|
SCREW CANN 6.5x35MM
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
270676287
|
|
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 6.5X35MM
|
Facility
|
IP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$1,631.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW CANN 6.5X35MM
|
Facility
|
OP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$3,370.00 |
| Rate for Payer: Aetna Commercial |
$2,022.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,022.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$3,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW CANN 6.5x50MM
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
270676289
|
|
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 6.5x50MM
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
270676289
|
|
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 6.5X55X16MM THR
|
Facility
|
IP
|
$5,130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.50 |
| Max. Negotiated Rate |
$1,241.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,026.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,241.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$769.50
|
|
|
SCREW CANN 6.5X55X16MM THR
|
Facility
|
OP
|
$5,130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.50 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Aetna Commercial |
$1,539.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,539.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,026.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,308.15
|
| Rate for Payer: Cigna Commercial |
$2,565.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,241.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$769.50
|
|
|
SCREW CANN 6.5x60MM 16MM THRD
|
Facility
|
IP
|
$1,103.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678282
|
|
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 6.5x60MM 16MM THRD
|
Facility
|
OP
|
$1,103.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678282
|
|
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 6.5x65MM 16MM THRD
|
Facility
|
IP
|
$1,136.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$274.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$274.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.44
|
|
|
SCREW CANN 6.5x65MM 16MM THRD
|
Facility
|
OP
|
$1,136.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$568.12 |
| Rate for Payer: Aetna Commercial |
$340.88
|
| Rate for Payer: Aetna Medicare Advantage |
$340.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$289.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$289.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$289.74
|
| Rate for Payer: Cigna Commercial |
$568.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$274.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.44
|
|
|
SCREW CANN 6.5x70MM 16MM THRD
|
Facility
|
IP
|
$1,136.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$274.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$274.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.44
|
|
|
SCREW CANN 6.5x70MM 16MM THRD
|
Facility
|
OP
|
$1,136.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$568.12 |
| Rate for Payer: Aetna Commercial |
$340.88
|
| Rate for Payer: Aetna Medicare Advantage |
$340.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$289.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$289.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$289.74
|
| Rate for Payer: Cigna Commercial |
$568.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$274.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.44
|
|
|
SCREW CANN 6.5x75MM 16MM THRD
|
Facility
|
OP
|
$1,136.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$568.12 |
| Rate for Payer: Aetna Commercial |
$340.88
|
| Rate for Payer: Aetna Medicare Advantage |
$340.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$289.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$289.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$289.74
|
| Rate for Payer: Cigna Commercial |
$568.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$274.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.44
|
|
|
SCREW CANN 6.5x75MM 16MM THRD
|
Facility
|
IP
|
$1,136.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$274.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$274.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.44
|
|
|
SCREW CANN 6.5x75mm SHORT THRD
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Aetna Commercial |
$562.50
|
| Rate for Payer: Aetna Medicare Advantage |
$562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$478.12
|
| Rate for Payer: Cigna Commercial |
$937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
SCREW CANN 6.5x75mm SHORT THRD
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
SCREW CANN 6.5x80MM 16MM THRD
|
Facility
|
OP
|
$1,136.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$568.12 |
| Rate for Payer: Aetna Commercial |
$340.88
|
| Rate for Payer: Aetna Medicare Advantage |
$340.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$289.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$289.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$289.74
|
| Rate for Payer: Cigna Commercial |
$568.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$274.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.44
|
|
|
SCREW CANN 6.5x80MM 16MM THRD
|
Facility
|
IP
|
$1,136.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$274.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$274.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.44
|
|
|
Screw Cann 6.5x80mm Short Thrd
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
270673713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
Screw Cann 6.5x80mm Short Thrd
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
270673713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Aetna Commercial |
$562.50
|
| Rate for Payer: Aetna Medicare Advantage |
$562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$478.12
|
| Rate for Payer: Cigna Commercial |
$937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
SCREW CANN 6.5x85mm SHORT THRD
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
SCREW CANN 6.5x85mm SHORT THRD
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Aetna Commercial |
$562.50
|
| Rate for Payer: Aetna Medicare Advantage |
$562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$478.12
|
| Rate for Payer: Cigna Commercial |
$937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
SCREW CANN 6.5X90MM
|
Facility
|
IP
|
$2,258.95
|
|
|
Service Code
|
HCPCS 2258.95
|
| Hospital Charge Code |
270705718
|
|
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 6.5X90MM
|
Facility
|
OP
|
$2,258.95
|
|
|
Service Code
|
HCPCS 2258.95
|
| Hospital Charge Code |
270705718
|
|
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
|
|