|
SCREW LOCKING FULL TREAD 5x50m
|
Facility
|
OP
|
$1,470.00
|
|
| Hospital Charge Code |
270671130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Medicare Advantage |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$374.85
|
| Rate for Payer: Cigna Commercial |
$735.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.50
|
|
|
SCREW LOCKING FULLY THD 5x30mm
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$355.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$294.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.50
|
|
|
SCREW LOCKING FULLY THD 5x30mm
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Medicare Advantage |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$374.85
|
| Rate for Payer: Cigna Commercial |
$735.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.50
|
|
|
SCREW LOCKING FULLY THD 5X65MM
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$338.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$338.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
|
|
SCREW LOCKING FULLY THD 5X65MM
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$420.00
|
| Rate for Payer: Aetna Medicare Advantage |
$420.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$357.00
|
| Rate for Payer: Cigna Commercial |
$700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$338.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
|
|
SCREW LOCKING FULLY THD 5x80MM
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$985.00 |
| Rate for Payer: Aetna Commercial |
$591.00
|
| Rate for Payer: Aetna Medicare Advantage |
$591.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$502.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$502.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$394.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$502.35
|
| Rate for Payer: Cigna Commercial |
$985.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$476.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$295.50
|
|
|
SCREW LOCKING FULLY THD 5x80MM
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$476.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$394.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$476.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$295.50
|
|
|
SCREW LOCKING FULLY THD 5x90MM
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Medicare Advantage |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$374.85
|
| Rate for Payer: Cigna Commercial |
$735.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.50
|
|
|
SCREW LOCKING FULLY THD 5x90MM
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$355.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$294.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.50
|
|
|
SCREW LOCKING FULLY THREADED
|
Facility
|
IP
|
$979.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.92 |
| Max. Negotiated Rate |
$237.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.92
|
|
|
SCREW LOCKING FULLY THREADED
|
Facility
|
OP
|
$979.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.92 |
| Max. Negotiated Rate |
$489.73 |
| Rate for Payer: Aetna Commercial |
$293.83
|
| Rate for Payer: Aetna Medicare Advantage |
$293.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$249.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$249.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$249.76
|
| Rate for Payer: Cigna Commercial |
$489.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.92
|
|
|
SCREW LOCKING FULLY THREADED 5
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$420.00
|
| Rate for Payer: Aetna Medicare Advantage |
$420.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$357.00
|
| Rate for Payer: Cigna Commercial |
$700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$338.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
|
|
SCREW LOCKING FULLY THREADED 5
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$338.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$338.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
|
|
SCREW LOCKING FUL THD 5X37.5MM
|
Facility
|
OP
|
$979.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.92 |
| Max. Negotiated Rate |
$489.73 |
| Rate for Payer: Aetna Commercial |
$293.83
|
| Rate for Payer: Aetna Medicare Advantage |
$293.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$249.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$249.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$249.76
|
| Rate for Payer: Cigna Commercial |
$489.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.92
|
|
|
SCREW LOCKING FUL THD 5X37.5MM
|
Facility
|
IP
|
$979.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.92 |
| Max. Negotiated Rate |
$237.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.92
|
|
|
SCREW LOCKING GLENOSPHERE
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
SCREW LOCKING GLENOSPHERE
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Medicare Advantage |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.12
|
| Rate for Payer: Cigna Commercial |
$337.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
SCREW LOCKING HEX 3.5x20MM
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
270656792
|
|
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 HEX 3.5x20MM
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
270656792
|
|
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 HEX 3.5x24MM
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
270656793
|
|
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 HEX 3.5x24MM
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
270656793
|
|
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 LG HD 2.7x16MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680849
|
|
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 LG HD 2.7x16MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680849
|
|
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 LG HD 2.7x18MM
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.50 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Aetna Commercial |
$363.00
|
| Rate for Payer: Aetna Medicare Advantage |
$363.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$308.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$308.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$242.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$308.55
|
| Rate for Payer: Cigna Commercial |
$605.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$181.50
|
|
|
SCREW LOCKING LG HD 2.7x18MM
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.50 |
| Max. Negotiated Rate |
$292.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$242.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$181.50
|
|