|
SCREW LOCK 14MM x2.4MM
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.75 |
| Max. Negotiated Rate |
$542.50 |
| Rate for Payer: Aetna Commercial |
$325.50
|
| Rate for Payer: Aetna Medicare Advantage |
$325.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$276.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$276.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$217.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$276.68
|
| Rate for Payer: Cigna Commercial |
$542.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$262.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.75
|
|
|
SCREW LOCK 14MM x2.4MM
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.75 |
| Max. Negotiated Rate |
$262.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$217.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$262.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.75
|
|
|
SCREW LOCK 2.3X11MM
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Medicare Advantage |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$183.60
|
| Rate for Payer: Cigna Commercial |
$360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
SCREW LOCK 2.3X11MM
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$174.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
SCREW LOCK 2.3X12MM
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Medicare Advantage |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$183.60
|
| Rate for Payer: Cigna Commercial |
$360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
SCREW LOCK 2.3X12MM
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$174.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
SCREW LOCK 2.3X14
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$174.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
SCREW LOCK 2.3X14
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Medicare Advantage |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$183.60
|
| Rate for Payer: Cigna Commercial |
$360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
SCREW LOCK 2.3X18MM
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$174.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
SCREW LOCK 2.3X18MM
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Medicare Advantage |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$183.60
|
| Rate for Payer: Cigna Commercial |
$360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
SCREW LOCK 2.7X10MM STRATUM
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693323
|
|
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 LOCK 2.7X10MM STRATUM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693323
|
|
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 LOCK 3.5mmX16m COL-3160
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
370638668
|
|
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 LOCK 3.5mmX16m COL-3160
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
370638668
|
|
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 LOCK 3.5mmX16mm COL-3160
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270638668
|
|
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 LOCK 3.5mmX16mm COL-3160
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270638668
|
|
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 LOCK 3.5MM x 18MM 614618
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270648606
|
|
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 LOCK 3.5MM x 18MM 614618
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270648606
|
|
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 LOCK 3.5mm x 20 COL3200
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270641012
|
|
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 LOCK 3.5mm x 20 COL3200
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270641012
|
|
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 LOCK 3.5MM x 20MM 614620
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648607
|
|
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 LOCK 3.5MM x 20MM 614620
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648607
|
|
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 LOCK 3.5MM x 40MM 614640
|
Facility
|
IP
|
$1,280.00
|
|
| Hospital Charge Code |
270648605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$309.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$256.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$309.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$192.00
|
|
|
SCREW LOCK 3.5MM x 40MM 614640
|
Facility
|
OP
|
$1,280.00
|
|
| Hospital Charge Code |
270648605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$384.00
|
| Rate for Payer: Aetna Medicare Advantage |
$384.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$256.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$326.40
|
| Rate for Payer: Cigna Commercial |
$640.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$309.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$192.00
|
|
|
SCREW LOCK 3.5X12MM
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$390.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$323.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$390.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$242.25
|
|