|
SCREW CANN SH/THRD 4.0x32MM
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270657141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x34mm
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x34mm
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x36mm
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN SH/THRD 4.0x36mm
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$250.29
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN SH/THRD 4.0x38MM
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270657084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x38MM
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270657084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x40MM
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN SH/THRD 4.0x40MM
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$250.29
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN SH/THRD 4.0x42MM
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x42MM
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x44MM
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x44MM
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x48MM
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x48MM
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x52mm
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x52mm
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x54mm
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$250.29
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN SH/THRD 4.0x54mm
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN SH/THRD 4.0x56mm
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN SH/THRD 4.0x56mm
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$250.29
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN SH/THRD 4.0x58mm
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x58mm
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x60mm
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN SH/THRD 4.0x60mm
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|