|
4.0MM/4.0MM CLAMP
|
Facility
|
IP
|
$1,435.40
|
|
| Hospital Charge Code |
270601807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.31 |
| Max. Negotiated Rate |
$215.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$215.31
|
|
|
4.0MM/4.0MM CLAMP
|
Facility
|
OP
|
$1,435.40
|
|
| Hospital Charge Code |
270601807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$717.70 |
| Rate for Payer: Aetna Commercial |
$545.45
|
| Rate for Payer: Aetna Medicare Advantage |
$430.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$366.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$366.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$366.03
|
| Rate for Payer: Cigna Commercial |
$717.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.20
|
| Rate for Payer: Oxford Commercial |
$287.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$215.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$287.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.77
|
|
|
4.0MM/4.0MM OPEN CLAMP
|
Facility
|
OP
|
$1,537.20
|
|
| Hospital Charge Code |
270601816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.66 |
| Max. Negotiated Rate |
$768.60 |
| Rate for Payer: Aetna Commercial |
$584.14
|
| Rate for Payer: Aetna Medicare Advantage |
$461.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$391.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$391.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$391.99
|
| Rate for Payer: Cigna Commercial |
$768.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$399.67
|
| Rate for Payer: Oxford Commercial |
$307.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$230.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$307.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.66
|
|
|
4.0MM/4.0MM OPEN CLAMP
|
Facility
|
IP
|
$1,537.20
|
|
| Hospital Charge Code |
270601816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.58 |
| Max. Negotiated Rate |
$230.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$230.58
|
|
|
4.0MM CANC LOCK SCREW 22MM
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.96
|
|
|
4.0MM CANC LOCK SCREW 22MM
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
4.0MM CANC LOCK SCREW 34MM
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$138.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$138.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.80
|
|
|
4.0MM CANC LOCK SCREW 34MM
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$286.00 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Medicare Advantage |
$171.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$145.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$145.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$145.86
|
| Rate for Payer: Cigna Commercial |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$138.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.24
|
|
|
4.0MM CANC LOCK SCREW 36MM
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
4.0MM CANC LOCK SCREW 36MM
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.96
|
|
|
4.0MM CANC LOCK SCREW 38MM
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.96
|
|
|
4.0MM CANC LOCK SCREW 38MM
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
4.0MM CANC LOCK SCREW 46MM
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$286.00 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Medicare Advantage |
$171.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$145.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$145.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$145.86
|
| Rate for Payer: Cigna Commercial |
$286.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$138.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.24
|
|
|
4.0MM CANC LOCK SCREW 46MM
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$138.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$138.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.80
|
|
|
4.0MM CANC LOCK SCREW 50MM
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.96
|
|
|
4.0MM CANC LOCK SCREW 50MM
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
4.0MM CANC LOCK SCREW 55MM
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
4.0MM CANC LOCK SCREW 55MM
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.96
|
|
|
4.0MM CANC LOCK SCREW 60MM
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$209.76
|
| Rate for Payer: Aetna Medicare Advantage |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.76
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.68
|
|
|
4.0MM CANC LOCK SCREW 60MM
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$133.58 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.80
|
|
|
4.0MM CANC LOCK SCRW 40MM
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.96
|
|
|
4.0MM CANC LOCK SCRW 40MM
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
4.0MM CANC SCR FT 26MM NS
|
Facility
|
IP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.12
|
|
|
4.0MM CANC SCR FT 26MM NS
|
Facility
|
OP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$94.05
|
| Rate for Payer: Aetna Medicare Advantage |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.11
|
| Rate for Payer: Cigna Commercial |
$123.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.03
|
|
|
4.0MM CANC SCR FT 30MM NS
|
Facility
|
OP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$94.05
|
| Rate for Payer: Aetna Medicare Advantage |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.11
|
| Rate for Payer: Cigna Commercial |
$123.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.03
|
|