|
$13,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$4,050.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,267.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
12x12x7 Spaces Peek
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$3,267.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,267.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
12x12x7 Spaces Peek
|
Facility
|
IP
|
$13,500.00
|
|
| Hospital Charge Code |
270662553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$3,267.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,267.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
12x12x7 Spaces Peek
|
Facility
|
OP
|
$13,500.00
|
|
| Hospital Charge Code |
270662553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,025.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Aetna Commercial |
$4,050.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,442.50
|
| Rate for Payer: Cigna Commercial |
$6,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,267.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,025.00
|
|
|
12X18 ANKLE NAIL
|
Facility
|
IP
|
$12,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,837.50 |
| Max. Negotiated Rate |
$2,964.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,964.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,837.50
|
|
|
12X18 ANKLE NAIL
|
Facility
|
OP
|
$12,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,837.50 |
| Max. Negotiated Rate |
$6,125.00 |
| Rate for Payer: Aetna Commercial |
$3,675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,123.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,123.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,123.75
|
| Rate for Payer: Cigna Commercial |
$6,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,964.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,837.50
|
|
|
12x24 TRAYMAT LINER PLOYPROLEN
|
Facility
|
IP
|
$3.45
|
|
| Hospital Charge Code |
270665052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.52
|
|
|
12x24 TRAYMAT LINER PLOYPROLEN
|
Facility
|
OP
|
$3.45
|
|
| Hospital Charge Code |
270665052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna Commercial |
$1.03
|
| Rate for Payer: Aetna Medicare Advantage |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.88
|
| Rate for Payer: Cigna Commercial |
$1.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.45
|
| Rate for Payer: Oxford Commercial |
$1.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.73
|
|
|
1.3 12 SCREW
|
Facility
|
IP
|
$450.25
|
|
| Hospital Charge Code |
270656586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$108.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$90.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.54
|
|
|
1.3 12 SCREW
|
Facility
|
OP
|
$450.25
|
|
| Hospital Charge Code |
270656586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$225.12 |
| Rate for Payer: Aetna Commercial |
$135.07
|
| Rate for Payer: Aetna Medicare Advantage |
$135.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.81
|
| Rate for Payer: Cigna Commercial |
$225.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.54
|
|
|
132 CEMENTED HIP STEM
|
Facility
|
OP
|
$22,305.00
|
|
| Hospital Charge Code |
270656398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,345.75 |
| Max. Negotiated Rate |
$11,152.50 |
| Rate for Payer: Aetna Commercial |
$6,691.50
|
| Rate for Payer: Aetna Medicare Advantage |
$6,691.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,687.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,687.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,461.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,687.77
|
| Rate for Payer: Cigna Commercial |
$11,152.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,397.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,345.75
|
|