|
HEADLESS COMPR SCREW 4.0MMXL42
|
Facility
|
OP
|
$2,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.63 |
| Max. Negotiated Rate |
$1,067.50 |
| Rate for Payer: Aetna Commercial |
$811.30
|
| Rate for Payer: Aetna Medicare Advantage |
$640.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$544.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$544.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$427.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$544.42
|
| Rate for Payer: Cigna Commercial |
$1,067.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$516.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$320.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.63
|
|
|
HEADLESS COMPR SCREW 4.0MMXL42
|
Facility
|
IP
|
$2,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.25 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$427.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$516.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$320.25
|
|
|
HEADLESS COMP SCREW 4.3 X 28MM
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688011
|
|
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
|
|
|
HEADLESS COMP SCREW 4.3 X 28MM
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688011
|
|
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
|
|
|
HEADLESS COUNTERSINK 3.0
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270677436
|
|
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
|
|
|
HEADLESS COUNTERSINK 3.0
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270677436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
HEADLESS COUNTSINK 5.5 MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270690333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$296.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
HEADLESS COUNTSINK 5.5 MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270690333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$513.50
|
| Rate for Payer: Oxford Commercial |
$395.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$395.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.09
|
|
|
HEADLESS SCREW 2.5X18MM
|
Facility
|
IP
|
$1,140.00
|
|
| Hospital Charge Code |
270702744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$275.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.00
|
|
|
HEADLESS SCREW 2.5X18MM
|
Facility
|
OP
|
$1,140.00
|
|
| Hospital Charge Code |
270702744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$433.20
|
| Rate for Payer: Aetna Medicare Advantage |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$290.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$290.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$290.70
|
| Rate for Payer: Cigna Commercial |
$570.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.38
|
|
|
HEADLESS SCREW 2.5X22MM
|
Facility
|
IP
|
$1,140.00
|
|
| Hospital Charge Code |
270702745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$275.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.00
|
|
|
HEADLESS SCREW 2.5X22MM
|
Facility
|
OP
|
$1,140.00
|
|
| Hospital Charge Code |
270702745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$433.20
|
| Rate for Payer: Aetna Medicare Advantage |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$290.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$290.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$290.70
|
| Rate for Payer: Cigna Commercial |
$570.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.38
|
|
|
HEADLESSSCREW 4X34MM
|
Facility
|
OP
|
$1,802.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270702065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$901.25 |
| Rate for Payer: Aetna Commercial |
$684.95
|
| Rate for Payer: Aetna Medicare Advantage |
$540.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$459.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$459.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$360.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$459.64
|
| Rate for Payer: Cigna Commercial |
$901.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$436.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$56.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$51.19
|
|
|
HEADLESSSCREW 4X34MM
|
Facility
|
IP
|
$1,802.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270702065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.38 |
| Max. Negotiated Rate |
$436.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$360.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$436.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.38
|
|
|
HEADLESS SCREW CAN 4.3 X 42 MM
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682611
|
|
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
|
|
|
HEADLESS SCREW CAN 4.3 X 42 MM
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682611
|
|
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
|
|
|
HEADLESS SCREW CAN 4.3 X 44
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688022
|
|
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
|
|
|
HEADLESS SCREW CAN 4.3 X 44
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688022
|
|
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
|
|
|
HEADLSS TROCAR DRILL PIN 75MM
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$729.60
|
| Rate for Payer: Aetna Medicare Advantage |
$576.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$384.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$489.60
|
| Rate for Payer: Cigna Commercial |
$960.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$464.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$288.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$60.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$54.53
|
|
|
HEADLSS TROCAR DRILL PIN 75MM
|
Facility
|
IP
|
$1,920.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$464.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$384.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$464.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$288.00
|
|
|
HEAD MALLORY CAL 34 11 107
|
Facility
|
IP
|
$52,390.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270660672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,858.50 |
| Max. Negotiated Rate |
$12,678.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10,478.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,678.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,858.50
|
|
|
HEAD MALLORY CAL 34 11 107
|
Facility
|
OP
|
$52,390.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270660672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,487.88 |
| Max. Negotiated Rate |
$26,195.00 |
| Rate for Payer: Aetna Commercial |
$19,908.20
|
| Rate for Payer: Aetna Medicare Advantage |
$15,717.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,359.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,359.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10,478.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,359.45
|
| Rate for Payer: Cigna Commercial |
$26,195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,678.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,858.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,655.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,487.88
|
|
|
HEAD METATARSAL LONG
|
Facility
|
OP
|
$5,000.00
|
|
| Hospital Charge Code |
270672048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$158.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$142.00
|
|
|
HEAD METATARSAL LONG
|
Facility
|
IP
|
$5,000.00
|
|
| Hospital Charge Code |
270672048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
HEAD MOD 36 -3 NECK 11363661
|
Facility
|
OP
|
$3,005.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270638378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.34 |
| Max. Negotiated Rate |
$1,502.50 |
| Rate for Payer: Aetna Commercial |
$1,141.90
|
| Rate for Payer: Aetna Medicare Advantage |
$901.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$766.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$766.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$601.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$766.27
|
| Rate for Payer: Cigna Commercial |
$1,502.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$727.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$94.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$85.34
|
|