|
SCREW 6.5 CANN 16MM THR 95M
|
Facility
|
OP
|
$1,139.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.87 |
| Max. Negotiated Rate |
$569.55 |
| Rate for Payer: Aetna Commercial |
$341.73
|
| Rate for Payer: Aetna Medicare Advantage |
$341.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$290.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$290.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$290.47
|
| Rate for Payer: Cigna Commercial |
$569.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.87
|
|
|
SCREW 6.5 CANN FULL THR 55MM
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.95 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Medicare Advantage |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$234.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.12
|
| Rate for Payer: Cigna Commercial |
$586.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.95
|
|
|
SCREW 6.5 CANN FULL THR 55MM
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.95 |
| Max. Negotiated Rate |
$283.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$234.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.95
|
|
|
SCREW 6.5 CANN FULL THR 85MM
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.95 |
| Max. Negotiated Rate |
$283.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$234.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.95
|
|
|
SCREW 6.5 CANN FULL THR 85MM
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.95 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Medicare Advantage |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$234.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.12
|
| Rate for Payer: Cigna Commercial |
$586.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.95
|
|
|
SCREW 6.5mm CAN 16x100 2332101
|
Facility
|
OP
|
$87.35
|
|
| Hospital Charge Code |
270610381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$43.67 |
| Rate for Payer: Aetna Commercial |
$26.20
|
| Rate for Payer: Aetna Medicare Advantage |
$26.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.27
|
| Rate for Payer: Cigna Commercial |
$43.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.10
|
|
|
SCREW 6.5mm CAN 16x100 2332101
|
Facility
|
IP
|
$87.35
|
|
| Hospital Charge Code |
270610381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.10
|
|
|
SCREW 6.5mm CAN 16X105 2332106
|
Facility
|
IP
|
$87.35
|
|
| Hospital Charge Code |
270610382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.10
|
|
|
SCREW 6.5mm CAN 16X105 2332106
|
Facility
|
OP
|
$87.35
|
|
| Hospital Charge Code |
270610382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$43.67 |
| Rate for Payer: Aetna Commercial |
$26.20
|
| Rate for Payer: Aetna Medicare Advantage |
$26.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.27
|
| Rate for Payer: Cigna Commercial |
$43.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.10
|
|
|
SCREW 6.5mm CAN 16X110 2332111
|
Facility
|
OP
|
$87.35
|
|
| Hospital Charge Code |
270610383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$43.67 |
| Rate for Payer: Aetna Commercial |
$26.20
|
| Rate for Payer: Aetna Medicare Advantage |
$26.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.27
|
| Rate for Payer: Cigna Commercial |
$43.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.10
|
|
|
SCREW 6.5mm CAN 16X110 2332111
|
Facility
|
IP
|
$87.35
|
|
| Hospital Charge Code |
270610383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.10
|
|
|
SCREW 6.5mm CAN 32X100 2333101
|
Facility
|
OP
|
$58.50
|
|
| Hospital Charge Code |
270610394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare Advantage |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.92
|
| Rate for Payer: Cigna Commercial |
$29.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.78
|
|
|
SCREW 6.5mm CAN 32X100 2333101
|
Facility
|
IP
|
$58.50
|
|
| Hospital Charge Code |
270610394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.78
|
|
|
SCREW 6.5mm CAN 32X105 2333106
|
Facility
|
OP
|
$109.70
|
|
| Hospital Charge Code |
270610395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$54.85 |
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Medicare Advantage |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.97
|
| Rate for Payer: Cigna Commercial |
$54.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.45
|
|
|
SCREW 6.5mm CAN 32X105 2333106
|
Facility
|
IP
|
$109.70
|
|
| Hospital Charge Code |
270610395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$26.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.45
|
|
|
SCREW 6.5mm CAN 32X110 2333111
|
Facility
|
OP
|
$109.70
|
|
| Hospital Charge Code |
270610396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$54.85 |
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Medicare Advantage |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.97
|
| Rate for Payer: Cigna Commercial |
$54.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.45
|
|
|
SCREW 6.5mm CAN 32X110 2333111
|
Facility
|
IP
|
$109.70
|
|
| Hospital Charge Code |
270610396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$26.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.45
|
|
|
SCREW 6.5MM CANC 105MM
|
Facility
|
OP
|
$149.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$74.92 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Aetna Medicare Advantage |
$44.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.21
|
| Rate for Payer: Cigna Commercial |
$74.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.48
|
|
|
SCREW 6.5MM CANC 105MM
|
Facility
|
IP
|
$149.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$36.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.48
|
|
|
SCREW 6.5MM CANC 110MM
|
Facility
|
OP
|
$145.50
|
|
| Hospital Charge Code |
270656192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Aetna Commercial |
$43.65
|
| Rate for Payer: Aetna Medicare Advantage |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.10
|
| Rate for Payer: Cigna Commercial |
$72.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.82
|
|
|
SCREW 6.5MM CANC 110MM
|
Facility
|
IP
|
$145.50
|
|
| Hospital Charge Code |
270656192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$35.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.82
|
|
|
SCREW 6.5MM CANC 110MM
|
Facility
|
OP
|
$149.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$74.92 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Aetna Medicare Advantage |
$44.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.21
|
| Rate for Payer: Cigna Commercial |
$74.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.48
|
|
|
SCREW 6.5MM CANC 110MM
|
Facility
|
IP
|
$149.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$36.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.48
|
|
|
SCREW 6.5MM CANC 16MM
|
Facility
|
OP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270655827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$69.53 |
| Rate for Payer: Aetna Commercial |
$41.72
|
| Rate for Payer: Aetna Medicare Advantage |
$41.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.46
|
| Rate for Payer: Cigna Commercial |
$69.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.86
|
|
|
SCREW 6.5MM CANC 16MM
|
Facility
|
IP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270655834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.86
|
|