|
SCREW LOCKING 4.0x22mm
|
Facility
|
OP
|
$1,060.00
|
|
| Hospital Charge Code |
270664512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna Commercial |
$318.00
|
| Rate for Payer: Aetna Medicare Advantage |
$318.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$270.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$270.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$270.30
|
| Rate for Payer: Cigna Commercial |
$530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$256.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.00
|
|
|
SCREW LOCKING 4.0 x 22mm370522
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
270638775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$135.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.00
|
|
|
SCREW LOCKING 4.0 x 22mm370522
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
270638775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$168.00
|
| Rate for Payer: Aetna Medicare Advantage |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$142.80
|
| Rate for Payer: Cigna Commercial |
$280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.00
|
|
|
SCREW LOCKING 4.0x24mm
|
Facility
|
OP
|
$594.00
|
|
| Hospital Charge Code |
270657128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna Commercial |
$178.20
|
| Rate for Payer: Aetna Medicare Advantage |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$151.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$151.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$151.47
|
| Rate for Payer: Cigna Commercial |
$297.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.10
|
|
|
SCREW LOCKING 4.0x24mm
|
Facility
|
IP
|
$594.00
|
|
| Hospital Charge Code |
270657128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$143.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$118.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.10
|
|
|
SCREW LOCKING 4.0x24mm
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna Commercial |
$318.00
|
| Rate for Payer: Aetna Medicare Advantage |
$318.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$270.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$270.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$270.30
|
| Rate for Payer: Cigna Commercial |
$530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$256.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.00
|
|
|
SCREW LOCKING 4.0x24mm
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$256.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$212.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$256.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.00
|
|
|
SCREW LOCKING 4.0 x 24mm370524
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
270638773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$168.00
|
| Rate for Payer: Aetna Medicare Advantage |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$142.80
|
| Rate for Payer: Cigna Commercial |
$280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.00
|
|
|
SCREW LOCKING 4.0 x 24mm370524
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
270638773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$135.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.00
|
|
|
SCREW LOCKING 4.0x26 371526
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270648069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$211.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
SCREW LOCKING 4.0x26 371526
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270648069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$262.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
SCREW LOCKING 4.0x28 371528
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$262.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
SCREW LOCKING 4.0x28 371528
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$211.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
SCREW LOCKING 4.0 X 28 MM
|
Facility
|
OP
|
$594.00
|
|
| Hospital Charge Code |
270665749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna Commercial |
$178.20
|
| Rate for Payer: Aetna Medicare Advantage |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$151.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$151.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$151.47
|
| Rate for Payer: Cigna Commercial |
$297.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.10
|
|
|
SCREW LOCKING 4.0 X 28 MM
|
Facility
|
IP
|
$594.00
|
|
| Hospital Charge Code |
270665749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$143.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$118.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.10
|
|
|
SCREW LOCKING 4.0 x 28mm370528
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
270638774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$168.00
|
| Rate for Payer: Aetna Medicare Advantage |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$142.80
|
| Rate for Payer: Cigna Commercial |
$280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.00
|
|
|
SCREW LOCKING 4.0 x 28mm370528
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
270638774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$135.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.00
|
|
|
SCREW LOCKING 4.0x30 371530
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$262.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
SCREW LOCKING 4.0x30 371530
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$211.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
SCREW LOCKING 4.0x30mm
|
Facility
|
OP
|
$611.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270628202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Aetna Commercial |
$183.54
|
| Rate for Payer: Aetna Medicare Advantage |
$183.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$156.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$156.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$122.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$156.01
|
| Rate for Payer: Cigna Commercial |
$305.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$148.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.77
|
|
|
SCREW LOCKING 4.0x30mm
|
Facility
|
IP
|
$611.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270628202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$148.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$122.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$148.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.77
|
|
|
SCREW LOCKING 4.0 x 30mm370530
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
270638772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$135.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.00
|
|
|
SCREW LOCKING 4.0 x 30mm370530
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
270638772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$168.00
|
| Rate for Payer: Aetna Medicare Advantage |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$142.80
|
| Rate for Payer: Cigna Commercial |
$280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.00
|
|
|
SCREW LOCKING 4.0x34 371534
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270648066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$211.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
SCREW LOCKING 4.0x34 371534
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270648066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$262.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|