|
SCREW 2.7x14 NNLCK 8140-27-014
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$72.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.00
|
|
|
SCREW 2.7x15 SNAP OFF NSO-2715
|
Facility
|
OP
|
$1,445.00
|
|
| Hospital Charge Code |
270653382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.75 |
| Max. Negotiated Rate |
$722.50 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare Advantage |
$433.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$368.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$368.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$289.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$368.48
|
| Rate for Payer: Cigna Commercial |
$722.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$349.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.75
|
|
|
SCREW 2.7x15 SNAP OFF NSO-2715
|
Facility
|
IP
|
$1,445.00
|
|
| Hospital Charge Code |
270653382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.75 |
| Max. Negotiated Rate |
$349.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$289.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$349.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.75
|
|
|
SCREW 2.7X16MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$210.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW 2.7X16MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW 2.7 X16 MM LOCKING
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$399.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$399.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$247.50
|
|
|
SCREW 2.7 X16 MM LOCKING
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$495.00
|
| Rate for Payer: Aetna Medicare Advantage |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$420.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$420.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$330.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$420.75
|
| Rate for Payer: Cigna Commercial |
$825.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$399.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$247.50
|
|
|
SCREW 2.7X18MM (L)
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
270703494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW 2.7X18MM (L)
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
270703494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW 2.7x18MM NON LOCKING
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$93.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.75
|
|
|
SCREW 2.7x18MM NON LOCKING
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Aetna Medicare Advantage |
$115.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$77.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.17
|
| Rate for Payer: Cigna Commercial |
$192.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.75
|
|
|
SCREW 2.7X20MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$210.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW 2.7X20MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW 2.7X20MM NON-LOCKING
|
Facility
|
IP
|
$770.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.63 |
| Max. Negotiated Rate |
$186.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$154.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$186.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.63
|
|
|
SCREW 2.7X20MM NON-LOCKING
|
Facility
|
OP
|
$770.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.63 |
| Max. Negotiated Rate |
$385.43 |
| Rate for Payer: Aetna Commercial |
$231.25
|
| Rate for Payer: Aetna Medicare Advantage |
$231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$196.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$196.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$154.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$196.57
|
| Rate for Payer: Cigna Commercial |
$385.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$186.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.63
|
|
|
SCREW 2.7X22MM NON-LOCKING
|
Facility
|
OP
|
$770.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.63 |
| Max. Negotiated Rate |
$385.43 |
| Rate for Payer: Aetna Commercial |
$231.25
|
| Rate for Payer: Aetna Medicare Advantage |
$231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$196.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$196.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$154.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$196.57
|
| Rate for Payer: Cigna Commercial |
$385.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$186.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.63
|
|
|
SCREW 2.7X22MM NON-LOCKING
|
Facility
|
IP
|
$770.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.63 |
| Max. Negotiated Rate |
$186.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$154.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$186.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.63
|
|
|
SCREW 2.7X22 SCREW
|
Facility
|
OP
|
$1,316.85
|
|
| Hospital Charge Code |
270656322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$658.42 |
| Rate for Payer: Aetna Commercial |
$395.06
|
| Rate for Payer: Aetna Medicare Advantage |
$395.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$335.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$335.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$263.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$335.80
|
| Rate for Payer: Cigna Commercial |
$658.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.53
|
|
|
SCREW 2.7X22 SCREW
|
Facility
|
IP
|
$1,316.85
|
|
| Hospital Charge Code |
270656322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$318.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$263.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.53
|
|
|
SCREW 2.7X24MM LOCKING
|
Facility
|
IP
|
$1,316.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$318.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$263.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.53
|
|
|
SCREW 2.7X24MM LOCKING
|
Facility
|
OP
|
$1,316.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$658.42 |
| Rate for Payer: Aetna Commercial |
$395.06
|
| Rate for Payer: Aetna Medicare Advantage |
$395.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$335.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$335.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$263.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$335.80
|
| Rate for Payer: Cigna Commercial |
$658.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.53
|
|
|
SCREW 2.7X24MM NL
|
Facility
|
IP
|
$370.00
|
|
| Hospital Charge Code |
270703493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$89.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$89.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.50
|
|
|
SCREW 2.7X24MM NL
|
Facility
|
OP
|
$370.00
|
|
| Hospital Charge Code |
270703493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna Commercial |
$111.00
|
| Rate for Payer: Aetna Medicare Advantage |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.35
|
| Rate for Payer: Cigna Commercial |
$185.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$89.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.50
|
|
|
SCREW 2.7X26MM L
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
270703495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW 2.7X26MM L
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
270703495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|