|
SCREW LOCKING Ti 4.0 X 20 MM
|
Facility
|
OP
|
$924.00
|
|
| Hospital Charge Code |
270667568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Aetna Medicare Advantage |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.62
|
| Rate for Payer: Cigna Commercial |
$462.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.60
|
|
|
SCREW LOCKING TI 4x40MM
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$627.50 |
| Rate for Payer: Aetna Commercial |
$376.50
|
| Rate for Payer: Aetna Medicare Advantage |
$376.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$320.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$320.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$320.02
|
| Rate for Payer: Cigna Commercial |
$627.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.25
|
|
|
SCREW LOCKING TI 4x40MM
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$303.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.25
|
|
|
SCREW LOCKING TI 4x42MM
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$627.50 |
| Rate for Payer: Aetna Commercial |
$376.50
|
| Rate for Payer: Aetna Medicare Advantage |
$376.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$320.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$320.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$320.02
|
| Rate for Payer: Cigna Commercial |
$627.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.25
|
|
|
SCREW LOCKING TI 4x42MM
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$303.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.25
|
|
|
SCREW LOCKING TI 4x60MM
|
Facility
|
OP
|
$927.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.08 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare Advantage |
$278.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$236.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$236.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$236.44
|
| Rate for Payer: Cigna Commercial |
$463.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$224.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.08
|
|
|
SCREW LOCKING TI 4x60MM
|
Facility
|
IP
|
$927.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.08 |
| Max. Negotiated Rate |
$224.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$224.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.08
|
|
|
SCREW LOCKING TI 4x65MM
|
Facility
|
OP
|
$927.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.08 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare Advantage |
$278.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$236.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$236.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$236.44
|
| Rate for Payer: Cigna Commercial |
$463.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$224.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.08
|
|
|
SCREW LOCKING TI 4x65MM
|
Facility
|
IP
|
$927.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.08 |
| Max. Negotiated Rate |
$224.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$224.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.08
|
|
|
SCREW LOCKING TI 4x70MM
|
Facility
|
IP
|
$927.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.08 |
| Max. Negotiated Rate |
$224.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$224.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.08
|
|
|
SCREW LOCKING TI 4x70MM
|
Facility
|
OP
|
$927.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.08 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare Advantage |
$278.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$236.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$236.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$236.44
|
| Rate for Payer: Cigna Commercial |
$463.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$224.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.08
|
|
|
SCREW LOCKING TI 4x80MM
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$303.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.25
|
|
|
SCREW LOCKING TI 4x80MM
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$627.50 |
| Rate for Payer: Aetna Commercial |
$376.50
|
| Rate for Payer: Aetna Medicare Advantage |
$376.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$320.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$320.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$320.02
|
| Rate for Payer: Cigna Commercial |
$627.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.25
|
|
|
SCREW LOCKING TI 4x85MM
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$303.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.25
|
|
|
SCREW LOCKING TI 4x85MM
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$627.50 |
| Rate for Payer: Aetna Commercial |
$376.50
|
| Rate for Payer: Aetna Medicare Advantage |
$376.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$320.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$320.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$320.02
|
| Rate for Payer: Cigna Commercial |
$627.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.25
|
|
|
SCREW LOCKING TI 4x90MM
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$627.50 |
| Rate for Payer: Aetna Commercial |
$376.50
|
| Rate for Payer: Aetna Medicare Advantage |
$376.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$320.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$320.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$320.02
|
| Rate for Payer: Cigna Commercial |
$627.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.25
|
|
|
SCREW LOCKING TI 4x90MM
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$303.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$303.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.25
|
|
|
SCREW LOCKING TI 5.0x32MM
|
Facility
|
IP
|
$945.00
|
|
| Hospital Charge Code |
270665915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$228.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$189.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$228.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.75
|
|
|
SCREW LOCKING TI 5.0x32MM
|
Facility
|
OP
|
$945.00
|
|
| Hospital Charge Code |
270665915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Medicare Advantage |
$283.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$240.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$240.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$240.97
|
| Rate for Payer: Cigna Commercial |
$472.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$228.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.75
|
|
|
SCREW LOCKING Ti 5.0x36mm
|
Facility
|
OP
|
$973.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270646025
|
|
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 Ti 5.0x36mm
|
Facility
|
IP
|
$1,290.00
|
|
| Hospital Charge Code |
270645025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$312.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$258.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$312.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$193.50
|
|
|
SCREW LOCKING Ti 5.0x36mm
|
Facility
|
OP
|
$766.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270641673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$383.15 |
| Rate for Payer: Aetna Commercial |
$229.89
|
| Rate for Payer: Aetna Medicare Advantage |
$229.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$195.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$195.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$153.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$195.41
|
| Rate for Payer: Cigna Commercial |
$383.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$185.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.94
|
|
|
SCREW LOCKING Ti 5.0x36mm
|
Facility
|
IP
|
$766.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270641673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$185.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$153.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$185.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.94
|
|
|
SCREW LOCKING Ti 5.0x36mm
|
Facility
|
OP
|
$1,290.00
|
|
| Hospital Charge Code |
270645025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$645.00 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Medicare Advantage |
$387.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$328.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$328.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$328.95
|
| Rate for Payer: Cigna Commercial |
$645.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$312.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$193.50
|
|
|
SCREW LOCKING Ti 5.0x36mm
|
Facility
|
IP
|
$973.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270646025
|
|
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
|
|