|
SCREW CORTICAL 3.5MM X 15MM
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Medicare Advantage |
$148.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.22
|
| Rate for Payer: Cigna Commercial |
$247.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$119.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.25
|
|
|
SCREW CORTICAL 3.5MM X 15MM
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$119.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$119.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.25
|
|
|
SCREW CORTICAL 3.5mm X 16mm
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270637504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CORTICAL 3.5mm X 16mm
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270637504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CORTICAL 3.5 MM X 18 MM
|
Facility
|
IP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.12
|
|
|
SCREW CORTICAL 3.5 MM X 18 MM
|
Facility
|
OP
|
$247.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$74.25
|
| Rate for Payer: Aetna Medicare Advantage |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.11
|
| Rate for Payer: Cigna Commercial |
$123.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.12
|
|
|
SCREW CORTICAL 3.5MM X 18MM
|
Facility
|
IP
|
$495.00
|
|
| Hospital Charge Code |
270661780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$119.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$119.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.25
|
|
|
SCREW CORTICAL 3.5MM X 18MM
|
Facility
|
OP
|
$495.00
|
|
| Hospital Charge Code |
270661780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Medicare Advantage |
$148.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.22
|
| Rate for Payer: Cigna Commercial |
$247.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$119.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.25
|
|
|
SCREW CORTICAL 3.5 MM X26MM
|
Facility
|
IP
|
$635.50
|
|
| Hospital Charge Code |
270697474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.33 |
| Max. Negotiated Rate |
$153.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$127.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.33
|
|
|
SCREW CORTICAL 3.5 MM X26MM
|
Facility
|
OP
|
$635.50
|
|
| Hospital Charge Code |
270697474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.33 |
| Max. Negotiated Rate |
$317.75 |
| Rate for Payer: Aetna Commercial |
$190.65
|
| Rate for Payer: Aetna Medicare Advantage |
$190.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$162.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$162.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$127.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$162.05
|
| Rate for Payer: Cigna Commercial |
$317.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.33
|
|
|
SCREW CORTICAL 3.5MM X 52MM
|
Facility
|
OP
|
$850.00
|
|
| Hospital Charge Code |
270665190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare Advantage |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$216.75
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
|
|
SCREW CORTICAL 3.5MM X 52MM
|
Facility
|
IP
|
$850.00
|
|
| Hospital Charge Code |
270665190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
|
|
SCREW CORTICAL 3.5MM X 8MM
|
Facility
|
IP
|
$495.00
|
|
| Hospital Charge Code |
270661771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$119.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$119.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.25
|
|
|
SCREW CORTICAL 3.5MM X 8MM
|
Facility
|
OP
|
$495.00
|
|
| Hospital Charge Code |
270661771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Medicare Advantage |
$148.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.22
|
| Rate for Payer: Cigna Commercial |
$247.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$119.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.25
|
|
|
SCREW CORTICAL 3.5MM X 9MM
|
Facility
|
OP
|
$495.00
|
|
| Hospital Charge Code |
270661772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Medicare Advantage |
$148.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$126.22
|
| Rate for Payer: Cigna Commercial |
$247.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$119.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.25
|
|
|
SCREW CORTICAL 3.5MM X 9MM
|
Facility
|
IP
|
$495.00
|
|
| Hospital Charge Code |
270661772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.25 |
| Max. Negotiated Rate |
$119.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$99.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$119.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$74.25
|
|
|
SCREW CORTICAL 3.5x10MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270664529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$52.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
SCREW CORTICAL 3.5x10MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270664529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$42.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
SCREW CORTICAL 3 5X10mm CS10
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270638003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
SCREW CORTICAL 3 5X10mm CS10
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270638003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$75.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
SCREW CORTICAL 3.5x12 mm
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CORTICAL 3.5x12 mm
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CORTICAL 3.5x12mm
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CORTICAL 3.5x12mm
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CORTICAL 3.5X12MM
|
Facility
|
OP
|
$585.00
|
|
| Hospital Charge Code |
270638281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna Commercial |
$175.50
|
| Rate for Payer: Aetna Medicare Advantage |
$175.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$149.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$149.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$149.18
|
| Rate for Payer: Cigna Commercial |
$292.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$141.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.75
|
|