|
SCREW 4.0 X 42 mm CANNULATED
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 42 mm CANNULATED
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 44 mm CANNULATED
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 44 mm CANNULATED
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 44 SHRT THD
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690797
|
|
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 4.0 X 44 SHRT THD
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690797
|
|
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 4.0 X 46 mm CANNULATED
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 46 mm CANNULATED
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 48 CCHS LONG THD
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690799
|
|
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 4.0 X 48 CCHS LONG THD
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690799
|
|
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 4.0 X 48 mm CANNULATED
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 48 mm CANNULATED
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 48 SHRT THD
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690798
|
|
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 4.0 X 48 SHRT THD
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690798
|
|
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 4.0X 50
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.25 |
| Max. Negotiated Rate |
$274.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$274.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.25
|
|
|
SCREW 4.0X 50
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.25 |
| Max. Negotiated Rate |
$567.50 |
| Rate for Payer: Aetna Commercial |
$340.50
|
| Rate for Payer: Aetna Medicare Advantage |
$340.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$289.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$289.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$289.43
|
| Rate for Payer: Cigna Commercial |
$567.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$274.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.25
|
|
|
SCREW 4.0 X 50 MM
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691651
|
|
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 4.0 X 50 MM
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691651
|
|
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 4.0 X 50 mm CANNULATED
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 50 mm CANNULATED
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 55 mm CANNULATED
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 55 mm CANNULATED
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 60 mm CANNULATED
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.0 X 60 mm CANNULATED
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW 4.25X14MM
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706109
|
|
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
|
|