|
SCREW CANCELLOUS 3.0X12MM
|
Facility
|
IP
|
$440.00
|
|
| Hospital Charge Code |
270669462
|
|
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 CANCELLOUS 32 MM 6.5 MM
|
Facility
|
OP
|
$143.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$42.96
|
| Rate for Payer: Aetna Medicare Advantage |
$42.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.52
|
| Rate for Payer: Cigna Commercial |
$71.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.48
|
|
|
SCREW CANCELLOUS 32 MM 6.5 MM
|
Facility
|
IP
|
$143.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.48
|
|
|
SCREW CANCELLOUS 36mm 3454-36
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
270640110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.77
|
| Rate for Payer: Cigna Commercial |
$52.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
|
|
SCREW CANCELLOUS 36mm 3454-36
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
270640110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$25.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
|
|
SCREW CANCELLOUS 4.0 36MM
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$240.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
SCREW CANCELLOUS 4.0 36MM
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$193.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
SCREW CANCELLOUS 40mm 3454-40
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
270640111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$25.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
|
|
SCREW CANCELLOUS 40mm 3454-40
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
270640111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.77
|
| Rate for Payer: Cigna Commercial |
$52.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.75
|
|
|
SCREW CANCELLOUS 4.0 X 14 MM
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$47.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.25
|
|
|
SCREW CANCELLOUS 4.0 X 14 MM
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Aetna Medicare Advantage |
$58.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.73
|
| Rate for Payer: Cigna Commercial |
$97.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.25
|
|
|
SCREW CANCELLOUS 4.0X16
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270661847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$52.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
SCREW CANCELLOUS 4.0X16
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270661847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$42.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
SCREW CANCELLOUS 4.0X18
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270661844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$42.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
SCREW CANCELLOUS 4.0X18
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270661844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$52.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
SCREW CANCELLOUS 4.0X18 CA4180
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270638172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CANCELLOUS 4.0X18 CA4180
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270638172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CANCELLOUS 4 0X20 CA4200
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270638170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CANCELLOUS 4 0X20 CA4200
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270638170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CANCELLOUS 4.0X24
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$52.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
SCREW CANCELLOUS 4.0X24
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$42.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
SCREW CANCELLOUS 4.0 X 24MM
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$168.00
|
| Rate for Payer: Aetna Medicare Advantage |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$142.80
|
| Rate for Payer: Cigna Commercial |
$280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.00
|
|
|
SCREW CANCELLOUS 4.0 X 24MM
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$135.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.00
|
|
|
SCREW CANCELLOUS 4.0X26 CA4260
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270638171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CANCELLOUS 4.0X26 CA4260
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270638171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|