|
SCREW BONE 4.5x40MM
|
Facility
|
IP
|
$136.50
|
|
| Hospital Charge Code |
270673226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$33.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
|
|
SCREW BONE 4.5x50MM
|
Facility
|
OP
|
$136.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Medicare Advantage |
$40.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.81
|
| Rate for Payer: Cigna Commercial |
$68.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
|
|
SCREW BONE 4.5x50MM
|
Facility
|
IP
|
$136.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$33.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
|
|
SCREW BONE 4.5x55MM
|
Facility
|
OP
|
$136.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Medicare Advantage |
$40.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.81
|
| Rate for Payer: Cigna Commercial |
$68.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
|
|
SCREW BONE 4.5x55MM
|
Facility
|
IP
|
$136.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$33.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
|
|
SCREW BONE 4.5x60MM
|
Facility
|
IP
|
$136.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$33.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
|
|
SCREW BONE 4.5x60MM
|
Facility
|
OP
|
$136.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Aetna Commercial |
$40.95
|
| Rate for Payer: Aetna Medicare Advantage |
$40.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.81
|
| Rate for Payer: Cigna Commercial |
$68.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.48
|
|
|
SCREW BONE 49 MM ALTREON 6.5 M
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$37.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
SCREW BONE 49 MM ALTREON 6.5 M
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$30.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
SCREW BONE 5.5MM X 25MM
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
SCREW BONE 5.5MM X 25MM
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
SCREW BONE 5.5MM X 30 MM
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
SCREW BONE 5.5MM X 30 MM
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
SCREW BONE 5X48MM CORTICAL
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$387.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$320.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$387.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.00
|
|
|
SCREW BONE 5X48MM CORTICAL
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$480.00
|
| Rate for Payer: Aetna Medicare Advantage |
$480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$320.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$408.00
|
| Rate for Payer: Cigna Commercial |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$387.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$240.00
|
|
|
SCREW BONE 6.5 DIA 15MM
|
Facility
|
OP
|
$660.00
|
|
| Hospital Charge Code |
270669160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW BONE 6.5 DIA 15MM
|
Facility
|
IP
|
$660.00
|
|
| Hospital Charge Code |
270669160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$159.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW BONE 6.5 DIA 20MM
|
Facility
|
OP
|
$660.00
|
|
| Hospital Charge Code |
270669161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW BONE 6.5 DIA 20MM
|
Facility
|
IP
|
$660.00
|
|
| Hospital Charge Code |
270669161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$159.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW BONE 6.5 DIA 25MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW BONE 6.5 DIA 25MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$159.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW BONE 6.5 DIA 30MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$159.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW BONE 6.5 DIA 30MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW BONE 6.5 DIA 35MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$159.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW BONE 6.5 DIA 35MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|