|
SCREW CORTICAL 3.5x50 CO3500
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
270641010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$120.00
|
| Rate for Payer: Aetna Medicare Advantage |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
SCREW CORTICAL 3.5x50MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270671942
|
|
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 3.5x50MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270671942
|
|
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 3.5x55MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270671943
|
|
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 3.5x55MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270671943
|
|
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 3.5X55MM
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$330.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
SCREW CORTICAL 3.5X55MM
|
Facility
|
OP
|
$1,365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare Advantage |
$409.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$348.07
|
| Rate for Payer: Cigna Commercial |
$682.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
SCREW CORTICAL 3.5x60MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270671944
|
|
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 3.5x60MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270671944
|
|
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 4.5 24MM
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
270663308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
SCREW CORTICAL 4.5 24MM
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
270663308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
SCREW CORTICAL 4.5mm x 34mm
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678695
|
|
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 4.5mm x 34mm
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678695
|
|
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 4.5x26mm
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$78.00
|
| Rate for Payer: Aetna Medicare Advantage |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.30
|
| Rate for Payer: Cigna Commercial |
$130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
|
SCREW CORTICAL 4.5x26mm
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$62.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
|
SCREW CORTICAL 4.5 X 30
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
SCREW CORTICAL 4.5 X 30
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
SCREW CORTICAL 4.5x30mm
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$96.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
SCREW CORTICAL 4.5x30mm
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$120.00
|
| Rate for Payer: Aetna Medicare Advantage |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
SCREW CORTICAL 4.5x34mm
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$62.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
|
SCREW CORTICAL 4.5x34mm
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$120.00
|
| Rate for Payer: Aetna Medicare Advantage |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
SCREW CORTICAL 4.5x34mm
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$96.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
SCREW CORTICAL 4.5x34mm
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$78.00
|
| Rate for Payer: Aetna Medicare Advantage |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.30
|
| Rate for Payer: Cigna Commercial |
$130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
|
SCREW CORTICAL 4.5 X 38
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|
|
SCREW CORTICAL 4.5 X 38
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna Commercial |
$73.50
|
| Rate for Payer: Aetna Medicare Advantage |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$62.48
|
| Rate for Payer: Cigna Commercial |
$122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.75
|
|