|
SCREW 3.5x14 LP LCK8161-35-014
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270658901
|
|
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
|
|
|
SCREW 3.5x14 LP LCK8161-35-014
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270658901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$189.75
|
| 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
|
|
|
SCREW 3.5 X 14 MM
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
SCREW 3.5 X 14 MM
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
SCREW 3.5 X 14MM
|
Facility
|
IP
|
$354.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$85.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.23
|
|
|
SCREW 3.5 X 14MM
|
Facility
|
OP
|
$354.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$177.45 |
| Rate for Payer: Aetna Commercial |
$106.47
|
| Rate for Payer: Aetna Medicare Advantage |
$106.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.50
|
| Rate for Payer: Cigna Commercial |
$177.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.23
|
|
|
SCREW 3.5X14MM
|
Facility
|
IP
|
$2,505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.75 |
| Max. Negotiated Rate |
$606.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$501.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$606.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.75
|
|
|
SCREW 3.5X14MM
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
SCREW 3.5X14MM
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
270669222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$943.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$780.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$943.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$585.00
|
|
|
SCREW 3.5X14MM
|
Facility
|
OP
|
$2,505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.75 |
| Max. Negotiated Rate |
$1,252.50 |
| Rate for Payer: Aetna Commercial |
$751.50
|
| Rate for Payer: Aetna Medicare Advantage |
$751.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$638.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$638.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$501.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$638.77
|
| Rate for Payer: Cigna Commercial |
$1,252.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$606.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.75
|
|
|
SCREW 3.5X14MM
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
SCREW 3.5X14MM
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
270669222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Aetna Commercial |
$1,170.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$994.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$994.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$780.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$994.50
|
| Rate for Payer: Cigna Commercial |
$1,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$943.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$585.00
|
|
|
SCREW 3.5X14MM LOCKING
|
Facility
|
OP
|
$2,889.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.37 |
| Max. Negotiated Rate |
$1,444.58 |
| Rate for Payer: Aetna Commercial |
$866.75
|
| Rate for Payer: Aetna Medicare Advantage |
$866.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$736.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$736.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$577.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$736.73
|
| Rate for Payer: Cigna Commercial |
$1,444.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$699.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$433.37
|
|
|
SCREW 3.5X14MM LOCKING
|
Facility
|
IP
|
$2,889.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.37 |
| Max. Negotiated Rate |
$699.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$577.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$699.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$433.37
|
|
|
SCREW 3.5X14MM NL
|
Facility
|
IP
|
$267.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.15 |
| Max. Negotiated Rate |
$64.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.15
|
|
|
SCREW 3.5X14MM NL
|
Facility
|
OP
|
$267.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.15 |
| Max. Negotiated Rate |
$133.82 |
| Rate for Payer: Aetna Commercial |
$80.30
|
| Rate for Payer: Aetna Medicare Advantage |
$80.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$53.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.25
|
| Rate for Payer: Cigna Commercial |
$133.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.15
|
|
|
SCREW 3.5x14MM POLY
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270657223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$1,149.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,149.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
|
|
SCREW 3.5x14MM POLY
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270657223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$1,425.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,211.25
|
| Rate for Payer: Cigna Commercial |
$2,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,149.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
|
|
SCREW 3.5X16
|
Facility
|
OP
|
$2,505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.75 |
| Max. Negotiated Rate |
$1,252.50 |
| Rate for Payer: Aetna Commercial |
$751.50
|
| Rate for Payer: Aetna Medicare Advantage |
$751.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$638.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$638.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$501.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$638.77
|
| Rate for Payer: Cigna Commercial |
$1,252.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$606.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.75
|
|
|
SCREW 3.5X16
|
Facility
|
IP
|
$2,505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.75 |
| Max. Negotiated Rate |
$606.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$501.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$606.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.75
|
|
|
SCREW 3.5X16MM
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270693119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
SCREW 3.5X16MM
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270693119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
SCREW 3.5X16MM
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270703473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
SCREW 3.5X16MM
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270703473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
SCREW 3.5X16 SYMPHONY
|
Facility
|
OP
|
$7,836.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.42 |
| Max. Negotiated Rate |
$3,918.07 |
| Rate for Payer: Aetna Commercial |
$2,350.84
|
| Rate for Payer: Aetna Medicare Advantage |
$2,350.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,998.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,998.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,567.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,998.22
|
| Rate for Payer: Cigna Commercial |
$3,918.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,896.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,175.42
|
|