|
KWIRE SS 1.25X150MM
|
Facility
|
OP
|
$70.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: Aetna Commercial |
$26.87
|
| Rate for Payer: Aetna Medicare Advantage |
$21.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.03
|
| Rate for Payer: Cigna Commercial |
$35.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.01
|
|
|
K-WIRE STANDARD TIP .9x152MM
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
270661784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: Aetna Medicare Advantage |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.35
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.20
|
| Rate for Payer: Oxford Commercial |
$34.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.83
|
|
|
K-WIRE STANDARD TIP .9x152MM
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
270661784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.50
|
|
|
K-WIRE STEINMANN 4 X.045
|
Facility
|
IP
|
$14.75
|
|
| Hospital Charge Code |
270680489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
|
|
K-WIRE STEINMANN 4 X.045
|
Facility
|
OP
|
$14.75
|
|
| Hospital Charge Code |
270680489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Aetna Commercial |
$5.61
|
| Rate for Payer: Aetna Medicare Advantage |
$4.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.76
|
| Rate for Payer: Cigna Commercial |
$7.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.83
|
| Rate for Payer: Oxford Commercial |
$2.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.42
|
|
|
K-WIRE STEINMANN 4 X.062
|
Facility
|
IP
|
$14.75
|
|
| Hospital Charge Code |
270680490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
|
|
K-WIRE STEINMANN 4 X.062
|
Facility
|
OP
|
$14.75
|
|
| Hospital Charge Code |
270680490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Aetna Commercial |
$5.61
|
| Rate for Payer: Aetna Medicare Advantage |
$4.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.76
|
| Rate for Payer: Cigna Commercial |
$7.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.83
|
| Rate for Payer: Oxford Commercial |
$2.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.42
|
|
|
K-WIRE STEINMANN 5 X.028
|
Facility
|
IP
|
$14.75
|
|
| Hospital Charge Code |
270680491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
|
|
K-WIRE STEINMANN 5 X.028
|
Facility
|
OP
|
$14.75
|
|
| Hospital Charge Code |
270680491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Aetna Commercial |
$5.61
|
| Rate for Payer: Aetna Medicare Advantage |
$4.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.76
|
| Rate for Payer: Cigna Commercial |
$7.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.83
|
| Rate for Payer: Oxford Commercial |
$2.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.42
|
|
|
K-WIRE STEINMANN 5 X.035
|
Facility
|
IP
|
$14.75
|
|
| Hospital Charge Code |
270680492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
|
|
K-WIRE STEINMANN 5 X.035
|
Facility
|
OP
|
$14.75
|
|
| Hospital Charge Code |
270680492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Aetna Commercial |
$5.61
|
| Rate for Payer: Aetna Medicare Advantage |
$4.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.76
|
| Rate for Payer: Cigna Commercial |
$7.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.83
|
| Rate for Payer: Oxford Commercial |
$2.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.42
|
|
|
K-WIRE STEINMANN 5 X.045
|
Facility
|
OP
|
$14.75
|
|
| Hospital Charge Code |
270680493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Aetna Commercial |
$5.61
|
| Rate for Payer: Aetna Medicare Advantage |
$4.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.76
|
| Rate for Payer: Cigna Commercial |
$7.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.83
|
| Rate for Payer: Oxford Commercial |
$2.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.42
|
|
|
K-WIRE STEINMANN 5 X.045
|
Facility
|
IP
|
$14.75
|
|
| Hospital Charge Code |
270680493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
|
|
K-WIRE STERILE 3x285MM
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270651319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.75 |
| Max. Negotiated Rate |
$238.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.75
|
|
|
K-WIRE STERILE 3x285MM
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270651319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$492.50 |
| Rate for Payer: Aetna Commercial |
$374.30
|
| Rate for Payer: Aetna Medicare Advantage |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$251.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$251.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$251.18
|
| Rate for Payer: Cigna Commercial |
$492.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.97
|
|
|
K-WIRES TROCAR PT 1 END 16MM X
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$159.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
K-WIRES TROCAR PT 1 END 16MM X
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$250.80
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.74
|
|
|
KWIRE TC SERIES 2.0/2.5 0.9X 1
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
270676510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.50
|
|
|
KWIRE TC SERIES 2.0/2.5 0.9X 1
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
270676510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare Advantage |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.95
|
| Rate for Payer: Cigna Commercial |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.40
|
| Rate for Payer: Oxford Commercial |
$18.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.56
|
|
|
K-WIRE THRD 2.5x150MM
|
Facility
|
IP
|
$80.20
|
|
| Hospital Charge Code |
270601818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.03
|
|
|
K-WIRE THRD 2.5x150MM
|
Facility
|
OP
|
$80.20
|
|
| Hospital Charge Code |
270601818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$40.10 |
| Rate for Payer: Aetna Commercial |
$30.48
|
| Rate for Payer: Aetna Medicare Advantage |
$24.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.45
|
| Rate for Payer: Cigna Commercial |
$40.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.85
|
| Rate for Payer: Oxford Commercial |
$16.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.04
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.28
|
|
|
KWIRE THRD RECON 3.2X400MM
|
Facility
|
IP
|
$1,919.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.85 |
| Max. Negotiated Rate |
$464.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$383.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$464.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$287.85
|
|
|
KWIRE THRD RECON 3.2X400MM
|
Facility
|
OP
|
$1,919.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$959.50 |
| Rate for Payer: Aetna Commercial |
$729.22
|
| Rate for Payer: Aetna Medicare Advantage |
$575.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$489.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$489.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$383.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$489.35
|
| Rate for Payer: Cigna Commercial |
$959.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$464.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$287.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$60.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$54.50
|
|
|
K-WIRE THREADED 2MMX280MM
|
Facility
|
IP
|
$169.50
|
|
| Hospital Charge Code |
270668424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$41.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.43
|
|
|
K-WIRE THREADED 2MMX280MM
|
Facility
|
OP
|
$169.50
|
|
| Hospital Charge Code |
270668424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Aetna Commercial |
$64.41
|
| Rate for Payer: Aetna Medicare Advantage |
$50.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.22
|
| Rate for Payer: Cigna Commercial |
$84.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.81
|
|