|
SCREW CANN 7.3x85mm FULL THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605083
|
|
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 7.3x85mm FULL THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605083
|
|
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 7.3x90MM 16MM THRD
|
Facility
|
IP
|
$1,101.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$266.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.20
|
|
|
SCREW CANN 7.3x90MM 16MM THRD
|
Facility
|
OP
|
$1,101.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$550.67 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare Advantage |
$330.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$280.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$280.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$280.84
|
| Rate for Payer: Cigna Commercial |
$550.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.20
|
|
|
SCREW CANN 7.3x90mm FULL THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605084
|
|
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 7.3x90mm FULL THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605084
|
|
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 7.3x95mm FULL THRD
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605085
|
|
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 7.3x95mm FULL THRD
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270605085
|
|
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 7DX95mmZIM 11469532
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270606328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$248.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
|
|
SCREW CANN 7DX95mmZIM 11469532
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270606328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$512.50 |
| Rate for Payer: Aetna Commercial |
$307.50
|
| Rate for Payer: Aetna Medicare Advantage |
$307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$261.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$261.38
|
| Rate for Payer: Cigna Commercial |
$512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.75
|
|
|
SCREW CANN ASNIS 4x36MM STER
|
Facility
|
OP
|
$931.20
|
|
| Hospital Charge Code |
270675647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$465.60 |
| Rate for Payer: Aetna Commercial |
$279.36
|
| Rate for Payer: Aetna Medicare Advantage |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$237.46
|
| Rate for Payer: Cigna Commercial |
$465.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN ASNIS 4x36MM STER
|
Facility
|
IP
|
$931.20
|
|
| Hospital Charge Code |
270675647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$225.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN ASNIS 4x40MM STER
|
Facility
|
OP
|
$931.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$465.60 |
| Rate for Payer: Aetna Commercial |
$279.36
|
| Rate for Payer: Aetna Medicare Advantage |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$237.46
|
| Rate for Payer: Cigna Commercial |
$465.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN ASNIS 4x40MM STER
|
Facility
|
IP
|
$931.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$225.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN ASNIS F/THD 4x40MM
|
Facility
|
OP
|
$931.20
|
|
| Hospital Charge Code |
270675786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$465.60 |
| Rate for Payer: Aetna Commercial |
$279.36
|
| Rate for Payer: Aetna Medicare Advantage |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$237.46
|
| Rate for Payer: Cigna Commercial |
$465.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN ASNIS F/THD 4x40MM
|
Facility
|
IP
|
$931.20
|
|
| Hospital Charge Code |
270675786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$225.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN ASNIS III 4X14MM
|
Facility
|
OP
|
$1,360.00
|
|
| Hospital Charge Code |
270670570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$408.00
|
| Rate for Payer: Aetna Medicare Advantage |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$346.80
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
|
|
SCREW CANN ASNIS III 4X14MM
|
Facility
|
IP
|
$1,360.00
|
|
| Hospital Charge Code |
270670570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$329.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
|
|
SCREW CANN ASNIS III 4x22MM
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$408.00
|
| Rate for Payer: Aetna Medicare Advantage |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$346.80
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
|
|
SCREW CANN ASNIS III 4x22MM
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$329.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
|
|
SCREW CANN ASNIS III 4x44MM
|
Facility
|
IP
|
$931.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$225.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN ASNIS III 4x44MM
|
Facility
|
OP
|
$931.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$465.60 |
| Rate for Payer: Aetna Commercial |
$279.36
|
| Rate for Payer: Aetna Medicare Advantage |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$237.46
|
| Rate for Payer: Cigna Commercial |
$465.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN ASNIS III 4x46MM
|
Facility
|
IP
|
$931.20
|
|
| Hospital Charge Code |
270674891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$225.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN ASNIS III 4x46MM
|
Facility
|
OP
|
$931.20
|
|
| Hospital Charge Code |
270674891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$465.60 |
| Rate for Payer: Aetna Commercial |
$279.36
|
| Rate for Payer: Aetna Medicare Advantage |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$237.46
|
| Rate for Payer: Cigna Commercial |
$465.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN ASNIS III 4X60MM
|
Facility
|
OP
|
$1,360.00
|
|
| Hospital Charge Code |
270670725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$408.00
|
| Rate for Payer: Aetna Medicare Advantage |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$346.80
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
|