|
SCREW CANCELLOUS LO PRO 4x38MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270671968
|
|
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 LO PRO 4x38MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270671968
|
|
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 LO PRO 4x40MM
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671969
|
|
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 LO PRO 4x40MM
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671969
|
|
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 LO PRO 4x42MM
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671970
|
|
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 LO PRO 4x42MM
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671970
|
|
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 LO PRO 4x44MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270671971
|
|
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 LO PRO 4x44MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270671971
|
|
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 LO PRO 4x46MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270671972
|
|
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 LO PRO 4x46MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270671972
|
|
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 LO PRO 4x48MM
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671973
|
|
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 LO PRO 4x48MM
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671973
|
|
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 LO PRO 4x50MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270669460
|
|
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 LO PRO 4x50MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270669460
|
|
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 LO PRO 4x55MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270671974
|
|
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 LO PRO 4x55MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270671974
|
|
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 LO PRO 4x60MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270671975
|
|
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 LO PRO 4x60MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270671975
|
|
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 PT 32 MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270662561
|
|
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 PT 32 MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270662561
|
|
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 THD HEX 36MM
|
Facility
|
IP
|
$205.00
|
|
| Hospital Charge Code |
270670935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$49.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.75
|
|
|
SCREW CANCELLOUS THD HEX 36MM
|
Facility
|
OP
|
$205.00
|
|
| Hospital Charge Code |
270670935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$102.50 |
| Rate for Payer: Aetna Commercial |
$61.50
|
| Rate for Payer: Aetna Medicare Advantage |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.27
|
| Rate for Payer: Cigna Commercial |
$102.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.75
|
|
|
SCREW CANCELLOUS TI 4X65MM
|
Facility
|
IP
|
$258.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$62.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.76
|
|
|
SCREW CANCELLOUS TI 4X65MM
|
Facility
|
OP
|
$258.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna Commercial |
$77.52
|
| Rate for Payer: Aetna Medicare Advantage |
$77.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.89
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.76
|
|
|
SCREW CANCELLOUS TI 4X70MM
|
Facility
|
OP
|
$258.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna Commercial |
$77.52
|
| Rate for Payer: Aetna Medicare Advantage |
$77.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.89
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.76
|
|