|
K-WIRE 2.3X 300MM
|
Facility
|
IP
|
$115.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.32
|
|
|
K-WIRE 2.3X 300MM
|
Facility
|
OP
|
$115.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Aetna Medicare Advantage |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.45
|
| Rate for Payer: Cigna Commercial |
$57.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.28
|
|
|
K WIRE 2.4 MM X 170 MM
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
270685919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Medicare Advantage |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.12
|
| Rate for Payer: Cigna Commercial |
$37.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.50
|
| Rate for Payer: Oxford Commercial |
$15.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.13
|
|
|
K WIRE 2.4 MM X 170 MM
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
270685919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
|
|
K-WIRE 2.5
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270686219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
K-WIRE 2.5
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270686219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.50
|
| Rate for Payer: Oxford Commercial |
$45.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.39
|
|
|
K-WIRE 2.5MM THREAD TIP
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
270656778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
K-WIRE 2.5MM THREAD TIP
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
270656778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna Medicare Advantage |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.50
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.00
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.84
|
|
|
K-WIRE 2.5x150MM
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
270674309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare Advantage |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.32
|
| Rate for Payer: Cigna Commercial |
$57.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.90
|
| Rate for Payer: Oxford Commercial |
$23.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.27
|
|
|
K-WIRE 2.5x150MM
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
270674309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
|
|
K-WIRE 2.5X200MM
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
K-WIRE 2.5X200MM
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693057
|
|
Hospital Revenue Code
|
278
|
| 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) NJ Health |
$75.00
|
| 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 |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.65
|
|
|
KWIRE 2.5x270mm
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270683635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
KWIRE 2.5x270mm
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270683635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.50
|
| Rate for Payer: Oxford Commercial |
$45.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.39
|
|
|
K-WIRE 2.5x270MM
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
270656781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
|
|
K-WIRE 2.5x270MM
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
270656781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna Medicare Advantage |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.50
|
| Rate for Payer: Cigna Commercial |
$50.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.00
|
| Rate for Payer: Oxford Commercial |
$20.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.84
|
|
|
K-WIRE 2MM
|
Facility
|
OP
|
$154.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Aetna Commercial |
$58.79
|
| Rate for Payer: Aetna Medicare Advantage |
$46.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.45
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.39
|
|
|
K-WIRE 2MM
|
Facility
|
IP
|
$154.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.20
|
|
|
KWIRE 2MMX450MM
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270643406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$118.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.20
|
|
|
KWIRE 2MMX450MM
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270643406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$185.44
|
| Rate for Payer: Aetna Medicare Advantage |
$146.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.44
|
| Rate for Payer: Cigna Commercial |
$244.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.86
|
|
|
K-WIRE 2X150MM
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.55
|
|
|
K-WIRE 2X150MM
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$30.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
K-WIRE 2 X TROCAR 1.1x100MM
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
270675272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
|
|
K-WIRE 2 X TROCAR 1.1x100MM
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
270675272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Medicare Advantage |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.55
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.60
|
| Rate for Payer: Oxford Commercial |
$42.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.96
|
|
|
K-WIRE 3.0 MM
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$477.50 |
| Rate for Payer: Aetna Commercial |
$362.90
|
| Rate for Payer: Aetna Medicare Advantage |
$286.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$243.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$243.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$191.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$243.53
|
| Rate for Payer: Cigna Commercial |
$477.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$143.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.12
|
|