|
SCREW CANN 4X50MM TITANIUM
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$313.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW CANN 4X50MM TITANIUM
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$647.50 |
| Rate for Payer: Aetna Commercial |
$388.50
|
| Rate for Payer: Aetna Medicare Advantage |
$388.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$330.23
|
| Rate for Payer: Cigna Commercial |
$647.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW CANN 6.50X50MM
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
SCREW CANN 6.50X50MM
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$3,225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
SCREW CANN 6.5-40MM THRD 75MM
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$561.00
|
| Rate for Payer: Cigna Commercial |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
|
|
SCREW CANN 6.5-40MM THRD 75MM
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$532.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
|
|
SCREW CANN 6.5MM THR 32MM55MM
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.95 |
| Max. Negotiated Rate |
$332.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$274.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$332.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.95
|
|
|
SCREW CANN 6.5MM THR 32MM55MM
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.95 |
| Max. Negotiated Rate |
$686.50 |
| Rate for Payer: Aetna Commercial |
$411.90
|
| Rate for Payer: Aetna Medicare Advantage |
$411.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$350.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$350.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$274.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$350.12
|
| Rate for Payer: Cigna Commercial |
$686.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$332.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.95
|
|
|
SCREW CANN 6.5MM X 55MM X 16MM
|
Facility
|
IP
|
$2,415.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$584.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$483.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$584.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.25
|
|
|
SCREW CANN 6.5MM X 55MM X 16MM
|
Facility
|
OP
|
$2,415.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: Aetna Commercial |
$724.50
|
| Rate for Payer: Aetna Medicare Advantage |
$724.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$615.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$615.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$483.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$615.83
|
| Rate for Payer: Cigna Commercial |
$1,207.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$584.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.25
|
|
|
SCREW CANN 6.5X100MM
|
Facility
|
OP
|
$2,258.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.84 |
| Max. Negotiated Rate |
$1,129.47 |
| Rate for Payer: Aetna Commercial |
$677.68
|
| Rate for Payer: Aetna Medicare Advantage |
$677.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$576.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$576.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$451.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$576.03
|
| Rate for Payer: Cigna Commercial |
$1,129.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$338.84
|
|
|
SCREW CANN 6.5X100MM
|
Facility
|
IP
|
$2,258.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.84 |
| Max. Negotiated Rate |
$546.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$451.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$338.84
|
|
|
SCREW CANN 6.5x115MM 32MM THRD
|
Facility
|
IP
|
$1,103.15
|
|
| Hospital Charge Code |
270678285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.47 |
| Max. Negotiated Rate |
$266.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.47
|
|
|
SCREW CANN 6.5x115MM 32MM THRD
|
Facility
|
OP
|
$1,103.15
|
|
| Hospital Charge Code |
270678285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.47 |
| Max. Negotiated Rate |
$551.58 |
| Rate for Payer: Aetna Commercial |
$330.94
|
| Rate for Payer: Aetna Medicare Advantage |
$330.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$281.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$281.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$281.30
|
| Rate for Payer: Cigna Commercial |
$551.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.47
|
|
|
SCREW CANN 6.5x120MM
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
270676292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$259.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$214.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$259.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.65
|
|
|
SCREW CANN 6.5x120MM
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
270676292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Medicare Advantage |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$273.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$273.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$273.11
|
| Rate for Payer: Cigna Commercial |
$535.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$259.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.65
|
|
|
SCREW CANN 6.5x125MM
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
270676293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$259.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$214.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$259.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.65
|
|
|
SCREW CANN 6.5x125MM
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
270676293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Medicare Advantage |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$273.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$273.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$273.11
|
| Rate for Payer: Cigna Commercial |
$535.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$259.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.65
|
|
|
SCREW CANN 6.5x125MM 32MM THRD
|
Facility
|
IP
|
$1,103.15
|
|
| Hospital Charge Code |
270678286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.47 |
| Max. Negotiated Rate |
$266.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.47
|
|
|
SCREW CANN 6.5x125MM 32MM THRD
|
Facility
|
OP
|
$1,103.15
|
|
| Hospital Charge Code |
270678286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.47 |
| Max. Negotiated Rate |
$551.58 |
| Rate for Payer: Aetna Commercial |
$330.94
|
| Rate for Payer: Aetna Medicare Advantage |
$330.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$281.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$281.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$281.30
|
| Rate for Payer: Cigna Commercial |
$551.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.47
|
|
|
SCREW CANN 6.5 X 12MM
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$330.00
|
| Rate for Payer: Aetna Medicare Advantage |
$330.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$280.50
|
| Rate for Payer: Cigna Commercial |
$550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
|
|
SCREW CANN 6.5 X 12MM
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$266.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
|
|
SCREW CANN 6.5x130MM 16MM THRD
|
Facility
|
OP
|
$1,103.15
|
|
| Hospital Charge Code |
270678287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.47 |
| Max. Negotiated Rate |
$551.58 |
| Rate for Payer: Aetna Commercial |
$330.94
|
| Rate for Payer: Aetna Medicare Advantage |
$330.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$281.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$281.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$281.30
|
| Rate for Payer: Cigna Commercial |
$551.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.47
|
|
|
SCREW CANN 6.5x130MM 16MM THRD
|
Facility
|
IP
|
$1,103.15
|
|
| Hospital Charge Code |
270678287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.47 |
| Max. Negotiated Rate |
$266.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.47
|
|
|
SCREW CANN 6.5x35MM
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
270676287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$259.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$214.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$259.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.65
|
|