|
CORTICAL SCREW 3.5 X 16MM
|
Facility
|
IP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681982
|
|
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
|
|
|
CORTICAL SCREW 3.5X16MM
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
270656492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
CORTICAL SCREW 3.5X16MM
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
270656492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$60.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.00
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
CORTICAL SCREW 3.5 X 18MM
|
Facility
|
OP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$74.25
|
| 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
|
|
|
CORTICAL SCREW 3.5 X 18MM
|
Facility
|
IP
|
$176.95
|
|
| Hospital Charge Code |
270657793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.54
|
|
|
CORTICAL SCREW 3.5 X 18MM
|
Facility
|
IP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663467
|
|
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
|
|
|
CORTICAL SCREW 3.5 X 18MM
|
Facility
|
OP
|
$176.95
|
|
| Hospital Charge Code |
270657793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$88.47 |
| Rate for Payer: Aetna Commercial |
$53.09
|
| Rate for Payer: Aetna Medicare Advantage |
$53.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.12
|
| Rate for Payer: Cigna Commercial |
$88.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.54
|
|
|
CORTICAL SCREW 3.5 X 20 MM
|
Facility
|
IP
|
$176.95
|
|
| Hospital Charge Code |
270657794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.54
|
|
|
CORTICAL SCREW 3.5 X 20 MM
|
Facility
|
OP
|
$176.95
|
|
| Hospital Charge Code |
270657794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$88.47 |
| Rate for Payer: Aetna Commercial |
$53.09
|
| Rate for Payer: Aetna Medicare Advantage |
$53.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.12
|
| Rate for Payer: Cigna Commercial |
$88.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.54
|
|
|
CORTICAL SCREW 3.5 X 20MM
|
Facility
|
OP
|
$176.95
|
|
| Hospital Charge Code |
270657796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$88.47 |
| Rate for Payer: Aetna Commercial |
$53.09
|
| Rate for Payer: Aetna Medicare Advantage |
$53.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.12
|
| Rate for Payer: Cigna Commercial |
$88.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.54
|
|
|
CORTICAL SCREW 3.5 X 20MM
|
Facility
|
IP
|
$176.95
|
|
| Hospital Charge Code |
270657796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.54
|
|
|
CORTICAL SCREW 3.5 X 24MM
|
Facility
|
OP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Medicare Advantage |
$74.25
|
| Rate for Payer: Aetna Commercial |
$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
|
|
|
CORTICAL SCREW 3.5 X 24MM
|
Facility
|
IP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663470
|
|
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
|
|
|
CORTICAL SCREW 3.5 X 26MM
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna Commercial |
$102.00
|
| Rate for Payer: Aetna Medicare Advantage |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.70
|
| Rate for Payer: Cigna Commercial |
$170.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.00
|
|
|
CORTICAL SCREW 3.5 X 26MM
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$68.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.00
|
|
|
CORTICAL SCREW 3.5 X 28MM
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$68.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.00
|
|
|
CORTICAL SCREW 3.5 X 28MM
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna Commercial |
$102.00
|
| Rate for Payer: Aetna Medicare Advantage |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.70
|
| Rate for Payer: Cigna Commercial |
$170.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.00
|
|
|
CORTICAL SCREW 3.5 X 30MM
|
Facility
|
IP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648246
|
|
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
|
|
|
CORTICAL SCREW 3.5 X 30MM
|
Facility
|
OP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$74.25
|
| 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
|
|
|
CORTICAL SCREW 3.5 X 50MM
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$59.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$59.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$59.67
|
| Rate for Payer: Cigna Commercial |
$117.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.10
|
|
|
CORTICAL SCREW 3.5 X 50MM
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$56.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$56.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.10
|
|
|
CORTICAL SCREW 3.5 X 50MM
|
Facility
|
OP
|
$176.95
|
|
| Hospital Charge Code |
270657797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$88.47 |
| Rate for Payer: Aetna Commercial |
$53.09
|
| Rate for Payer: Aetna Medicare Advantage |
$53.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.12
|
| Rate for Payer: Cigna Commercial |
$88.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.54
|
|
|
CORTICAL SCREW 3.5 X 50MM
|
Facility
|
IP
|
$176.95
|
|
| Hospital Charge Code |
270657797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.54
|
|
|
CORTICAL SCREW 3.5 X 55MM
|
Facility
|
OP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$74.25
|
| 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
|
|
|
CORTICAL SCREW 3.5 X 55MM
|
Facility
|
IP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676100
|
|
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
|
|