|
SCREW CANN P/THD 4x32MM
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673666
|
|
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 P/THD 4x32MM
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673666
|
|
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 P/THD 5.0x48mm
|
Facility
|
OP
|
$505.00
|
|
| Hospital Charge Code |
270624916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$252.50 |
| Rate for Payer: Aetna Commercial |
$151.50
|
| Rate for Payer: Aetna Medicare Advantage |
$151.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.78
|
| Rate for Payer: Cigna Commercial |
$252.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.75
|
|
|
SCREW CANN P/THD 5.0x48mm
|
Facility
|
IP
|
$505.00
|
|
| Hospital Charge Code |
270624916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$122.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.75
|
|
|
SCREW CANN P/THRD 3.5x30MM
|
Facility
|
IP
|
$827.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270622122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.12 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.12
|
|
|
SCREW CANN P/THRD 3.5x30MM
|
Facility
|
OP
|
$827.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270622122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.12 |
| Max. Negotiated Rate |
$413.75 |
| Rate for Payer: Aetna Commercial |
$248.25
|
| Rate for Payer: Aetna Medicare Advantage |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$211.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$211.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$211.01
|
| Rate for Payer: Cigna Commercial |
$413.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$200.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.12
|
|
|
SCREW CANN P/THRD 3.5x32MM
|
Facility
|
IP
|
$803.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270608217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$194.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.51
|
|
|
SCREW CANN P/THRD 3.5x32MM
|
Facility
|
OP
|
$803.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270608217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$401.70 |
| Rate for Payer: Aetna Commercial |
$241.02
|
| Rate for Payer: Aetna Medicare Advantage |
$241.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.87
|
| Rate for Payer: Cigna Commercial |
$401.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.51
|
|
|
SCREW CANN P/THRD 3.5x34MM
|
Facility
|
OP
|
$803.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270632481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$401.70 |
| Rate for Payer: Aetna Commercial |
$241.02
|
| Rate for Payer: Aetna Medicare Advantage |
$241.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.87
|
| Rate for Payer: Cigna Commercial |
$401.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.51
|
|
|
SCREW CANN P/THRD 3.5x34MM
|
Facility
|
IP
|
$803.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270632481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$194.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.51
|
|
|
SCREW CANN P/THRD 4.5x20MM
|
Facility
|
IP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$207.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.39
|
|
|
SCREW CANN P/THRD 4.5x20MM
|
Facility
|
OP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$427.98 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare Advantage |
$256.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.27
|
| Rate for Payer: Cigna Commercial |
$427.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.39
|
|
|
SCREW CANN P/THRD 4.5x22mm
|
Facility
|
IP
|
$855.95
|
|
| Hospital Charge Code |
270604877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$207.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.39
|
|
|
SCREW CANN P/THRD 4.5x22mm
|
Facility
|
OP
|
$855.95
|
|
| Hospital Charge Code |
270604877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$427.98 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare Advantage |
$256.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.27
|
| Rate for Payer: Cigna Commercial |
$427.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.39
|
|
|
SCREW CANN P/THRD 4.5x26mm
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$252.50 |
| Rate for Payer: Aetna Commercial |
$151.50
|
| Rate for Payer: Aetna Medicare Advantage |
$151.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.78
|
| Rate for Payer: Cigna Commercial |
$252.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.75
|
|
|
SCREW CANN P/THRD 4.5x26mm
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$122.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.75
|
|
|
SCREW CANN P/THRD 4.5x30mm
|
Facility
|
OP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$427.98 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare Advantage |
$256.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.27
|
| Rate for Payer: Cigna Commercial |
$427.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.39
|
|
|
SCREW CANN P/THRD 4.5x30mm
|
Facility
|
IP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$207.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.39
|
|
|
SCREW CANN P/THRD 4.5x32mm
|
Facility
|
OP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$427.98 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare Advantage |
$256.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.27
|
| Rate for Payer: Cigna Commercial |
$427.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.39
|
|
|
SCREW CANN P/THRD 4.5x32mm
|
Facility
|
IP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$207.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.39
|
|
|
SCREW CANN P/THRD 4.5x34mm
|
Facility
|
IP
|
$831.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.65 |
| Max. Negotiated Rate |
$201.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.65
|
|
|
SCREW CANN P/THRD 4.5x34mm
|
Facility
|
OP
|
$831.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.65 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Medicare Advantage |
$249.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$211.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$211.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$211.91
|
| Rate for Payer: Cigna Commercial |
$415.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.65
|
|
|
SCREW CANN P/THRD 4.5x36mm
|
Facility
|
IP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$207.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.39
|
|
|
SCREW CANN P/THRD 4.5x36mm
|
Facility
|
OP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.39 |
| Max. Negotiated Rate |
$427.98 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare Advantage |
$256.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.27
|
| Rate for Payer: Cigna Commercial |
$427.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.39
|
|
|
SCREW CANN P/THRD 4.5x38mm
|
Facility
|
IP
|
$881.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.25 |
| Max. Negotiated Rate |
$213.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$176.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$213.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.25
|
|