|
SCREW CORTEX 4.5x44mm
|
Facility
|
OP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$20.86
|
| Rate for Payer: Aetna Medicare Advantage |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.74
|
| Rate for Payer: Cigna Commercial |
$34.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x54mm
|
Facility
|
IP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x54mm
|
Facility
|
OP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$20.86
|
| Rate for Payer: Aetna Medicare Advantage |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.74
|
| Rate for Payer: Cigna Commercial |
$34.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x62mm
|
Facility
|
IP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x62mm
|
Facility
|
OP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$20.86
|
| Rate for Payer: Aetna Medicare Advantage |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.74
|
| Rate for Payer: Cigna Commercial |
$34.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x64mm
|
Facility
|
IP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x64mm
|
Facility
|
OP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$20.86
|
| Rate for Payer: Aetna Medicare Advantage |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.74
|
| Rate for Payer: Cigna Commercial |
$34.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x66mm
|
Facility
|
IP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x66mm
|
Facility
|
OP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$20.86
|
| Rate for Payer: Aetna Medicare Advantage |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.74
|
| Rate for Payer: Cigna Commercial |
$34.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x66MM
|
Facility
|
IP
|
$88.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.28
|
|
|
SCREW CORTEX 4.5x66MM
|
Facility
|
OP
|
$88.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$44.25 |
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna Medicare Advantage |
$26.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.57
|
| Rate for Payer: Cigna Commercial |
$44.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.28
|
|
|
SCREW CORTEX 4.5x68mm
|
Facility
|
OP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$20.86
|
| Rate for Payer: Aetna Medicare Advantage |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.74
|
| Rate for Payer: Cigna Commercial |
$34.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x68mm
|
Facility
|
IP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x70mm
|
Facility
|
OP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$20.86
|
| Rate for Payer: Aetna Medicare Advantage |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.74
|
| Rate for Payer: Cigna Commercial |
$34.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x70mm
|
Facility
|
IP
|
$69.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.43
|
|
|
SCREW CORTEX 4.5x90 214.890
|
Facility
|
IP
|
$100.50
|
|
| Hospital Charge Code |
270631343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$24.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.07
|
|
|
SCREW CORTEX 4.5x90 214.890
|
Facility
|
OP
|
$100.50
|
|
| Hospital Charge Code |
270631343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Aetna Commercial |
$30.15
|
| Rate for Payer: Aetna Medicare Advantage |
$30.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.63
|
| Rate for Payer: Cigna Commercial |
$50.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.07
|
|
|
SCREW CORTEX LOCKNG 3.5MMx10MM
|
Facility
|
IP
|
$735.00
|
|
| Hospital Charge Code |
270647950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$177.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
|
|
SCREW CORTEX LOCKNG 3.5MMx10MM
|
Facility
|
OP
|
$735.00
|
|
| Hospital Charge Code |
270647950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare Advantage |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$187.43
|
| Rate for Payer: Cigna Commercial |
$367.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
SCREW CORTEX LOCKNG 3.5MMx12MM
|
Facility
|
IP
|
$735.00
|
|
| Hospital Charge Code |
270647949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$177.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
SCREW CORTEX LOCKNG 3.5MMx12MM
|
Facility
|
OP
|
$735.00
|
|
| Hospital Charge Code |
270647949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare Advantage |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$187.43
|
| Rate for Payer: Cigna Commercial |
$367.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
SCREW CORTEX LOCKNG 3.5MMx14MM
|
Facility
|
IP
|
$735.00
|
|
| Hospital Charge Code |
270647948C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$177.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
SCREW CORTEX LOCKNG 3.5MMx14MM
|
Facility
|
IP
|
$735.00
|
|
| Hospital Charge Code |
270647948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$177.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
SCREW CORTEX LOCKNG 3.5MMx14MM
|
Facility
|
OP
|
$735.00
|
|
| Hospital Charge Code |
270647948C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare Advantage |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$187.43
|
| Rate for Payer: Cigna Commercial |
$367.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|
|
SCREW CORTEX LOCKNG 3.5MMx14MM
|
Facility
|
OP
|
$735.00
|
|
| Hospital Charge Code |
270647948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare Advantage |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$187.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$187.43
|
| Rate for Payer: Cigna Commercial |
$367.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$177.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.25
|
|