|
SCREW CORTEX SLF TAP 3.5x36MM
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.74
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x38MM
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x38MM
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.74
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x40MM
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.74
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x40MM
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x45MM
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x45MM
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.74
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x50MM
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x50MM
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.74
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x55MM
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.74
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x55MM
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x65MM
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x65MM
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.74
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x75MM
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x75MM
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.74
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x80MM
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x80MM
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x80MM
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.74
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 3.5x80MM
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$27.93
|
| Rate for Payer: Aetna Medicare Advantage |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.74
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.96
|
|
|
SCREW CORTEX SLF TAP 4.5x42MM
|
Facility
|
OP
|
$91.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$45.58 |
| Rate for Payer: Aetna Commercial |
$27.34
|
| Rate for Payer: Aetna Medicare Advantage |
$27.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.24
|
| Rate for Payer: Cigna Commercial |
$45.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.67
|
|
|
SCREW CORTEX SLF TAP 4.5x42MM
|
Facility
|
IP
|
$91.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.67
|
|
|
SCREW CORTEX SLF TAP 4.5x48MM
|
Facility
|
OP
|
$91.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$45.58 |
| Rate for Payer: Aetna Commercial |
$27.34
|
| Rate for Payer: Aetna Medicare Advantage |
$27.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.24
|
| Rate for Payer: Cigna Commercial |
$45.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.67
|
|
|
SCREW CORTEX SLF TAP 4.5x48MM
|
Facility
|
IP
|
$91.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.67
|
|
|
SCREW CORTEX SLF TAP 4.5x54MM
|
Facility
|
IP
|
$91.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.67
|
|
|
SCREW CORTEX SLF TAP 4.5x54MM
|
Facility
|
OP
|
$91.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$45.58 |
| Rate for Payer: Aetna Commercial |
$27.34
|
| Rate for Payer: Aetna Medicare Advantage |
$27.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.24
|
| Rate for Payer: Cigna Commercial |
$45.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.67
|
|