|
SCREW D/THRD TI 2.0x22mm
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270669704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
SCREW D/THRD TI 2.0x24mm
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270669878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
SCREW D/THRD TI 2.0x24mm
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270669878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
SCREW D/THRD TI 2.0x26mm
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
270669703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW D/THRD TI 2.0x26mm
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
270669703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare Advantage |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$337.88
|
| Rate for Payer: Cigna Commercial |
$662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW D/THRD TI 3.0x14mm
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
270669702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW D/THRD TI 3.0x14mm
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
270669702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare Advantage |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$337.88
|
| Rate for Payer: Cigna Commercial |
$662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW D/THRD TI 3.0x30mm
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
270669879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW D/THRD TI 3.0x30mm
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
270669879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare Advantage |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$337.88
|
| Rate for Payer: Cigna Commercial |
$662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW D/THRD TI 3.0x34mm
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
270669880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW D/THRD TI 3.0x34mm
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
270669880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$662.50 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare Advantage |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$337.88
|
| Rate for Payer: Cigna Commercial |
$662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$320.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SCREW D/THRD TI 3.0x38mm
|
Facility
|
IP
|
$1,475.00
|
|
| Hospital Charge Code |
270670788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$356.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
SCREW D/THRD TI 3.0x38mm
|
Facility
|
OP
|
$1,475.00
|
|
| Hospital Charge Code |
270670788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$442.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
SCREWE BONE FUL THD 2.4 X 26MM
|
Facility
|
IP
|
$770.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.63 |
| Max. Negotiated Rate |
$186.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$154.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$186.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.63
|
|
|
SCREWE BONE FUL THD 2.4 X 26MM
|
Facility
|
OP
|
$770.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.63 |
| Max. Negotiated Rate |
$385.43 |
| Rate for Payer: Aetna Commercial |
$231.25
|
| Rate for Payer: Aetna Medicare Advantage |
$231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$196.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$196.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$154.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$196.57
|
| Rate for Payer: Cigna Commercial |
$385.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$186.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.63
|
|
|
SCREW ECT 4.5 SLF TP 16-64MM**
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
1605674
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Aetna Medicare Advantage |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.01
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.65
|
|
|
SCREW ECT 4.5 SLF TP 16-64MM**
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
1605674
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$12.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.65
|
|
|
SCREW ECT CANC FL THD 10-20MM
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
1603695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
SCREW ECT CANC FL THD 10-20MM
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
1603695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
SCREW ECT CANC FL THD 22-32MM
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
1603703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Aetna Commercial |
$13.20
|
| Rate for Payer: Aetna Medicare Advantage |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.22
|
| Rate for Payer: Cigna Commercial |
$22.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.60
|
|
|
SCREW ECT CANC FL THD 22-32MM
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
1603703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$10.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.60
|
|
|
SCREW ECT CANC FL THD 34-60MM
|
Facility
|
OP
|
$47.00
|
|
| Hospital Charge Code |
1603711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: Aetna Commercial |
$14.10
|
| Rate for Payer: Aetna Medicare Advantage |
$14.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.98
|
| Rate for Payer: Cigna Commercial |
$23.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.05
|
|
|
SCREW ECT CANC FL THD 34-60MM
|
Facility
|
IP
|
$47.00
|
|
| Hospital Charge Code |
1603711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$11.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.05
|
|
|
SCREW ECT CANC PT THD 22-30MM
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
1603737
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$13.50
|
| Rate for Payer: Aetna Medicare Advantage |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.47
|
| Rate for Payer: Cigna Commercial |
$22.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.75
|
|
|
SCREW ECT CANC PT THD 22-30MM
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
1603737
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.75
|
|