|
SCREW CAN FULL THRD HD 3X20MM
|
Facility
|
OP
|
$962.50
|
|
| Hospital Charge Code |
270702430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$481.25 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Aetna Medicare Advantage |
$288.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$245.44
|
| Rate for Payer: Cigna Commercial |
$481.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN FULL THRD HD 3X36MM
|
Facility
|
IP
|
$962.00
|
|
| Hospital Charge Code |
270702431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$232.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.30
|
|
|
SCREW CAN FULL THRD HD 3X36MM
|
Facility
|
OP
|
$962.00
|
|
| Hospital Charge Code |
270702431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: Aetna Commercial |
$288.60
|
| Rate for Payer: Aetna Medicare Advantage |
$288.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$245.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$245.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$245.31
|
| Rate for Payer: Cigna Commercial |
$481.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.30
|
|
|
SCREW CAN HD 3X14MM
|
Facility
|
IP
|
$972.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$235.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$194.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.88
|
|
|
SCREW CAN HD 3X14MM
|
Facility
|
OP
|
$972.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$486.25 |
| Rate for Payer: Aetna Commercial |
$291.75
|
| Rate for Payer: Aetna Medicare Advantage |
$291.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$247.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$247.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$247.99
|
| Rate for Payer: Cigna Commercial |
$486.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.88
|
|
|
SCREW CAN HD 3X16MM
|
Facility
|
IP
|
$962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$232.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN HD 3X16MM
|
Facility
|
OP
|
$962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$481.25 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Aetna Medicare Advantage |
$288.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$245.44
|
| Rate for Payer: Cigna Commercial |
$481.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN HD 3 X 20MM
|
Facility
|
IP
|
$962.50
|
|
| Hospital Charge Code |
270701956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$232.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN HD 3 X 20MM
|
Facility
|
OP
|
$962.50
|
|
| Hospital Charge Code |
270701956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$481.25 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Aetna Medicare Advantage |
$288.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$245.44
|
| Rate for Payer: Cigna Commercial |
$481.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN HD 3 X 22MM
|
Facility
|
OP
|
$962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$481.25 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Aetna Medicare Advantage |
$288.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$245.44
|
| Rate for Payer: Cigna Commercial |
$481.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN HD 3 X 22MM
|
Facility
|
IP
|
$962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$232.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN HD 3 X 26 MM
|
Facility
|
OP
|
$962.50
|
|
| Hospital Charge Code |
270701880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$481.25 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Aetna Medicare Advantage |
$288.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$245.44
|
| Rate for Payer: Cigna Commercial |
$481.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN HD 3 X 26 MM
|
Facility
|
IP
|
$962.50
|
|
| Hospital Charge Code |
270701880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$232.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN HD 3X34MM
|
Facility
|
OP
|
$962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$481.25 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Aetna Medicare Advantage |
$288.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$245.44
|
| Rate for Payer: Cigna Commercial |
$481.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN HD 3X34MM
|
Facility
|
IP
|
$962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$232.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW CAN LOCKNG 7.3x80 222573
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
270634363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.15 |
| Max. Negotiated Rate |
$560.50 |
| Rate for Payer: Aetna Commercial |
$336.30
|
| Rate for Payer: Aetna Medicare Advantage |
$336.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.86
|
| Rate for Payer: Cigna Commercial |
$560.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.15
|
|
|
SCREW CAN LOCKNG 7.3x80 222573
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
270634363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.15 |
| Max. Negotiated Rate |
$271.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.15
|
|
|
SCREW CAN MOD CREOAMP 6.5X35MM
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$1,812.50 |
| Rate for Payer: Aetna Commercial |
$1,087.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$924.38
|
| Rate for Payer: Cigna Commercial |
$1,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
|
|
SCREW CAN MOD CREOAMP 6.5X35MM
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$877.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
|
|
SCREW CANN 16mm THD 1146-105
|
Facility
|
IP
|
$757.65
|
|
| Hospital Charge Code |
270619542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.65 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$151.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$183.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.65
|
|
|
SCREW CANN 16mm THD 1146-105
|
Facility
|
OP
|
$757.65
|
|
| Hospital Charge Code |
270619542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.65 |
| Max. Negotiated Rate |
$378.82 |
| Rate for Payer: Aetna Commercial |
$227.29
|
| Rate for Payer: Aetna Medicare Advantage |
$227.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$193.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$193.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$151.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$193.20
|
| Rate for Payer: Cigna Commercial |
$378.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$183.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.65
|
|
|
SCREW CANN 20MM THD 6.5x75MM
|
Facility
|
OP
|
$2,120.00
|
|
| Hospital Charge Code |
270674057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$636.00
|
| Rate for Payer: Aetna Medicare Advantage |
$636.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$424.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,060.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$513.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.00
|
|
|
SCREW CANN 20MM THD 6.5x75MM
|
Facility
|
IP
|
$2,120.00
|
|
| Hospital Charge Code |
270674057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$513.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$424.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$513.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.00
|
|
|
SCREW CANN 20MM THD 6.5x80MM
|
Facility
|
OP
|
$2,120.00
|
|
| Hospital Charge Code |
270674056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$636.00
|
| Rate for Payer: Aetna Medicare Advantage |
$636.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$424.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,060.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$513.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.00
|
|
|
SCREW CANN 20MM THD 6.5x80MM
|
Facility
|
IP
|
$2,120.00
|
|
| Hospital Charge Code |
270674056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$513.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$424.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$513.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.00
|
|