|
SCREW CORT LOCK 2.7X12 COL2120
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270641013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
SCREW CORT LOCK 2.7X12 COL2120
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270641013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$84.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
SCREW CORT LOCK 2.7x18 COL2180
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270641014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
SCREW CORT LOCK 2.7x18 COL2180
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270641014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$84.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
SCREW CORT LOCK 3.5X36MM NS
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$189.75
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCK 3.5X36MM NS
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCK 3.5X38MM NS
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270658905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$194.81 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$161.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.75
|
|
|
SCREW CORT LOCK 3.5X38MM NS
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270658905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$402.50 |
| Rate for Payer: Aetna Commercial |
$241.50
|
| Rate for Payer: Aetna Medicare Advantage |
$241.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$205.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$205.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$161.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$205.28
|
| Rate for Payer: Cigna Commercial |
$402.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.75
|
|
|
SCREW CORT LOCK 3.5X40MM NS
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$189.75
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCK 3.5X40MM NS
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCKING 3.5x10mm
|
Facility
|
OP
|
$905.00
|
|
| Hospital Charge Code |
270669273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$452.50 |
| Rate for Payer: Aetna Commercial |
$271.50
|
| Rate for Payer: Aetna Medicare Advantage |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$230.78
|
| Rate for Payer: Cigna Commercial |
$452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
|
|
SCREW CORT LOCKING 3.5x10mm
|
Facility
|
IP
|
$905.00
|
|
| Hospital Charge Code |
270669273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$219.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
|
|
SCREW CORT LOCKING 3.5x16mm
|
Facility
|
IP
|
$632.50
|
|
| Hospital Charge Code |
270701883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCKING 3.5x16mm
|
Facility
|
OP
|
$632.50
|
|
| Hospital Charge Code |
270701883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$189.75
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCKING 3.5x18mm
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$189.75
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCKING 3.5x18mm
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCKING 3.5x46mm
|
Facility
|
OP
|
$905.00
|
|
| Hospital Charge Code |
270669276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$452.50 |
| Rate for Payer: Aetna Commercial |
$271.50
|
| Rate for Payer: Aetna Medicare Advantage |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$230.78
|
| Rate for Payer: Cigna Commercial |
$452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
|
|
SCREW CORT LOCKING 3.5x46mm
|
Facility
|
IP
|
$905.00
|
|
| Hospital Charge Code |
270669276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$219.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
|
|
SCREW CORT LOCKING TI 3.5X34MM
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664435
|
|
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 CORT LOCKING TI 3.5X34MM
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664435
|
|
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 CORT LO PRO 2.4x24MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORT LO PRO 2.4x24MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORT LO PRO 2.4x26MM
|
Facility
|
OP
|
$550.00
|
|
| Hospital Charge Code |
270677129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORT LO PRO 2.4x26MM
|
Facility
|
IP
|
$550.00
|
|
| Hospital Charge Code |
270677129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORT LO PRO 2.4x28MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|