|
SCREW 6.5X50
|
Facility
|
IP
|
$11,205.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699238
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.84 |
| Max. Negotiated Rate |
$2,711.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,241.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,711.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,680.84
|
|
|
SCREW 6.5 X 50HDLESS COMP THD
|
Facility
|
IP
|
$1,468.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$355.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$293.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.25
|
|
|
SCREW 6.5 X 50HDLESS COMP THD
|
Facility
|
OP
|
$1,468.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$734.17 |
| Rate for Payer: Aetna Commercial |
$440.50
|
| Rate for Payer: Aetna Medicare Advantage |
$440.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$374.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$374.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$293.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$374.43
|
| Rate for Payer: Cigna Commercial |
$734.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.25
|
|
|
SCREW 6.5X50MM
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704743
|
|
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 6.5X50MM
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704743
|
|
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 6.5X50MM
|
Facility
|
IP
|
$3,625.00
|
|
| Hospital Charge Code |
270702661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$877.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
|
|
SCREW 6.5X50MM
|
Facility
|
OP
|
$3,625.00
|
|
| Hospital Charge Code |
270702661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$1,812.50 |
| Rate for Payer: Aetna Commercial |
$1,087.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$924.38
|
| Rate for Payer: Cigna Commercial |
$1,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
|
|
SCREW 6.5 X 60MM
|
Facility
|
IP
|
$4,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.50 |
| Max. Negotiated Rate |
$1,076.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$890.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,076.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$667.50
|
|
|
SCREW 6.5 X 60MM
|
Facility
|
OP
|
$4,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.50 |
| Max. Negotiated Rate |
$2,225.00 |
| Rate for Payer: Aetna Commercial |
$1,335.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,335.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,134.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,134.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$890.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,134.75
|
| Rate for Payer: Cigna Commercial |
$2,225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,076.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$667.50
|
|
|
SCREW 6.5X60MM
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$1,425.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,211.25
|
| Rate for Payer: Cigna Commercial |
$2,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,149.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
|
|
SCREW 6.5X60MM
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$1,149.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,149.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
|
|
SCREW 6.5X60MM
|
Facility
|
OP
|
$2,301.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.27 |
| Max. Negotiated Rate |
$1,150.90 |
| Rate for Payer: Aetna Commercial |
$690.54
|
| Rate for Payer: Aetna Medicare Advantage |
$690.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$586.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$586.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$586.96
|
| Rate for Payer: Cigna Commercial |
$1,150.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$557.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.27
|
|
|
SCREW 6.5X60MM
|
Facility
|
IP
|
$2,301.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.27 |
| Max. Negotiated Rate |
$557.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$460.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$557.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$345.27
|
|
|
SCREW 6.5 X 65MM
|
Facility
|
OP
|
$3,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.75 |
| Max. Negotiated Rate |
$1,762.50 |
| Rate for Payer: Aetna Commercial |
$1,057.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,057.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$898.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$898.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$705.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$898.88
|
| Rate for Payer: Cigna Commercial |
$1,762.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$853.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$528.75
|
|
|
SCREW 6.5 X 65MM
|
Facility
|
IP
|
$3,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.75 |
| Max. Negotiated Rate |
$853.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$705.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$853.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$528.75
|
|
|
SCREW 6.5X65MM 015.3287
|
Facility
|
IP
|
$4,450.00
|
|
| Hospital Charge Code |
270702564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.50 |
| Max. Negotiated Rate |
$1,076.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$890.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,076.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$667.50
|
|
|
SCREW 6.5X65MM 015.3287
|
Facility
|
OP
|
$4,450.00
|
|
| Hospital Charge Code |
270702564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.50 |
| Max. Negotiated Rate |
$2,225.00 |
| Rate for Payer: Aetna Commercial |
$1,335.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,335.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,134.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,134.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$890.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,134.75
|
| Rate for Payer: Cigna Commercial |
$2,225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,076.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$667.50
|
|
|
SCREW 6.5 X 80MM
|
Facility
|
OP
|
$3,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.75 |
| Max. Negotiated Rate |
$1,762.50 |
| Rate for Payer: Aetna Commercial |
$1,057.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,057.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$898.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$898.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$705.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$898.88
|
| Rate for Payer: Cigna Commercial |
$1,762.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$853.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$528.75
|
|
|
SCREW 6.5 X 80MM
|
Facility
|
IP
|
$3,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.75 |
| Max. Negotiated Rate |
$853.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$705.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$853.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$528.75
|
|
|
SCREW 6MM
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$100.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$83.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.25
|
|
|
SCREW 6MM
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$207.50 |
| Rate for Payer: Aetna Commercial |
$124.50
|
| Rate for Payer: Aetna Medicare Advantage |
$124.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$83.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.83
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.25
|
|
|
SCREW 6 X 35 MM
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$2,117.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
|
|
SCREW 6 X 35 MM
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Aetna Commercial |
$2,625.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,625.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,231.25
|
| Rate for Payer: Cigna Commercial |
$4,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
|
|
SCREW 70MM LOW PROFILE
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270648243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$84.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
SCREW 70MM LOW PROFILE
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270648243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|