|
SCREW LOCKING 3.5x38mm
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5x38MM
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
270656789
|
|
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 3.5x38MM
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
270656789
|
|
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 3.5x40mm
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
270670769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5x40mm
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
270670769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5x40MM
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
270667703
|
|
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 3.5x40MM
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
270667703
|
|
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 3.5x42mm
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
270670773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5x42mm
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
270670773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5x42MM
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
270667702
|
|
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 3.5x42MM
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
270667702
|
|
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 3.5x44mm
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
270671862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5x44mm
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
270671862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5x44MM
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
270656790
|
|
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 3.5x44MM
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
270656790
|
|
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 3.5X4.5X15MM
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW LOCKING 3.5X4.5X15MM
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW LOCKING 3.5X4.75X20MM
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW LOCKING 3.5X4.75X20MM
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW LOCKING 3.5 X 52 MM
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$151.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$124.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.60
|
|
|
SCREW LOCKING 3.5 X 52 MM
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Medicare Advantage |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$159.12
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.60
|
|
|
SCREW LOCKING 3.5x52mm
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
270670776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5x52mm
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
270670776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5 X 65
|
Facility
|
IP
|
$937.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$226.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.62
|
|
|
SCREW LOCKING 3.5 X 65
|
Facility
|
OP
|
$937.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$468.75 |
| Rate for Payer: Aetna Commercial |
$281.25
|
| Rate for Payer: Aetna Medicare Advantage |
$281.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$239.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$239.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$239.06
|
| Rate for Payer: Cigna Commercial |
$468.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.62
|
|