|
SCREW LOCKING TI 5.0X38MM
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664324
|
|
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 5.0X38MM
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664324
|
|
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 5.0x40mm
|
Facility
|
OP
|
$973.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633465
|
|
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 5.0x40mm
|
Facility
|
IP
|
$973.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633465
|
|
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
|
|
|
SCREW LOCKING TI 5.0x50MM
|
Facility
|
IP
|
$951.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$230.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.75
|
|
|
SCREW LOCKING TI 5.0x50MM
|
Facility
|
OP
|
$951.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$475.85 |
| Rate for Payer: Aetna Commercial |
$285.51
|
| Rate for Payer: Aetna Medicare Advantage |
$285.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$242.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$242.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$242.68
|
| Rate for Payer: Cigna Commercial |
$475.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.75
|
|
|
SCREW LOCKING TI 5.0x64mm
|
Facility
|
OP
|
$924.00
|
|
| Hospital Charge Code |
270675114
|
|
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 5.0x64mm
|
Facility
|
IP
|
$924.00
|
|
| Hospital Charge Code |
270675114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$223.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$184.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.60
|
|
|
SCREW LOCKING TI 5.0x70mm
|
Facility
|
IP
|
$980.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.04 |
| Max. Negotiated Rate |
$237.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.04
|
|
|
SCREW LOCKING TI 5.0x70mm
|
Facility
|
OP
|
$980.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.04 |
| Max. Negotiated Rate |
$490.12 |
| Rate for Payer: Aetna Commercial |
$294.07
|
| Rate for Payer: Aetna Medicare Advantage |
$294.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$249.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$249.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$249.96
|
| Rate for Payer: Cigna Commercial |
$490.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.04
|
|
|
SCREW LOCKING TI 5.0x74MM
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$223.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$184.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.60
|
|
|
SCREW LOCKING TI 5.0x74MM
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676340
|
|
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 5.0x74MM
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$223.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$184.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.60
|
|
|
SCREW LOCKING TI 5.0x74MM
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671810
|
|
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 5.0X86MM
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$660.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$546.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$660.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$409.50
|
|
|
SCREW LOCKING TI 5.0X86MM
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: Aetna Commercial |
$819.00
|
| Rate for Payer: Aetna Medicare Advantage |
$819.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$546.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$696.15
|
| Rate for Payer: Cigna Commercial |
$1,365.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$660.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$409.50
|
|
|
SCREW LOCKING TI 5x24mm
|
Facility
|
IP
|
$984.20
|
|
| Hospital Charge Code |
270673779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.63 |
| Max. Negotiated Rate |
$238.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.63
|
|
|
SCREW LOCKING TI 5x24mm
|
Facility
|
OP
|
$984.20
|
|
| Hospital Charge Code |
270673779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.63 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Aetna Commercial |
$295.26
|
| Rate for Payer: Aetna Medicare Advantage |
$295.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$250.97
|
| Rate for Payer: Cigna Commercial |
$492.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.63
|
|
|
SCREW LOCKING TI 5X26MM
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$210.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$174.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$210.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$130.50
|
|
|
SCREW LOCKING TI 5X26MM
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Medicare Advantage |
$261.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$174.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$221.85
|
| Rate for Payer: Cigna Commercial |
$435.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$210.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$130.50
|
|
|
SCREW LOCKING TI 5x28mm
|
Facility
|
OP
|
$984.20
|
|
| Hospital Charge Code |
270673768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.63 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Aetna Commercial |
$295.26
|
| Rate for Payer: Aetna Medicare Advantage |
$295.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$250.97
|
| Rate for Payer: Cigna Commercial |
$492.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.63
|
|
|
SCREW LOCKING TI 5x28mm
|
Facility
|
IP
|
$984.20
|
|
| Hospital Charge Code |
270673768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.63 |
| Max. Negotiated Rate |
$238.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.63
|
|
|
SCREW LOCKING TI 5x32mm
|
Facility
|
IP
|
$984.20
|
|
| Hospital Charge Code |
270673778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.63 |
| Max. Negotiated Rate |
$238.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.63
|
|
|
SCREW LOCKING TI 5x32mm
|
Facility
|
OP
|
$984.20
|
|
| Hospital Charge Code |
270673778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.63 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Aetna Commercial |
$295.26
|
| Rate for Payer: Aetna Medicare Advantage |
$295.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$250.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$250.97
|
| Rate for Payer: Cigna Commercial |
$492.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.63
|
|
|
SCREW LOCKING TI 5x38mm
|
Facility
|
IP
|
$984.20
|
|
| Hospital Charge Code |
270673771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.63 |
| Max. Negotiated Rate |
$238.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.63
|
|