|
SCREW 6.5X45MM
|
Facility
|
IP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$1,631.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW 6.5X45MM
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270702662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$217.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$145.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
SCREW 6.5X45MM
|
Facility
|
OP
|
$5,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704029
|
|
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 6.5X45MM
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704680
|
|
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 6.5X45MM
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704680
|
|
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 6.5X45MM
|
Facility
|
IP
|
$5,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704029
|
|
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 6.5X45MM
|
Facility
|
IP
|
$4,500.00
|
|
| Hospital Charge Code |
270703136
|
|
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 6.5X45MM
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704744
|
|
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 6.5X45MM
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270702662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$175.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$145.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
SCREW 6.5X45MM
|
Facility
|
OP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$3,370.00 |
| Rate for Payer: Aetna Commercial |
$2,022.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,022.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$3,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW 6.5X45MM
|
Facility
|
OP
|
$4,500.00
|
|
| Hospital Charge Code |
270703136
|
|
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 6.5X45MM
|
Facility
|
IP
|
$8,180.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.11 |
| Max. Negotiated Rate |
$1,979.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,636.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,979.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,227.11
|
|
|
SCREW 6.5X45MM
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704744
|
|
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 6.5X45MM
|
Facility
|
OP
|
$8,180.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.11 |
| Max. Negotiated Rate |
$4,090.38 |
| Rate for Payer: Aetna Commercial |
$2,454.22
|
| Rate for Payer: Aetna Medicare Advantage |
$2,454.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,086.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,086.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,636.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,086.09
|
| Rate for Payer: Cigna Commercial |
$4,090.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,979.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,227.11
|
|
|
SCREW 6.5X45MM #11-4645
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.50 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,083.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,083.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,083.75
|
| Rate for Payer: Cigna Commercial |
$2,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,028.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$637.50
|
|
|
SCREW 6.5X45MM #11-4645
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.50 |
| Max. Negotiated Rate |
$1,028.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,028.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$637.50
|
|
|
SCREW 6.5X45MM ACCELUS
|
Facility
|
IP
|
$2,000.00
|
|
| Hospital Charge Code |
270703471
|
|
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 6.5X45MM ACCELUS
|
Facility
|
OP
|
$2,000.00
|
|
| Hospital Charge Code |
270703471
|
|
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 6.5X45MM POLYAXIAL
|
Facility
|
IP
|
$10,285.00
|
|
| Hospital Charge Code |
270662658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,542.75 |
| Max. Negotiated Rate |
$2,488.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,057.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,488.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,542.75
|
|
|
SCREW 6.5X45MM POLYAXIAL
|
Facility
|
OP
|
$10,285.00
|
|
| Hospital Charge Code |
270662658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,542.75 |
| Max. Negotiated Rate |
$5,142.50 |
| Rate for Payer: Aetna Commercial |
$3,085.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,085.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,622.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,622.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,057.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,622.68
|
| Rate for Payer: Cigna Commercial |
$5,142.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,488.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,542.75
|
|
|
SCREW 6.5X45MM POLY RELINE 2C
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$93.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.75
|
|
|
SCREW 6.5X45MM POLY RELINE 2C
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Aetna Medicare Advantage |
$115.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$98.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$98.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$77.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$98.17
|
| Rate for Payer: Cigna Commercial |
$192.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.75
|
|
|
SCREW 6.5 X 45 MM RELINE
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$2,700.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
|
|
SCREW 6.5 X 45 MM RELINE
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682865
|
|
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
|
|
|
SCREW 6.5X50
|
Facility
|
OP
|
$11,205.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.84 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$3,361.68
|
| Rate for Payer: Aetna Medicare Advantage |
$3,361.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,857.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,857.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,241.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,857.43
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,711.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,680.84
|
|