|
SCREW 1.5mm CORTICAL 235004015
|
Facility
|
IP
|
$37.75
|
|
| Hospital Charge Code |
270610102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$9.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.66
|
|
|
SCREW 1.5MM TI CORTEX SELF TAP
|
Facility
|
OP
|
$148.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.25 |
| Max. Negotiated Rate |
$74.15 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare Advantage |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.82
|
| Rate for Payer: Cigna Commercial |
$74.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.25
|
|
|
SCREW 1.5MM TI CORTEX SELF TAP
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
270656857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Medicare Advantage |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.72
|
| Rate for Payer: Cigna Commercial |
$72.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.60
|
|
|
SCREW 1.5MM TI CORTEX SELF TAP
|
Facility
|
IP
|
$148.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.25 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.66
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.25
|
|
|
SCREW 1.5MM TI CORTEX SELF TAP
|
Facility
|
IP
|
$144.00
|
|
| Hospital Charge Code |
270656857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.60
|
|
|
SCREW 1.5MM TI CORTEX SELF TAP
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$36.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.91
|
|
|
SCREW 1.5MM TI CORTEX SELF TAP
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$76.38 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare Advantage |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$30.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.95
|
| Rate for Payer: Cigna Commercial |
$76.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.91
|
|
|
SCREW 1.5 X 4MM
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$118.58 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$98.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
|
|
SCREW 1.5 X 4MM
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$147.00
|
| Rate for Payer: Aetna Medicare Advantage |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.95
|
| Rate for Payer: Cigna Commercial |
$245.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.50
|
|
|
SCREW 1.5 X 5 MM
|
Facility
|
OP
|
$420.00
|
|
| Hospital Charge Code |
270662167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.10
|
| Rate for Payer: Cigna Commercial |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
SCREW 1.5 X 5 MM
|
Facility
|
IP
|
$420.00
|
|
| Hospital Charge Code |
270662167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
SCREW 1.5x6m HT X-DRIVE 916106
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
270642178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
SCREW 1.5x6m HT X-DRIVE 916106
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
270642178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$84.00
|
| Rate for Payer: Aetna Medicare Advantage |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.40
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
SCREW 1.6MM
|
Facility
|
OP
|
$5,605.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.75 |
| Max. Negotiated Rate |
$2,802.50 |
| Rate for Payer: Aetna Commercial |
$1,681.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,681.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,429.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,429.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,121.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,429.28
|
| Rate for Payer: Cigna Commercial |
$2,802.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,356.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$840.75
|
|
|
SCREW 1.6MM
|
Facility
|
IP
|
$5,605.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.75 |
| Max. Negotiated Rate |
$1,356.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,121.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,356.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$840.75
|
|
|
SCREW 16 MM 1.5
|
Facility
|
OP
|
$1,980.00
|
|
| Hospital Charge Code |
270702799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna Commercial |
$594.00
|
| Rate for Payer: Aetna Medicare Advantage |
$594.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$504.90
|
| Rate for Payer: Cigna Commercial |
$990.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$479.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$297.00
|
|
|
SCREW 16 MM 1.5
|
Facility
|
IP
|
$1,980.00
|
|
| Hospital Charge Code |
270702799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$479.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$396.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$479.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$297.00
|
|
|
SCREW 16MM 2.0
|
Facility
|
OP
|
$2,132.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.80 |
| Max. Negotiated Rate |
$1,066.00 |
| Rate for Payer: Aetna Commercial |
$639.60
|
| Rate for Payer: Aetna Medicare Advantage |
$639.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$543.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$543.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$426.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$543.66
|
| Rate for Payer: Cigna Commercial |
$1,066.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$515.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.80
|
|
|
SCREW 16MM 2.0
|
Facility
|
IP
|
$2,132.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.80 |
| Max. Negotiated Rate |
$515.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$426.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$515.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.80
|
|
|
SCREW 16 MM 2.4 MM LOCKING
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$240.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
SCREW 16 MM 2.4 MM LOCKING
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$193.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
SCREW 16MM 24MM NON LOCK
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna Commercial |
$136.50
|
| Rate for Payer: Aetna Medicare Advantage |
$136.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$91.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$116.03
|
| Rate for Payer: Cigna Commercial |
$227.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.25
|
|
|
SCREW 16MM 24MM NON LOCK
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$110.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$91.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.25
|
|
|
SCREW 16MM FIXED
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689966
|
|
Hospital Revenue Code
|
278
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SCREW 16MM FIXED
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689966
|
|
Hospital Revenue Code
|
278
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|