|
SCREW 6.5mm CANC 32X95 2333096
|
Facility
|
OP
|
$109.70
|
|
| Hospital Charge Code |
270610393
|
|
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 CANC 32X95 2333096
|
Facility
|
IP
|
$109.70
|
|
| Hospital Charge Code |
270610393
|
|
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 60mm 2332061
|
Facility
|
OP
|
$79.45
|
|
| Hospital Charge Code |
270610373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Aetna Commercial |
$23.84
|
| Rate for Payer: Aetna Medicare Advantage |
$23.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.26
|
| Rate for Payer: Cigna Commercial |
$39.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.92
|
|
|
SCREW 6.5mm CANC 60mm 2332061
|
Facility
|
IP
|
$79.45
|
|
| Hospital Charge Code |
270610373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$19.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.92
|
|
|
SCREW 6.5MM CANCELLOUS 100MM
|
Facility
|
OP
|
$145.50
|
|
| Hospital Charge Code |
270656190
|
|
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 CANCELLOUS 100MM
|
Facility
|
IP
|
$145.50
|
|
| Hospital Charge Code |
270656190
|
|
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 CANCELLOUS 105MM
|
Facility
|
IP
|
$145.50
|
|
| Hospital Charge Code |
270656191
|
|
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 CANCELLOUS 105MM
|
Facility
|
OP
|
$145.50
|
|
| Hospital Charge Code |
270656191
|
|
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 CANCELLOUS 115MM
|
Facility
|
IP
|
$186.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.04
|
|
|
SCREW 6.5MM CANCELLOUS 115MM
|
Facility
|
OP
|
$186.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$93.47 |
| Rate for Payer: Aetna Commercial |
$56.09
|
| Rate for Payer: Aetna Medicare Advantage |
$56.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.67
|
| Rate for Payer: Cigna Commercial |
$93.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.04
|
|
|
SCREW 6.5MM CANCELLOUS 120MM
|
Facility
|
OP
|
$186.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$93.47 |
| Rate for Payer: Aetna Commercial |
$56.09
|
| Rate for Payer: Aetna Medicare Advantage |
$56.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.67
|
| Rate for Payer: Cigna Commercial |
$93.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.04
|
|
|
SCREW 6.5MM CANCELLOUS 120MM
|
Facility
|
IP
|
$186.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$37.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.04
|
|
|
SCREW 6.5MM CANCELLOUS 45MM
|
Facility
|
IP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656179
|
|
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
|
|
|
SCREW 6.5MM CANCELLOUS 45MM
|
Facility
|
OP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656179
|
|
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 CANCELLOUS 50MM
|
Facility
|
OP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656180
|
|
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 CANCELLOUS 50MM
|
Facility
|
IP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656180
|
|
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
|
|
|
SCREW 6.5MM CANCELLOUS 55MM
|
Facility
|
IP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656181
|
|
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
|
|
|
SCREW 6.5MM CANCELLOUS 55MM
|
Facility
|
OP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656181
|
|
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 CANCELLOUS 60MM
|
Facility
|
IP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656182
|
|
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
|
|
|
SCREW 6.5MM CANCELLOUS 60MM
|
Facility
|
OP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656182
|
|
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 CANCELLOUS 65MM
|
Facility
|
IP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656183
|
|
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
|
|
|
SCREW 6.5MM CANCELLOUS 65MM
|
Facility
|
OP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656183
|
|
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 CANCELLOUS 70MM
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
270656184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANCELLOUS 70MM
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
270656184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANCELLOUS 75MM
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
270656185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|