|
SCREW COMPR 7X470MM
|
Facility
|
OP
|
$3,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna Commercial |
$1,110.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$943.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$943.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$740.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$943.50
|
| Rate for Payer: Cigna Commercial |
$1,850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$895.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$555.00
|
|
|
SCREW COMPR 7X470MM
|
Facility
|
IP
|
$3,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$895.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$740.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$895.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$555.00
|
|
|
SCREW COMPR 7X55MM
|
Facility
|
OP
|
$3,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna Commercial |
$1,110.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$943.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$943.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$740.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$943.50
|
| Rate for Payer: Cigna Commercial |
$1,850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$895.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$555.00
|
|
|
SCREW COMPR 7X55MM
|
Facility
|
IP
|
$3,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$895.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$740.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$895.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$555.00
|
|
|
SCREW COMPR 8MM THD 2.5x22MM
|
Facility
|
IP
|
$2,090.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$505.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$418.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$505.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$313.50
|
|
|
SCREW COMPR 8MM THD 2.5x22MM
|
Facility
|
OP
|
$2,090.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna Commercial |
$627.00
|
| Rate for Payer: Aetna Medicare Advantage |
$627.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$532.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$532.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$418.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$532.95
|
| Rate for Payer: Cigna Commercial |
$1,045.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$505.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$313.50
|
|
|
SCREW COMPRE FT STD 4.6x36MM
|
Facility
|
IP
|
$2,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.50 |
| Max. Negotiated Rate |
$510.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$422.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$510.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$316.50
|
|
|
SCREW COMPRE FT STD 4.6x36MM
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.50 |
| Max. Negotiated Rate |
$1,055.00 |
| Rate for Payer: Aetna Commercial |
$633.00
|
| Rate for Payer: Aetna Medicare Advantage |
$633.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$538.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$538.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$422.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$538.05
|
| Rate for Payer: Cigna Commercial |
$1,055.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$510.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$316.50
|
|
|
SCREW COMPRESS 3.0MM 40mm LONG
|
Facility
|
IP
|
$2,991.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.75 |
| Max. Negotiated Rate |
$723.99 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$598.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$723.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$448.75
|
|
|
SCREW COMPRESS 3.0MM 40mm LONG
|
Facility
|
OP
|
$2,991.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.75 |
| Max. Negotiated Rate |
$1,495.85 |
| Rate for Payer: Aetna Commercial |
$897.51
|
| Rate for Payer: Aetna Medicare Advantage |
$897.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$762.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$762.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$598.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$762.88
|
| Rate for Payer: Cigna Commercial |
$1,495.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$723.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$448.75
|
|
|
SCREW COMPRESSION 2.4 X 26 NN
|
Facility
|
OP
|
$1,410.00
|
|
| Hospital Charge Code |
270665340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Medicare Advantage |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$359.55
|
| Rate for Payer: Cigna Commercial |
$705.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
|
|
SCREW COMPRESSION 2.4 X 26 NN
|
Facility
|
IP
|
$1,410.00
|
|
| Hospital Charge Code |
270665340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$341.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
|
|
SCREW COMPRESSION 3.0 HEADLESS
|
Facility
|
IP
|
$1,410.00
|
|
| Hospital Charge Code |
270661768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$341.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
|
|
SCREW COMPRESSION 3.0 HEADLESS
|
Facility
|
OP
|
$1,410.00
|
|
| Hospital Charge Code |
270661768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Medicare Advantage |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$359.55
|
| Rate for Payer: Cigna Commercial |
$705.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
|
|
SCREW COMPRESSION 3.0x24mm
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
270645526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW COMPRESSION 3.0x24mm
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
270645526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare Advantage |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$337.88
|
| Rate for Payer: Cigna Commercial |
$662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW COMPRESSION 30X26
|
Facility
|
IP
|
$1,410.00
|
|
| Hospital Charge Code |
270665337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$341.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
|
|
SCREW COMPRESSION 30X26
|
Facility
|
OP
|
$1,410.00
|
|
| Hospital Charge Code |
270665337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Medicare Advantage |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$359.55
|
| Rate for Payer: Cigna Commercial |
$705.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
|
|
SCREW COMPRESSION 3.0x28mm
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
270645525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare Advantage |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$337.88
|
| Rate for Payer: Cigna Commercial |
$662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW COMPRESSION 3.0x28mm
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
270645525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW COMPRESSION 3.5x28mm
|
Facility
|
OP
|
$2,110.00
|
|
| Hospital Charge Code |
270667261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.50 |
| Max. Negotiated Rate |
$1,055.00 |
| Rate for Payer: Aetna Commercial |
$633.00
|
| Rate for Payer: Aetna Medicare Advantage |
$633.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$538.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$538.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$422.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$538.05
|
| Rate for Payer: Cigna Commercial |
$1,055.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$510.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$316.50
|
|
|
SCREW COMPRESSION 3.5x28mm
|
Facility
|
IP
|
$2,110.00
|
|
| Hospital Charge Code |
270667261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.50 |
| Max. Negotiated Rate |
$510.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$422.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$510.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$316.50
|
|
|
SCREW COMPRESSION 5.0X50MM
|
Facility
|
OP
|
$2,994.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$449.14 |
| Max. Negotiated Rate |
$1,497.12 |
| Rate for Payer: Aetna Commercial |
$898.27
|
| Rate for Payer: Aetna Medicare Advantage |
$898.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$763.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$763.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$598.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$763.53
|
| Rate for Payer: Cigna Commercial |
$1,497.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$724.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$449.14
|
|
|
SCREW COMPRESSION 5.0X50MM
|
Facility
|
IP
|
$2,994.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$449.14 |
| Max. Negotiated Rate |
$724.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$598.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$724.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$449.14
|
|
|
SCREW COMPRESSION 6.5mm X 80mm
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
270637463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$525.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|