|
SCREW CANN 7.3x110MM 16MM THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x110mm FULL THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x110mm FULL THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x115mm FULL THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x115mm FULL THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x120MM 16MM THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x120MM 16MM THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x120mm FULL THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x120mm FULL THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x125mm
|
Facility
|
OP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$69.53 |
| Rate for Payer: Aetna Commercial |
$41.72
|
| Rate for Payer: Aetna Medicare Advantage |
$41.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.46
|
| Rate for Payer: Cigna Commercial |
$69.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.86
|
|
|
SCREW CANN 7.3x125mm
|
Facility
|
IP
|
$139.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.86
|
|
|
SCREW CANN 7.3x125MM 16MM THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x125MM 16MM THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x125mm FULL THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x125mm FULL THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x130MM 16MM THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x130MM 16MM THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x130mm FULL THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x130mm FULL THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.3x135MM 16MM THRD
|
Facility
|
OP
|
$1,096.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.54 |
| Max. Negotiated Rate |
$548.48 |
| Rate for Payer: Aetna Commercial |
$329.08
|
| Rate for Payer: Aetna Medicare Advantage |
$329.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$279.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$279.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$219.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$279.72
|
| Rate for Payer: Cigna Commercial |
$548.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$265.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.54
|
|
|
SCREW CANN 7.3x135MM 16MM THRD
|
Facility
|
IP
|
$1,096.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.54 |
| Max. Negotiated Rate |
$265.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$219.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$265.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.54
|
|
|
SCREW CANN 7.3x140MM 16MM THRD
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Medicare Advantage |
$319.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$271.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$271.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$271.57
|
| Rate for Payer: Cigna Commercial |
$532.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$257.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.75
|
|
|
SCREW CANN 7.3x140MM 16MM THRD
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$257.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$213.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$257.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.75
|
|
|
SCREW CANN 7.3x145MM 16MM THRD
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Medicare Advantage |
$319.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$271.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$271.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$271.57
|
| Rate for Payer: Cigna Commercial |
$532.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$257.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.75
|
|
|
SCREW CANN 7.3x145MM 16MM THRD
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$257.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$213.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$257.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.75
|
|