|
SCREW 2.0mm TITAN CORTEX 34mm
|
Facility
|
OP
|
$123.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$61.88 |
| Rate for Payer: Aetna Commercial |
$37.12
|
| Rate for Payer: Aetna Medicare Advantage |
$37.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.56
|
| Rate for Payer: Cigna Commercial |
$61.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.56
|
|
|
SCREW 2.0mm TITAN CORTEX 36mm
|
Facility
|
IP
|
$123.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$29.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.56
|
|
|
SCREW 2.0mm TITAN CORTEX 36mm
|
Facility
|
OP
|
$123.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$61.88 |
| Rate for Payer: Aetna Commercial |
$37.12
|
| Rate for Payer: Aetna Medicare Advantage |
$37.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.56
|
| Rate for Payer: Cigna Commercial |
$61.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.56
|
|
|
SCREW 2.0mm TITAN CORTEX 38mm
|
Facility
|
OP
|
$123.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$61.88 |
| Rate for Payer: Aetna Commercial |
$37.12
|
| Rate for Payer: Aetna Medicare Advantage |
$37.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.56
|
| Rate for Payer: Cigna Commercial |
$61.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.56
|
|
|
SCREW 2.0mm TITAN CORTEX 38mm
|
Facility
|
IP
|
$123.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$29.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.56
|
|
|
SCREW 20 MM VERSATRIO
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$60.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
SCREW 20 MM VERSATRIO
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$75.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
SCREW 2.0MM X 12MM
|
Facility
|
OP
|
$1,990.45
|
|
| Hospital Charge Code |
270668724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.57 |
| Max. Negotiated Rate |
$995.23 |
| Rate for Payer: Aetna Commercial |
$597.13
|
| Rate for Payer: Aetna Medicare Advantage |
$597.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$507.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$507.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$398.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$507.56
|
| Rate for Payer: Cigna Commercial |
$995.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$481.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$298.57
|
|
|
SCREW 2.0MM X 12MM
|
Facility
|
IP
|
$1,990.45
|
|
| Hospital Charge Code |
270668724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.57 |
| Max. Negotiated Rate |
$481.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$398.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$481.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$298.57
|
|
|
SCREW 2.0x11 SNAP OFF NSO-2011
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270653383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Aetna Commercial |
$402.00
|
| Rate for Payer: Aetna Medicare Advantage |
$402.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$341.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$341.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$268.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$341.70
|
| Rate for Payer: Cigna Commercial |
$670.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.00
|
|
|
SCREW 2.0x11 SNAP OFF NSO-2011
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270653383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$324.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$268.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.00
|
|
|
SCREW 2.0x13 SNAP OFF NSO-2013
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270653384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Aetna Commercial |
$402.00
|
| Rate for Payer: Aetna Medicare Advantage |
$402.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$341.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$341.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$268.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$341.70
|
| Rate for Payer: Cigna Commercial |
$670.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.00
|
|
|
SCREW 2.0x13 SNAP OFF NSO-2013
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270653384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$324.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$268.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.00
|
|
|
SCREW 2.0x14 LAG CANNULATED
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648357
|
|
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 2.0x14 LAG CANNULATED
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648357
|
|
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 2.0 X 14MM .5 THREAD
|
Facility
|
IP
|
$1,069.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.46 |
| Max. Negotiated Rate |
$258.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$213.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$258.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.46
|
|
|
SCREW 2.0 X 14MM .5 THREAD
|
Facility
|
OP
|
$1,069.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.46 |
| Max. Negotiated Rate |
$534.88 |
| Rate for Payer: Aetna Commercial |
$320.93
|
| Rate for Payer: Aetna Medicare Advantage |
$320.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$213.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$272.79
|
| Rate for Payer: Cigna Commercial |
$534.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$258.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.46
|
|
|
SCREW 2.0x16 LAG CANNULATED
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648358
|
|
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 2.0x16 LAG CANNULATED
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648358
|
|
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 2.0X38 LAG CANNULATED
|
Facility
|
OP
|
$1,575.00
|
|
| Hospital Charge Code |
270648907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Aetna Commercial |
$472.50
|
| Rate for Payer: Aetna Medicare Advantage |
$472.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$401.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$401.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$401.62
|
| Rate for Payer: Cigna Commercial |
$787.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$381.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$236.25
|
|
|
SCREW 2.0X38 LAG CANNULATED
|
Facility
|
IP
|
$1,575.00
|
|
| Hospital Charge Code |
270648907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$381.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$381.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$236.25
|
|
|
SCREW 2.0X4MM
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
270702376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$525.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
SCREW 2.0X4MM
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
270702376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$423.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
SCREW 2.0X6MM
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
270702377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$525.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
SCREW 2.0X6MM
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
270702377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$423.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|