|
K- WIRE 9 .045
|
Facility
|
IP
|
$12.10
|
|
| Hospital Charge Code |
270684575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.81
|
|
|
K- WIRE 9 .045
|
Facility
|
OP
|
$12.10
|
|
| Hospital Charge Code |
270684575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$4.60
|
| Rate for Payer: Aetna Medicare Advantage |
$3.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.09
|
| Rate for Payer: Cigna Commercial |
$6.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.15
|
| Rate for Payer: Oxford Commercial |
$2.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
|
K- WIRE 9 .062
|
Facility
|
IP
|
$12.10
|
|
| Hospital Charge Code |
270684576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.81
|
|
|
K- WIRE 9 .062
|
Facility
|
OP
|
$12.10
|
|
| Hospital Charge Code |
270684576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$4.60
|
| Rate for Payer: Aetna Medicare Advantage |
$3.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.09
|
| Rate for Payer: Cigna Commercial |
$6.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.15
|
| Rate for Payer: Oxford Commercial |
$2.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
|
K-WIRE 9MM
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$22.80
|
| Rate for Payer: Aetna Medicare Advantage |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.30
|
| Rate for Payer: Cigna Commercial |
$30.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.70
|
|
|
K-WIRE 9MM
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$14.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
|
|
K-WIRE .9MM 4
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
270675711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
|
|
K-WIRE .9MM 4
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
270675711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$22.80
|
| Rate for Payer: Aetna Medicare Advantage |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.30
|
| Rate for Payer: Cigna Commercial |
$30.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.60
|
| Rate for Payer: Oxford Commercial |
$12.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.70
|
|
|
KWIRE .9MMX152MM STANDARD TIP
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$33.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.00
|
|
|
KWIRE .9MMX152MM STANDARD TIP
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$53.20
|
| Rate for Payer: Aetna Medicare Advantage |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.70
|
| Rate for Payer: Cigna Commercial |
$70.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.98
|
|
|
KWIRE ANKLE 1.6MMX22.9CM
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna Commercial |
$92.34
|
| Rate for Payer: Aetna Medicare Advantage |
$72.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.97
|
| Rate for Payer: Cigna Commercial |
$121.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.90
|
|
|
KWIRE ANKLE 1.6MMX22.9CM
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.45 |
| Max. Negotiated Rate |
$58.81 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.45
|
|
|
K-WIRE ATTACHMENT F/PEN DRIVE
|
Facility
|
IP
|
$9,924.00
|
|
| Hospital Charge Code |
270674161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,488.60 |
| Max. Negotiated Rate |
$1,488.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,488.60
|
|
|
K-WIRE ATTACHMENT F/PEN DRIVE
|
Facility
|
OP
|
$9,924.00
|
|
| Hospital Charge Code |
270674161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.84 |
| Max. Negotiated Rate |
$4,962.00 |
| Rate for Payer: Aetna Commercial |
$3,771.12
|
| Rate for Payer: Aetna Medicare Advantage |
$2,977.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,530.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,530.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,530.62
|
| Rate for Payer: Cigna Commercial |
$4,962.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,580.24
|
| Rate for Payer: Oxford Commercial |
$1,984.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,488.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,984.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$313.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$281.84
|
|
|
K-WIRE BEVELED LAT 12IN 1.5MM
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Medicare Advantage |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.00
|
| Rate for Payer: Cigna Commercial |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.04
|
|
|
K-WIRE BEVELED LAT 12IN 1.5MM
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
|
|
K-WIRE BLUNT-ABBOTT SPINE
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
270339020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Medicare Advantage |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.25
|
|
|
K-WIRE BLUNT-ABBOTT SPINE
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
270339020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$53.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
K-WIRE BLUNT NITINOL 21X1.4MM
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698154
|
|
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
|
|
|
K-WIRE BLUNT NITINOL 21X1.4MM
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698154
|
|
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
|
|
|
KWIRE BLUNT NITOL 20INCH
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696836
|
|
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 BLUNT NITOL 20INCH
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696836
|
|
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 BLUNT TIP
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.50
|
|
|
K-WIRE BLUNT TIP
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
KWIRE BONE 1.6MM 9IN
|
Facility
|
OP
|
$187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Aetna Commercial |
$71.25
|
| Rate for Payer: Aetna Medicare Advantage |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.81
|
| Rate for Payer: Cigna Commercial |
$93.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.33
|
|