|
PLATE DHS 38mm 4HOLE 135
|
Facility
|
IP
|
$2,208.00
|
|
| Hospital Charge Code |
270603807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.20 |
| Max. Negotiated Rate |
$534.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$441.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$534.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$331.20
|
|
|
PLATE DIS RAD 3 HOLE RIGHT
|
Facility
|
OP
|
$12,550.00
|
|
| Hospital Charge Code |
270703505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.42 |
| Max. Negotiated Rate |
$6,275.00 |
| Rate for Payer: Aetna Commercial |
$4,769.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,200.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,200.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,200.25
|
| Rate for Payer: Cigna Commercial |
$6,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,037.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,882.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$396.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$356.42
|
|
|
PLATE DIS RAD 3 HOLE RIGHT
|
Facility
|
IP
|
$12,550.00
|
|
| Hospital Charge Code |
270703505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$3,037.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,037.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,882.50
|
|
|
PLATE DISTAL 2.7/3 5MM RT 8 HO
|
Facility
|
IP
|
$6,804.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,020.69 |
| Max. Negotiated Rate |
$1,646.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,360.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,646.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.69
|
|
|
PLATE DISTAL 2.7/3 5MM RT 8 HO
|
Facility
|
OP
|
$6,804.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$3,402.30 |
| Rate for Payer: Aetna Commercial |
$2,585.75
|
| Rate for Payer: Aetna Medicare Advantage |
$2,041.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,735.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,735.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,360.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,735.17
|
| Rate for Payer: Cigna Commercial |
$3,402.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,646.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$215.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.25
|
|
|
PLATE DISTAL 2.7 MM 8 HOLE
|
Facility
|
OP
|
$6,804.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$3,402.30 |
| Rate for Payer: Aetna Commercial |
$2,585.75
|
| Rate for Payer: Aetna Medicare Advantage |
$2,041.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,735.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,735.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,360.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,735.17
|
| Rate for Payer: Cigna Commercial |
$3,402.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,646.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$215.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.25
|
|
|
PLATE DISTAL 2.7 MM 8 HOLE
|
Facility
|
IP
|
$6,804.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,020.69 |
| Max. Negotiated Rate |
$1,646.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,360.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,646.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.69
|
|
|
PLATE DISTAL CLAVICLE 70MM
|
Facility
|
OP
|
$2,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.10 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$1,045.00
|
| Rate for Payer: Aetna Medicare Advantage |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$701.25
|
| Rate for Payer: Cigna Commercial |
$1,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$665.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$86.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$78.10
|
|
|
PLATE DISTAL CLAVICLE 70MM
|
Facility
|
IP
|
$2,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$665.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$665.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
|
|
PLATE DISTAL FEMORA R 3H 122mm
|
Facility
|
OP
|
$7,500.00
|
|
| Hospital Charge Code |
270671122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$3,750.00 |
| Rate for Payer: Aetna Commercial |
$2,850.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,912.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,912.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,912.50
|
| Rate for Payer: Cigna Commercial |
$3,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,815.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,125.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$237.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$213.00
|
|
|
PLATE DISTAL FEMORA R 3H 122mm
|
Facility
|
IP
|
$7,500.00
|
|
| Hospital Charge Code |
270671122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$1,815.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,815.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,125.00
|
|
|
PLATE DISTAL FEMUR 5H 156MM LF
|
Facility
|
IP
|
$6,804.00
|
|
| Hospital Charge Code |
270674359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,020.60 |
| Max. Negotiated Rate |
$1,646.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,360.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,646.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.60
|
|
|
PLATE DISTAL FEMUR 5H 156MM LF
|
Facility
|
OP
|
$6,804.00
|
|
| Hospital Charge Code |
270674359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.23 |
| Max. Negotiated Rate |
$3,402.00 |
| Rate for Payer: Aetna Commercial |
$2,585.52
|
| Rate for Payer: Aetna Medicare Advantage |
$2,041.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,735.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,735.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,360.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,735.02
|
| Rate for Payer: Cigna Commercial |
$3,402.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,646.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$215.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.23
|
|
|
PLATE DISTAL FEMUR 6H LF 166MM
|
Facility
|
IP
|
$9,824.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.62 |
| Max. Negotiated Rate |
$2,377.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,964.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,377.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,473.62
|
|
|
PLATE DISTAL FEMUR 6H LF 166MM
|
Facility
|
OP
|
$9,824.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$4,912.05 |
| Rate for Payer: Aetna Commercial |
$3,733.16
|
| Rate for Payer: Aetna Medicare Advantage |
$2,947.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,505.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,505.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,964.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,505.15
|
| Rate for Payer: Cigna Commercial |
$4,912.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,377.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,473.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$310.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$279.00
|
|
|
PLATE DISTAL FEMUR LEFT
|
Facility
|
OP
|
$5,379.00
|
|
| Hospital Charge Code |
270668421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.76 |
| Max. Negotiated Rate |
$2,689.50 |
| Rate for Payer: Aetna Commercial |
$2,044.02
|
| Rate for Payer: Aetna Medicare Advantage |
$1,613.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,371.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,371.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,075.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,371.64
|
| Rate for Payer: Cigna Commercial |
$2,689.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,301.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$806.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$169.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$152.76
|
|
|
PLATE DISTAL FEMUR LEFT
|
Facility
|
IP
|
$5,379.00
|
|
| Hospital Charge Code |
270668421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$806.85 |
| Max. Negotiated Rate |
$1,301.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,075.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,301.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$806.85
|
|
|
PLATE DISTAL FEMUR RT 6 HOLE
|
Facility
|
OP
|
$12,730.00
|
|
| Hospital Charge Code |
270668436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.53 |
| Max. Negotiated Rate |
$6,365.00 |
| Rate for Payer: Aetna Commercial |
$4,837.40
|
| Rate for Payer: Aetna Medicare Advantage |
$3,819.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,246.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,246.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,546.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,246.15
|
| Rate for Payer: Cigna Commercial |
$6,365.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,080.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,909.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$402.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$361.53
|
|
|
PLATE DISTAL FEMUR RT 6 HOLE
|
Facility
|
IP
|
$12,730.00
|
|
| Hospital Charge Code |
270668436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,909.50 |
| Max. Negotiated Rate |
$3,080.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,546.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,080.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,909.50
|
|
|
PLATE DISTAL FIBULA
|
Facility
|
OP
|
$5,885.00
|
|
| Hospital Charge Code |
270702537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.13 |
| Max. Negotiated Rate |
$2,942.50 |
| Rate for Payer: Aetna Commercial |
$2,236.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,765.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,500.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,500.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,177.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,500.67
|
| Rate for Payer: Cigna Commercial |
$2,942.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,424.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$882.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$185.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$167.13
|
|
|
PLATE DISTAL FIBULA
|
Facility
|
IP
|
$5,885.00
|
|
| Hospital Charge Code |
270702537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.75 |
| Max. Negotiated Rate |
$1,424.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,177.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,424.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$882.75
|
|
|
PLATE DISTALFIBULA 13HOLE 2.7R
|
Facility
|
IP
|
$4,734.00
|
|
| Hospital Charge Code |
270664152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.10 |
| Max. Negotiated Rate |
$1,145.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$946.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,145.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$710.10
|
|
|
PLATE DISTALFIBULA 13HOLE 2.7R
|
Facility
|
OP
|
$4,734.00
|
|
| Hospital Charge Code |
270664152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.45 |
| Max. Negotiated Rate |
$2,367.00 |
| Rate for Payer: Aetna Commercial |
$1,798.92
|
| Rate for Payer: Aetna Medicare Advantage |
$1,420.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,207.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,207.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$946.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,207.17
|
| Rate for Payer: Cigna Commercial |
$2,367.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,145.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$710.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$149.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$134.45
|
|
|
PLATE DISTALFIBULA 15HOLE 2.7L
|
Facility
|
OP
|
$4,938.00
|
|
| Hospital Charge Code |
270664154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.24 |
| Max. Negotiated Rate |
$2,469.00 |
| Rate for Payer: Aetna Commercial |
$1,876.44
|
| Rate for Payer: Aetna Medicare Advantage |
$1,481.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,259.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,259.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$987.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,259.19
|
| Rate for Payer: Cigna Commercial |
$2,469.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$740.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$156.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$140.24
|
|
|
PLATE DISTALFIBULA 15HOLE 2.7L
|
Facility
|
IP
|
$4,938.00
|
|
| Hospital Charge Code |
270664154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.70 |
| Max. Negotiated Rate |
$1,195.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$987.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$740.70
|
|