|
SCREW BOLT 2 PIECE SCHANZ
|
Facility
|
OP
|
$1,144.90
|
|
| Hospital Charge Code |
270691905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.84 |
| Max. Negotiated Rate |
$572.45 |
| Rate for Payer: Aetna Commercial |
$343.47
|
| Rate for Payer: Aetna Medicare Advantage |
$343.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$291.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$291.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$291.95
|
| Rate for Payer: Cigna Commercial |
$572.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$148.84
|
| Rate for Payer: Oxford Commercial |
$572.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$572.45
|
|
|
SCREW BOLT CANN POSTMNT SCHANZ
|
Facility
|
IP
|
$1,265.90
|
|
| Hospital Charge Code |
270691906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.88 |
| Max. Negotiated Rate |
$189.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$189.88
|
|
|
SCREW BOLT CANN POSTMNT SCHANZ
|
Facility
|
OP
|
$1,265.90
|
|
| Hospital Charge Code |
270691906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.57 |
| Max. Negotiated Rate |
$632.95 |
| Rate for Payer: Aetna Commercial |
$379.77
|
| Rate for Payer: Aetna Medicare Advantage |
$379.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$322.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$322.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$322.80
|
| Rate for Payer: Cigna Commercial |
$632.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.57
|
| Rate for Payer: Oxford Commercial |
$632.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$189.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$632.95
|
|
|
SCREW BOLT POST MOUNT SCHANZ
|
Facility
|
OP
|
$1,232.00
|
|
| Hospital Charge Code |
270691904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$369.60
|
| Rate for Payer: Aetna Medicare Advantage |
$369.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$314.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$314.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$314.16
|
| Rate for Payer: Cigna Commercial |
$616.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.16
|
| Rate for Payer: Oxford Commercial |
$616.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$616.00
|
|
|
SCREW BOLT POST MOUNT SCHANZ
|
Facility
|
IP
|
$1,232.00
|
|
| Hospital Charge Code |
270691904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$184.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.80
|
|
|
SCREW BONE 16.0MM ACUTRAK
|
Facility
|
IP
|
$2,695.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.25 |
| Max. Negotiated Rate |
$652.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$539.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$652.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$404.25
|
|
|
SCREW BONE 16.0MM ACUTRAK
|
Facility
|
OP
|
$2,695.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.25 |
| Max. Negotiated Rate |
$1,347.50 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Aetna Medicare Advantage |
$808.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$687.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$687.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$687.23
|
| Rate for Payer: Cigna Commercial |
$1,347.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$652.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$404.25
|
|
|
SCREW BONE 1.7MMx9MM 58-17009E
|
Facility
|
IP
|
$550.00
|
|
| Hospital Charge Code |
270655368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW BONE 1.7MMx9MM 58-17009E
|
Facility
|
OP
|
$550.00
|
|
| Hospital Charge Code |
270655368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW BONE 180/50 A6018050
|
Facility
|
OP
|
$420.00
|
|
| Hospital Charge Code |
270639792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.10
|
| Rate for Payer: Cigna Commercial |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
SCREW BONE 180/50 A6018050
|
Facility
|
IP
|
$420.00
|
|
| Hospital Charge Code |
270639792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
SCREW BONE 20MMx2.7MM 52-27620
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
270640885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Medicare Advantage |
$157.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.88
|
| Rate for Payer: Cigna Commercial |
$262.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
|
|
SCREW BONE 20MMx2.7MM 52-27620
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
270640885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$127.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
|
|
SCREW BONE 2.3MM X 14MM
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
270667224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
SCREW BONE 2.3MM X 14MM
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
270667224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Medicare Advantage |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.12
|
| Rate for Payer: Cigna Commercial |
$337.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
SCREW BONE 2.3x13MM
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270657987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$134.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.25
|
|
|
SCREW BONE 2.3x13MM
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270657987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Medicare Advantage |
$166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$141.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$141.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$141.53
|
| Rate for Payer: Cigna Commercial |
$277.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.25
|
|
|
SCREW BONE 2.3X15MM
|
Facility
|
IP
|
$685.00
|
|
| Hospital Charge Code |
270669550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$165.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
|
|
SCREW BONE 2.3X15MM
|
Facility
|
OP
|
$685.00
|
|
| Hospital Charge Code |
270669550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$342.50 |
| Rate for Payer: Aetna Commercial |
$205.50
|
| Rate for Payer: Aetna Medicare Advantage |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$174.68
|
| Rate for Payer: Cigna Commercial |
$342.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
|
|
SCREW BONE 2.7 20MM
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$121.12
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|
|
SCREW BONE 2.7 20MM
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|
|
SCREW BONE 2.7X10MM
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
270648953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Medicare Advantage |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.12
|
| Rate for Payer: Cigna Commercial |
$337.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
SCREW BONE 2.7X10MM
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
270648953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
SCREW BONE 2.7X12MM
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Medicare Advantage |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.12
|
| Rate for Payer: Cigna Commercial |
$337.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
SCREW BONE 2.7X12MM
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|