|
SCREW CORTICAL NL 3.5X11MM
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Medicare Advantage |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$130.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$130.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$130.81
|
| Rate for Payer: Cigna Commercial |
$256.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$124.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.95
|
|
|
SCREW CORTICAL NL 3.5X11MM
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$102.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$124.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.95
|
|
|
SCREW CORTICAL NONLCK 3.5x16MM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$125.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
|
|
SCREW CORTICAL NONLCK 3.5x16MM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$156.00
|
| Rate for Payer: Aetna Medicare Advantage |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.60
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
|
|
SCREW CORTICAL TI 5mmx48mm
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
SCREW CORTICAL TI 5mmx48mm
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$235.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
SCREW CORTICAL TI 5X22MM
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Medicare Advantage |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.75
|
| Rate for Payer: Cigna Commercial |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5X22MM
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x28mm
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Medicare Advantage |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.75
|
| Rate for Payer: Cigna Commercial |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x28mm
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x32mm
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$209.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$172.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$209.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.60
|
|
|
SCREW CORTICAL TI 5x32mm
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$259.20
|
| Rate for Payer: Aetna Medicare Advantage |
$259.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$220.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$220.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$220.32
|
| Rate for Payer: Cigna Commercial |
$432.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$209.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.60
|
|
|
SCREW CORTICAL TI 5x34MM
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270640513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW CORTICAL TI 5x34MM
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270640513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW CORTICAL TI 5x42MM
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x42MM
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Medicare Advantage |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.75
|
| Rate for Payer: Cigna Commercial |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x44MM
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270640724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x44MM
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270640724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Medicare Advantage |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.75
|
| Rate for Payer: Cigna Commercial |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x46mm
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270641744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Medicare Advantage |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.75
|
| Rate for Payer: Cigna Commercial |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x46mm
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270641744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x52MM
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270647827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Medicare Advantage |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.75
|
| Rate for Payer: Cigna Commercial |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x52MM
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270647827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL TI 5x54MM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$188.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$156.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$188.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$117.00
|
|
|
SCREW CORTICAL TI 5x54MM
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Medicare Advantage |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$198.90
|
| Rate for Payer: Cigna Commercial |
$390.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$188.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$117.00
|
|
|
SCREW CORTICAL TI 5x58mm
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
270665510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Medicare Advantage |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.75
|
| Rate for Payer: Cigna Commercial |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|