|
SCREW 6.5MM LOW PROF HEX 35MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
SCREW 6.5MM LOW PROF HEX 35MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
SCREW 65MM MULTI-DIRECT
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
2701648245
|
|
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 65MM MULTI-DIRECT
|
Facility
|
OP
|
$1,180.00
|
|
| Hospital Charge Code |
2701648245
|
|
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 65MM MULTI-DIRECTIONAL
|
Facility
|
OP
|
$1,180.00
|
|
| Hospital Charge Code |
270648245
|
|
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 65MM MULTI-DIRECTIONAL
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
270648245
|
|
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 6.5MM X40MM OW EXT TAB
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,575.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
SCREW 6.5MM X40MM OW EXT TAB
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
SCREW 6.5MM X45MM OW EXT TAB
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,575.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
SCREW 6.5MM X45MM OW EXT TAB
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
SCREW 6.5X30MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
SCREW 6.5X30MM
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$332.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$332.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
|
|
SCREW 6.5X30MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
SCREW 6.5X30MM
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Aetna Commercial |
$412.50
|
| Rate for Payer: Aetna Medicare Advantage |
$412.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$350.62
|
| Rate for Payer: Cigna Commercial |
$687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$332.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
|
|
SCREW 6.5X30MM
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$532.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
|
|
SCREW 6.5X30MM
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$561.00
|
| Rate for Payer: Cigna Commercial |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
|
|
SCREW 6.5X35MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
SCREW 6.5X35MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
SCREW 6.5X35MM
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
SCREW 6.5X35MM
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$1,650.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
SCREW 6.5X35MM
|
Facility
|
OP
|
$5,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$817.50 |
| Max. Negotiated Rate |
$2,725.00 |
| Rate for Payer: Aetna Commercial |
$1,635.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,635.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,389.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,389.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,090.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,389.75
|
| Rate for Payer: Cigna Commercial |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,318.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$817.50
|
|
|
SCREW 6.5X35MM
|
Facility
|
IP
|
$4,500.00
|
|
| Hospital Charge Code |
270703134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
SCREW 6.5X35MM
|
Facility
|
IP
|
$5,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$817.50 |
| Max. Negotiated Rate |
$1,318.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,090.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,318.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$817.50
|
|
|
SCREW 6.5X35MM
|
Facility
|
OP
|
$4,500.00
|
|
| Hospital Charge Code |
270703134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,350.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
SCREW 6.5X36MM COB CHR HD TI S
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
|