|
GUIDE PIN 2.0
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.10
|
| Rate for Payer: Cigna Commercial |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.93
|
|
|
GUIDE PIN 2.0 X 150CM
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.10
|
| Rate for Payer: Cigna Commercial |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.93
|
|
|
GUIDE PIN 2.0 X 150CM
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
GUIDE PIN 250MM ALTA
|
Facility
|
IP
|
$136.00
|
|
| Hospital Charge Code |
270335181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.40
|
|
|
GUIDE PIN 250MM ALTA
|
Facility
|
OP
|
$136.00
|
|
| Hospital Charge Code |
270335181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$51.68
|
| Rate for Payer: Aetna Medicare Advantage |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.68
|
| Rate for Payer: Cigna Commercial |
$68.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.36
|
| Rate for Payer: Oxford Commercial |
$27.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.86
|
|
|
GUIDE PIN 27MM
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Medicare Advantage |
$562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$478.12
|
| Rate for Payer: Cigna Commercial |
$937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.25
|
|
|
GUIDE PIN 27MM
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
GUIDE PIN 2MM
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
270667236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$132.50 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Medicare Advantage |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.58
|
| Rate for Payer: Cigna Commercial |
$132.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.53
|
|
|
GUIDE PIN 2MM
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270687088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Oxford Commercial |
$75.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.65
|
|
|
GUIDE PIN 2MM
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270687088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
GUIDE PIN 2MM
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
270667236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$64.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.75
|
|
|
GUIDE PIN 2MM/.078 DIA
|
Facility
|
IP
|
$183.75
|
|
| Hospital Charge Code |
270652502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$27.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.56
|
|
|
GUIDE PIN 2MM/.078 DIA
|
Facility
|
OP
|
$183.75
|
|
| Hospital Charge Code |
270652502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$91.88 |
| Rate for Payer: Aetna Commercial |
$69.83
|
| Rate for Payer: Aetna Medicare Advantage |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.86
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.77
|
| Rate for Payer: Oxford Commercial |
$36.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.22
|
|
|
GUIDE PIN 2mm NON THREADED
|
Facility
|
OP
|
$69.44
|
|
| Hospital Charge Code |
270679218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$34.72 |
| Rate for Payer: Aetna Commercial |
$26.39
|
| Rate for Payer: Aetna Medicare Advantage |
$20.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.71
|
| Rate for Payer: Cigna Commercial |
$34.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.05
|
| Rate for Payer: Oxford Commercial |
$13.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.89
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.97
|
|
|
GUIDE PIN 2mm NON THREADED
|
Facility
|
IP
|
$69.44
|
|
| Hospital Charge Code |
270679218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$10.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.42
|
|
|
GUIDE PIN 3.2MM
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
270692839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$132.50 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Medicare Advantage |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.58
|
| Rate for Payer: Cigna Commercial |
$132.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.90
|
| Rate for Payer: Oxford Commercial |
$53.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$53.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.53
|
|
|
GUIDE PIN 3.2MM
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
270692839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.75
|
|
|
GUIDEPIN 3X75MM
|
Facility
|
OP
|
$1,715.00
|
|
| Hospital Charge Code |
270700536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.71 |
| Max. Negotiated Rate |
$857.50 |
| Rate for Payer: Aetna Commercial |
$651.70
|
| Rate for Payer: Aetna Medicare Advantage |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$437.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$437.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$437.32
|
| Rate for Payer: Cigna Commercial |
$857.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$445.90
|
| Rate for Payer: Oxford Commercial |
$343.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$257.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$343.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.71
|
|
|
GUIDEPIN 3X75MM
|
Facility
|
IP
|
$1,715.00
|
|
| Hospital Charge Code |
270700536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.25 |
| Max. Negotiated Rate |
$257.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$257.25
|
|
|
GUIDE PIN DRL TIP 2.8X300MM ST
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$699.20
|
| Rate for Payer: Aetna Medicare Advantage |
$552.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$469.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$469.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$368.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$469.20
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$445.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$276.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$58.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.26
|
|
|
GUIDE PIN DRL TIP 2.8X300MM ST
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$368.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$445.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$276.00
|
|
|
GUIDE PIN FLAREHAWK 7
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.20
|
|
|
GUIDE PIN FLAREHAWK 7
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
GUIDE PIN METATARSAL
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270669664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
GUIDE PIN METATARSAL
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270672050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.94
|
|