|
SCREW 3.5X16 SYMPHONY
|
Facility
|
IP
|
$7,836.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.42 |
| Max. Negotiated Rate |
$1,896.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,567.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,896.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,175.42
|
|
|
SCREW 3.5X18
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
270661845
|
|
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
|
|
|
SCREW 3.5X18
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
270661845
|
|
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
|
|
|
SCREW 3.5X1.8 CORT NON LOCKING
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270648916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
SCREW 3.5X1.8 CORT NON LOCKING
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270648916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$84.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
SCREW 3.5X18 LOCKING
|
Facility
|
OP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648920
|
|
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
|
|
|
SCREW 3.5X18 LOCKING
|
Facility
|
IP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648920
|
|
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
|
|
|
SCREW 3.5 X 18 MM
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
270648659
|
|
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
|
|
|
SCREW 3.5 X 18 MM
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
270648659
|
|
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
|
|
|
SCREW 3.5X20 LOCKING LP
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
270648913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$43.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
|
|
SCREW 3.5X20 LOCKING LP
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
270648913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.90
|
| Rate for Payer: Cigna Commercial |
$90.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.00
|
|
|
SCREW 3.5X20MM
|
Facility
|
OP
|
$3,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Aetna Commercial |
$1,102.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,102.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$937.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$937.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$937.12
|
| Rate for Payer: Cigna Commercial |
$1,837.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$889.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$551.25
|
|
|
SCREW 3.5X20MM
|
Facility
|
IP
|
$3,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$889.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$735.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$889.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$551.25
|
|
|
SCREW 3.5X22
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
SCREW 3.5X22
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
SCREW 3.5X22MM
|
Facility
|
OP
|
$3,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Aetna Commercial |
$1,102.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,102.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$937.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$937.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$937.12
|
| Rate for Payer: Cigna Commercial |
$1,837.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$889.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$551.25
|
|
|
SCREW 3.5X22MM
|
Facility
|
IP
|
$3,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$889.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$735.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$889.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$551.25
|
|
|
SCREW 3.5X23/26MM TRANSVERSE
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$892.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
SCREW 3.5X23/26MM TRANSVERSE
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
SCREW 3.5x24 LCK8161-35-024
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
270658903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$194.81 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$161.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.75
|
|
|
SCREW 3.5x24 LCK8161-35-024
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
270658903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$402.50 |
| Rate for Payer: Aetna Commercial |
$241.50
|
| Rate for Payer: Aetna Medicare Advantage |
$241.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$205.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$205.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$161.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$205.28
|
| Rate for Payer: Cigna Commercial |
$402.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.75
|
|
|
SCREW 3.5X24MM NONLOCKING
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.00 |
| Max. Negotiated Rate |
$295.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$295.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.00
|
|
|
SCREW 3.5X24MM NONLOCKING
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.00 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna Commercial |
$366.00
|
| Rate for Payer: Aetna Medicare Advantage |
$366.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$311.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$311.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$311.10
|
| Rate for Payer: Cigna Commercial |
$610.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$295.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.00
|
|
|
SCREW 3.5X24 NON LOCKING
|
Facility
|
OP
|
$320.00
|
|
| Hospital Charge Code |
270664864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$96.00
|
| Rate for Payer: Aetna Medicare Advantage |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$64.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.60
|
| Rate for Payer: Cigna Commercial |
$160.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.00
|
|
|
SCREW 3.5X24 NON LOCKING
|
Facility
|
IP
|
$320.00
|
|
| Hospital Charge Code |
270664864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$77.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$64.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.00
|
|