|
SCREW LOCKING 5.5x30mm
|
Facility
|
OP
|
$910.00
|
|
| Hospital Charge Code |
270671123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna Commercial |
$273.00
|
| Rate for Payer: Aetna Medicare Advantage |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$232.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$232.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$182.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$232.05
|
| Rate for Payer: Cigna Commercial |
$455.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$220.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.50
|
|
|
SCREW LOCKING 5.5x32MM
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$647.50 |
| Rate for Payer: Aetna Commercial |
$388.50
|
| Rate for Payer: Aetna Medicare Advantage |
$388.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$330.23
|
| Rate for Payer: Cigna Commercial |
$647.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW LOCKING 5.5x32MM
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$313.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW LOCKING 5.5x36MM
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$647.50 |
| Rate for Payer: Aetna Commercial |
$388.50
|
| Rate for Payer: Aetna Medicare Advantage |
$388.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$330.23
|
| Rate for Payer: Cigna Commercial |
$647.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW LOCKING 5.5x36MM
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$313.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW LOCKING 5.5x38MM
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$647.50 |
| Rate for Payer: Aetna Commercial |
$388.50
|
| Rate for Payer: Aetna Medicare Advantage |
$388.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$330.23
|
| Rate for Payer: Cigna Commercial |
$647.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW LOCKING 5.5x38MM
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$313.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW LOCKING 5.5x55MM
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$313.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW LOCKING 5.5x55MM
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$647.50 |
| Rate for Payer: Aetna Commercial |
$388.50
|
| Rate for Payer: Aetna Medicare Advantage |
$388.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$330.23
|
| Rate for Payer: Cigna Commercial |
$647.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW LOCKING 5.5x90mm
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$220.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$182.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$220.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.50
|
|
|
SCREW LOCKING 5.5x90mm
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna Commercial |
$273.00
|
| Rate for Payer: Aetna Medicare Advantage |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$232.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$232.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$182.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$232.05
|
| Rate for Payer: Cigna Commercial |
$455.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$220.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.50
|
|
|
SCREW LOCKING 5.5x95mm
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna Commercial |
$273.00
|
| Rate for Payer: Aetna Medicare Advantage |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$232.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$232.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$182.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$232.05
|
| Rate for Payer: Cigna Commercial |
$455.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$220.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.50
|
|
|
SCREW LOCKING 5.5x95mm
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$220.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$182.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$220.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.50
|
|
|
SCREW LOCKING 5MM 42MM XL 25
|
Facility
|
IP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692418
|
|
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 LOCKING 5MM 42MM XL 25
|
Facility
|
OP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692418
|
|
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 LOCKING 5MM 44MM XL 25
|
Facility
|
OP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692419
|
|
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 LOCKING 5MM 44MM XL 25
|
Facility
|
IP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692419
|
|
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 LOCKING 5MM 56MM XL 25
|
Facility
|
IP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692417
|
|
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 LOCKING 5MM 56MM XL 25
|
Facility
|
OP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692417
|
|
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 LOCKING 5MMX26MM
|
Facility
|
OP
|
$885.00
|
|
| Hospital Charge Code |
270668423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Aetna Commercial |
$265.50
|
| Rate for Payer: Aetna Medicare Advantage |
$265.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$225.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$225.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$225.68
|
| Rate for Payer: Cigna Commercial |
$442.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.75
|
|
|
SCREW LOCKING 5MMX26MM
|
Facility
|
IP
|
$885.00
|
|
| Hospital Charge Code |
270668423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$214.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.75
|
|
|
SCREW LOCKING 5MMX40MM
|
Facility
|
OP
|
$885.00
|
|
| Hospital Charge Code |
270668422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.75
|
| Rate for Payer: Aetna Commercial |
$265.50
|
| Rate for Payer: Aetna Medicare Advantage |
$265.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$225.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$225.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$225.68
|
| Rate for Payer: Cigna Commercial |
$442.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.17
|
|
|
SCREW LOCKING 5MMX40MM
|
Facility
|
IP
|
$885.00
|
|
| Hospital Charge Code |
270668422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$214.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.75
|
|
|
SCREW LOCKING 5MMx42MM
|
Facility
|
OP
|
$973.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$486.68 |
| Rate for Payer: Aetna Commercial |
$292.00
|
| Rate for Payer: Aetna Medicare Advantage |
$292.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$194.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.20
|
| Rate for Payer: Cigna Commercial |
$486.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.00
|
|
|
SCREW LOCKING 5MMx42MM
|
Facility
|
IP
|
$973.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$235.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$194.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.00
|
|