|
GUIDE PIN METATARSAL
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270669664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
GUIDE PIN METATARSAL
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270672050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$84.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
GUIDE PIN N-FORCE 7.3 3.2MM
|
Facility
|
IP
|
$495.00
|
|
| Hospital Charge Code |
270687089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.25
|
|
|
GUIDE PIN N-FORCE 7.3 3.2MM
|
Facility
|
OP
|
$495.00
|
|
| Hospital Charge Code |
270687089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Medicare Advantage |
$148.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.22
|
| Rate for Payer: Cigna Commercial |
$247.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.70
|
| Rate for Payer: Oxford Commercial |
$99.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$99.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.06
|
|
|
GUIDEPIN PERFORM 3X100MM
|
Facility
|
OP
|
$1,810.00
|
|
| Hospital Charge Code |
270700537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$905.00 |
| Rate for Payer: Aetna Commercial |
$687.80
|
| Rate for Payer: Aetna Medicare Advantage |
$543.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$461.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$461.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$461.55
|
| Rate for Payer: Cigna Commercial |
$905.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$470.60
|
| Rate for Payer: Oxford Commercial |
$362.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$271.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$362.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$57.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$51.40
|
|
|
GUIDEPIN PERFORM 3X100MM
|
Facility
|
IP
|
$1,810.00
|
|
| Hospital Charge Code |
270700537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$271.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$271.50
|
|
|
GUIDE PIN PHALANGEAL
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270672049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.52
|
|
|
GUIDE PIN PHALANGEAL
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270669665
|
|
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 PHALANGEAL
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270669665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
GUIDE PIN PHALANGEAL
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270672049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
GUIDE PLS A.I.M. ING 9MMx10DEG
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
270671343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
|
GUIDE PLS A.I.M. ING 9MMx10DEG
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
270671343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Medicare Advantage |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.30
|
| Rate for Payer: Cigna Commercial |
$130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.60
|
| Rate for Payer: Oxford Commercial |
$52.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.38
|
|
|
GUIDE RADIAL CATH IKARI LT 3.5
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270675912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
GUIDE RADIAL CATH IKARI LT 3.5
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270675912
|
|
Hospital Revenue Code
|
272
|
| 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) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.20
|
|
|
GUIDE RADIAL CATH IKAR LT 3.75
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270675913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
GUIDE RADIAL CATH IKAR LT 3.75
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270675913
|
|
Hospital Revenue Code
|
272
|
| 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) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.20
|
|
|
GUIDE REAMER 4 PEG AUG LEFT
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270699508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.31 |
| Max. Negotiated Rate |
$762.50 |
| Rate for Payer: Aetna Commercial |
$579.50
|
| Rate for Payer: Aetna Medicare Advantage |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$388.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$388.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$388.88
|
| Rate for Payer: Cigna Commercial |
$762.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$396.50
|
| Rate for Payer: Oxford Commercial |
$305.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$228.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$305.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.31
|
|
|
GUIDE REAMER 4 PEG AUG LEFT
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270699508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.75 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$228.75
|
|
|
GUIDE ROD 2.5x280MM W/STOP
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
270650157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.75
|
|
|
GUIDE ROD 2.5x280MM W/STOP
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
270650157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Medicare Advantage |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.67
|
| Rate for Payer: Cigna Commercial |
$142.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.10
|
| Rate for Payer: Oxford Commercial |
$57.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$57.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.09
|
|
|
GUIDE SAFEGUARD
|
Facility
|
IP
|
$3,200.00
|
|
| Hospital Charge Code |
270668390
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$480.00
|
|
|
GUIDE SAFEGUARD
|
Facility
|
OP
|
$3,200.00
|
|
| Hospital Charge Code |
270668390
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.88 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,216.00
|
| Rate for Payer: Aetna Medicare Advantage |
$960.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$816.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$816.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$816.00
|
| Rate for Payer: Cigna Commercial |
$1,600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$832.00
|
| Rate for Payer: Oxford Commercial |
$640.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$480.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$640.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$101.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$90.88
|
|
|
GUIDESCOPE LOPRO S20
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
270683599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Medicare Advantage |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.30
|
| Rate for Payer: Cigna Commercial |
$130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.60
|
| Rate for Payer: Oxford Commercial |
$52.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.38
|
|
|
GUIDESCOPE LOPRO S20
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
270683599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
|
GUIDE SHEALTH PINNACLE 8FR 90
|
Facility
|
OP
|
$675.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
270686367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$337.88 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare Advantage |
$202.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.32
|
| Rate for Payer: Cigna Commercial |
$337.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.19
|
|