|
SCREW LOCKING 3.5x14MM
|
Facility
|
OP
|
$740.00
|
|
| Hospital Charge Code |
270676765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$222.00
|
| Rate for Payer: Aetna Medicare Advantage |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$148.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$188.70
|
| Rate for Payer: Cigna Commercial |
$370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.00
|
|
|
SCREW LOCKING 3.5X14MM
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270646205
|
|
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 3.5X14MM
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270646205
|
|
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 LOCKING 3.5x16MM
|
Facility
|
IP
|
$740.00
|
|
| Hospital Charge Code |
270676764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$179.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$148.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.00
|
|
|
SCREW LOCKING 3.5x16MM
|
Facility
|
OP
|
$740.00
|
|
| Hospital Charge Code |
270676764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$222.00
|
| Rate for Payer: Aetna Medicare Advantage |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$148.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$188.70
|
| Rate for Payer: Cigna Commercial |
$370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.00
|
|
|
SCREW LOCKING 3.5X16MM
|
Facility
|
IP
|
$2,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$644.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$533.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$644.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$399.75
|
|
|
SCREW LOCKING 3.5X16MM
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Medicare Advantage |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$367.20
|
| Rate for Payer: Cigna Commercial |
$720.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$348.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.00
|
|
|
SCREW LOCKING 3.5X16MM
|
Facility
|
OP
|
$2,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$1,332.50 |
| Rate for Payer: Aetna Commercial |
$799.50
|
| Rate for Payer: Aetna Medicare Advantage |
$799.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$679.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$679.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$533.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$679.58
|
| Rate for Payer: Cigna Commercial |
$1,332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$644.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$399.75
|
|
|
SCREW LOCKING 3.5X16MM
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$348.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$348.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.00
|
|
|
SCREW LOCKING 3.5 X 17
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$42.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
SCREW LOCKING 3.5 X 17
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$52.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
SCREW LOCKING 3.5 X 18
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270638099
|
|
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 LOCKING 3.5 X 18
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270638099
|
|
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 LOCKING 3.5x18MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$336.00
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5x18MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5 X 20MM
|
Facility
|
IP
|
$642.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.41 |
| Max. Negotiated Rate |
$155.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$128.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$155.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.41
|
|
|
SCREW LOCKING 3.5 X 20MM
|
Facility
|
OP
|
$642.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.41 |
| Max. Negotiated Rate |
$321.35 |
| Rate for Payer: Aetna Commercial |
$192.81
|
| Rate for Payer: Aetna Medicare Advantage |
$192.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$163.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$163.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$128.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$163.89
|
| Rate for Payer: Cigna Commercial |
$321.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$155.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.41
|
|
|
SCREW LOCKING 3.5x20MM
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$283.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$234.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.50
|
|
|
SCREW LOCKING 3.5x20MM
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Medicare Advantage |
$351.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$298.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$298.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$298.35
|
| Rate for Payer: Cigna Commercial |
$585.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.50
|
|
|
SCREW LOCKING 3.5x20MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5x20MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$336.00
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5X20MM
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$348.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$348.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.00
|
|
|
SCREW LOCKING 3.5X20MM
|
Facility
|
OP
|
$1,180.00
|
|
| Hospital Charge Code |
270665784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna Commercial |
$354.00
|
| Rate for Payer: Aetna Medicare Advantage |
$354.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$300.90
|
| Rate for Payer: Cigna Commercial |
$590.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
|
|
SCREW LOCKING 3.5X20MM
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
270665784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$285.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
|
|
SCREW LOCKING 3.5X20MM
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Medicare Advantage |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$367.20
|
| Rate for Payer: Cigna Commercial |
$720.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$348.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.00
|
|