|
SCREW LOCK FASTP 2.7MM HIGHP
|
Facility
|
IP
|
$2,725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.75 |
| Max. Negotiated Rate |
$659.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$545.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$659.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$408.75
|
|
|
SCREW LOCK FASTP 2.7MM HIGHP
|
Facility
|
OP
|
$2,725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.75 |
| Max. Negotiated Rate |
$1,362.50 |
| Rate for Payer: Aetna Commercial |
$817.50
|
| Rate for Payer: Aetna Medicare Advantage |
$817.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$694.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$694.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$545.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$694.88
|
| Rate for Payer: Cigna Commercial |
$1,362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$659.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$408.75
|
|
|
SCREW LOCK FOR IM 5MM32MMXL25
|
Facility
|
OP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$444.15 |
| Rate for Payer: Aetna Commercial |
$266.49
|
| Rate for Payer: Aetna Medicare Advantage |
$266.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$226.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$226.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$226.52
|
| Rate for Payer: Cigna Commercial |
$444.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.25
|
|
|
SCREW LOCK FOR IM 5MM32MMXL25
|
Facility
|
IP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$214.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.66
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.25
|
|
|
SCREW LOCK FULL THRD 5x42.5mm
|
Facility
|
OP
|
$949.45
|
|
| Hospital Charge Code |
270673212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.42 |
| Max. Negotiated Rate |
$474.73 |
| Rate for Payer: Aetna Commercial |
$284.83
|
| Rate for Payer: Aetna Medicare Advantage |
$284.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$242.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$242.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$189.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$242.11
|
| Rate for Payer: Cigna Commercial |
$474.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.42
|
|
|
SCREW LOCK FULL THRD 5x42.5mm
|
Facility
|
IP
|
$949.45
|
|
| Hospital Charge Code |
270673212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.42 |
| Max. Negotiated Rate |
$229.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$189.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.42
|
|
|
SCREW LOCKG CANN 5.0X60 222542
|
Facility
|
IP
|
$754.00
|
|
| Hospital Charge Code |
270633661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$182.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$182.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.10
|
|
|
SCREW LOCKG CANN 5.0X60 222542
|
Facility
|
OP
|
$754.00
|
|
| Hospital Charge Code |
270633661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$377.00 |
| Rate for Payer: Aetna Commercial |
$226.20
|
| Rate for Payer: Aetna Medicare Advantage |
$226.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$192.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$192.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$192.27
|
| Rate for Payer: Cigna Commercial |
$377.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$182.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.10
|
|
|
SCREW LOCKG CANN 5.0X85 222554
|
Facility
|
IP
|
$754.00
|
|
| Hospital Charge Code |
270630780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$182.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$182.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.10
|
|
|
SCREW LOCKG CANN 5.0X85 222554
|
Facility
|
OP
|
$754.00
|
|
| Hospital Charge Code |
270630780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$377.00 |
| Rate for Payer: Aetna Commercial |
$226.20
|
| Rate for Payer: Aetna Medicare Advantage |
$226.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$192.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$192.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$192.27
|
| Rate for Payer: Cigna Commercial |
$377.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$182.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.10
|
|
|
SCREW LOCKG LO PRO 2.4MMX16MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668415
|
|
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 LOCKG LO PRO 2.4MMX16MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668415
|
|
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 LOCK HEXALOBE 3.5X10MM
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna Commercial |
$213.00
|
| Rate for Payer: Aetna Medicare Advantage |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$181.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$181.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$142.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$181.05
|
| Rate for Payer: Cigna Commercial |
$355.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$106.50
|
|
|
SCREW LOCK HEXALOBE 3.5X10MM
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$171.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$142.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$106.50
|
|
|
SCREW LOCKING 10 MM X 2.4 MM
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683984
|
|
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 LOCKING 10 MM X 2.4 MM
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683984
|
|
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 LOCKING 12MM
|
Facility
|
IP
|
$850.00
|
|
| Hospital Charge Code |
270661799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
|
|
SCREW LOCKING 12MM
|
Facility
|
OP
|
$850.00
|
|
| Hospital Charge Code |
270661799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare Advantage |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$216.75
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$205.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.50
|
|
|
SCREW LOCKING 12MM x2.4mm
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680995
|
|
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 LOCKING 12MM x2.4mm
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680995
|
|
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 LOCKING 14MM
|
Facility
|
IP
|
$21.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.21
|
|
|
SCREW LOCKING 14MM
|
Facility
|
OP
|
$21.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$10.70 |
| Rate for Payer: Aetna Commercial |
$6.42
|
| Rate for Payer: Aetna Medicare Advantage |
$6.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.46
|
| Rate for Payer: Cigna Commercial |
$10.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.21
|
|
|
SCREW LOCKING 1.5 X 10MM
|
Facility
|
OP
|
$197.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$98.67 |
| Rate for Payer: Aetna Commercial |
$59.20
|
| Rate for Payer: Aetna Medicare Advantage |
$59.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.32
|
| Rate for Payer: Cigna Commercial |
$98.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.60
|
|
|
SCREW LOCKING 1.5 X 10MM
|
Facility
|
IP
|
$197.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.60
|
|
|
SCREW LOCKING 1.7x14MM
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna Commercial |
$237.00
|
| Rate for Payer: Aetna Medicare Advantage |
$237.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$158.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.45
|
| Rate for Payer: Cigna Commercial |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$191.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.50
|
|