|
SCREW 3.5X26MM
|
Facility
|
OP
|
$3,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704443
|
|
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 3.5X26MM
|
Facility
|
IP
|
$3,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704443
|
|
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 3.5X26 NON LOCKING
|
Facility
|
OP
|
$320.00
|
|
| Hospital Charge Code |
270664860
|
|
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 3.5X26 NON LOCKING
|
Facility
|
IP
|
$320.00
|
|
| Hospital Charge Code |
270664860
|
|
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
|
|
|
SCREW 3.5 X 32 MM
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$949.00 |
| Rate for Payer: Aetna Commercial |
$569.40
|
| Rate for Payer: Aetna Medicare Advantage |
$569.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$483.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$483.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$379.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$483.99
|
| Rate for Payer: Cigna Commercial |
$949.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$459.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.70
|
|
|
SCREW 3.5 X 32 MM
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$459.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$379.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$459.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.70
|
|
|
SCREW 3.5 X 32MM
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Medicare Advantage |
$414.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$351.90
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$333.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.00
|
|
|
SCREW 3.5 X 32MM
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$333.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$333.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.00
|
|
|
SCREW 3.5X32MM NONLOCKING
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705399
|
|
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 3.5X32MM NONLOCKING
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705399
|
|
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 3.5 X 44 NON LOCKING
|
Facility
|
OP
|
$1,365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare Advantage |
$409.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$348.07
|
| Rate for Payer: Cigna Commercial |
$682.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
SCREW 3.5 X 44 NON LOCKING
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$330.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
SCREW 3.5 X 44 NON LOCKING
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$330.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
SCREW 3.5 X 44 NON LOCKING
|
Facility
|
OP
|
$1,365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare Advantage |
$409.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$348.07
|
| Rate for Payer: Cigna Commercial |
$682.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
SCREW 3.5x48 MD 8163-35-048
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
270658911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$285.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
|
|
SCREW 3.5x48 MD 8163-35-048
|
Facility
|
OP
|
$1,180.00
|
|
| Hospital Charge Code |
270658911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna Commercial |
$354.00
|
| Rate for Payer: Aetna Medicare Advantage |
$354.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$300.90
|
| Rate for Payer: Cigna Commercial |
$590.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
|
|
SCREW 3.5x48 MD 8163-35-052
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
270658912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$285.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
|
|
SCREW 3.5x48 MD 8163-35-052
|
Facility
|
OP
|
$1,180.00
|
|
| Hospital Charge Code |
270658912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna Commercial |
$354.00
|
| Rate for Payer: Aetna Medicare Advantage |
$354.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$300.90
|
| Rate for Payer: Cigna Commercial |
$590.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
|
|
SCREW 3.5X 50MM LAPIDUS
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$333.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$333.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.00
|
|
|
SCREW 3.5X 50MM LAPIDUS
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Medicare Advantage |
$414.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$351.90
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$333.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.00
|
|
|
SCREW 3.5x55 LPNL 1312-18-055
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270658915
|
|
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 3.5x55 LPNL 1312-18-055
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270658915
|
|
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 3.5x56 LCK 8161-35-056
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
270658907
|
|
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 3.5x56 LCK 8161-35-056
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
270658907
|
|
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 3.5x56 MD 8163-35-056
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
270658914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$285.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
|