|
SCREW BONE 3.5mm x38mm NONLOCK
|
Facility
|
OP
|
$216.00
|
|
| Hospital Charge Code |
700643720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Medicare Advantage |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55.08
|
| Rate for Payer: Cigna Commercial |
$108.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.40
|
|
|
SCREW BONE 3.5mm x46mm NONLOCK
|
Facility
|
OP
|
$216.00
|
|
| Hospital Charge Code |
270643719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Medicare Advantage |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55.08
|
| Rate for Payer: Cigna Commercial |
$108.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.40
|
|
|
SCREW BONE 3.5mm x46mm NONLOCK
|
Facility
|
IP
|
$216.00
|
|
| Hospital Charge Code |
270643719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$52.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$43.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.40
|
|
|
SCREW BONE 3.5mm x8mm LOCKING
|
Facility
|
OP
|
$440.00
|
|
| Hospital Charge Code |
270643723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$132.00
|
| Rate for Payer: Aetna Medicare Advantage |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$88.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$112.20
|
| Rate for Payer: Cigna Commercial |
$220.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$106.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.00
|
|
|
SCREW BONE 3.5mm x8mm LOCKING
|
Facility
|
IP
|
$440.00
|
|
| Hospital Charge Code |
270643723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$106.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$88.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$106.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.00
|
|
|
SCREW BONE 3.5 X 10
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664510
|
|
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 3.5 X 10
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664510
|
|
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 3.5 x 14mm
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
270665825
|
|
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 BONE 3.5 x 14mm
|
Facility
|
OP
|
$1,180.00
|
|
| Hospital Charge Code |
270665825
|
|
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 BONE 3.5x14mm LOCK 27714
|
Facility
|
OP
|
$535.00
|
|
| Hospital Charge Code |
270643345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.25 |
| Max. Negotiated Rate |
$267.50 |
| Rate for Payer: Aetna Commercial |
$160.50
|
| Rate for Payer: Aetna Medicare Advantage |
$160.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$107.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.43
|
| Rate for Payer: Cigna Commercial |
$267.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.25
|
|
|
SCREW BONE 3.5x14mm LOCK 27714
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
270643345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.25 |
| Max. Negotiated Rate |
$129.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$107.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.25
|
|
|
SCREW BONE 3.5 X 16MM 40-36016
|
Facility
|
IP
|
$21.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.21
|
|
|
SCREW BONE 3.5 X 16MM 40-36016
|
Facility
|
OP
|
$21.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$10.70 |
| Rate for Payer: Aetna Commercial |
$6.42
|
| Rate for Payer: Aetna Medicare Advantage |
$6.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.46
|
| Rate for Payer: Cigna Commercial |
$10.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.21
|
|
|
SCREW BONE 3.5 X 24
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270645511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
SCREW BONE 3.5 X 24
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
SCREW BONE 3.5 X 24
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
SCREW BONE 3.5 X 24
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270645511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
SCREW BONE 3.5x30 338930
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
270648059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$60.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.00
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
SCREW BONE 3.5x30 338930
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
270648059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
SCREW BONE 3.5x32 338632
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$35.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
|
|
SCREW BONE 3.5x32 338632
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$72.50 |
| Rate for Payer: Aetna Commercial |
$43.50
|
| Rate for Payer: Aetna Medicare Advantage |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.98
|
| Rate for Payer: Cigna Commercial |
$72.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
|
|
SCREW BONE 3.5x36 338636
|
Facility
|
IP
|
$145.00
|
|
| Hospital Charge Code |
270648067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$35.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
|
|
SCREW BONE 3.5x36 338636
|
Facility
|
OP
|
$145.00
|
|
| Hospital Charge Code |
270648067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$72.50 |
| Rate for Payer: Aetna Commercial |
$43.50
|
| Rate for Payer: Aetna Medicare Advantage |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.98
|
| Rate for Payer: Cigna Commercial |
$72.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
|
|
SCREW BONE 3.5 X 36MM
|
Facility
|
OP
|
$455.00
|
|
| Hospital Charge Code |
270660357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna Commercial |
$136.50
|
| Rate for Payer: Aetna Medicare Advantage |
$136.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$91.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$116.03
|
| Rate for Payer: Cigna Commercial |
$227.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.25
|
|
|
SCREW BONE 3.5 X 36MM
|
Facility
|
IP
|
$455.00
|
|
| Hospital Charge Code |
270660357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$110.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$91.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.25
|
|