|
SCREW CANN P/THRD 4.5x38mm
|
Facility
|
OP
|
$881.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.25 |
| Max. Negotiated Rate |
$440.82 |
| Rate for Payer: Aetna Commercial |
$264.50
|
| Rate for Payer: Aetna Medicare Advantage |
$264.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$176.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.82
|
| Rate for Payer: Cigna Commercial |
$440.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$213.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.25
|
|
|
SCREW CANN P/THRD 4.5x40mm
|
Facility
|
IP
|
$881.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604887
|
|
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
|
|
|
SCREW CANN P/THRD 4.5x40mm
|
Facility
|
OP
|
$881.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.25 |
| Max. Negotiated Rate |
$440.82 |
| Rate for Payer: Aetna Commercial |
$264.50
|
| Rate for Payer: Aetna Medicare Advantage |
$264.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$176.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.82
|
| Rate for Payer: Cigna Commercial |
$440.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$213.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.25
|
|
|
SCREW CANN P/THRD 4.5x42mm
|
Facility
|
IP
|
$881.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604888
|
|
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
|
|
|
SCREW CANN P/THRD 4.5x42mm
|
Facility
|
OP
|
$881.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.25 |
| Max. Negotiated Rate |
$440.82 |
| Rate for Payer: Aetna Commercial |
$264.50
|
| Rate for Payer: Aetna Medicare Advantage |
$264.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$176.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.82
|
| Rate for Payer: Cigna Commercial |
$440.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$213.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.25
|
|
|
SCREW CANN P/THRD 4.5x44mm
|
Facility
|
OP
|
$881.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270655922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.25 |
| Max. Negotiated Rate |
$440.82 |
| Rate for Payer: Aetna Commercial |
$264.50
|
| Rate for Payer: Aetna Medicare Advantage |
$264.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$224.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$224.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$176.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$224.82
|
| Rate for Payer: Cigna Commercial |
$440.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$213.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.25
|
|
|
SCREW CANN P/THRD 4.5x44mm
|
Facility
|
IP
|
$881.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270655922
|
|
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
|
|
|
SCREW CANN P/THRD 4.5x46mm
|
Facility
|
OP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604889
|
|
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 4.5x46mm
|
Facility
|
IP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604889
|
|
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 4.5x50mm
|
Facility
|
IP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604893
|
|
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 4.5x50mm
|
Facility
|
OP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604893
|
|
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 4.5x52mm
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604894
|
|
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 4.5x52mm
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604894
|
|
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 4.5x54mm
|
Facility
|
IP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604895
|
|
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 4.5x54mm
|
Facility
|
OP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604895
|
|
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 4.5x56mm
|
Facility
|
OP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604896
|
|
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 4.5x56mm
|
Facility
|
IP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604896
|
|
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 4.5x60mm
|
Facility
|
OP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604897
|
|
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 4.5x60mm
|
Facility
|
IP
|
$855.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604897
|
|
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 4.5x68mm
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604891
|
|
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 4.5x68mm
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604891
|
|
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 4.5x72mm
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604899
|
|
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 4.5x72mm
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604899
|
|
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/THREADED 4x28MM
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667258
|
|
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/THREADED 4x28MM
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667258
|
|
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
|
|