|
SCREW MVX CANN 36 P23536
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270609880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
SCREW MVX CANN 38 P23538
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270609881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
SCREW MVX CANN 38 P23538
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270609881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
SCREW NAUTILUS POLYAX 8.5X80MM
|
Facility
|
OP
|
$6,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$3,487.50 |
| Rate for Payer: Aetna Commercial |
$2,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,778.62
|
| Rate for Payer: Cigna Commercial |
$3,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
SCREW NAUTILUS POLYAX 8.5X80MM
|
Facility
|
IP
|
$6,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$1,687.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
SCREW NAUTILUS POLYAX 8.5X80MM
|
Facility
|
IP
|
$6,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$1,687.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
SCREW NAUTILUS POLYAX 8.5X80MM
|
Facility
|
OP
|
$6,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$3,487.50 |
| Rate for Payer: Aetna Commercial |
$2,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,778.62
|
| Rate for Payer: Cigna Commercial |
$3,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
SCREW NAUTILUS POLYAX 8.5X90MM
|
Facility
|
IP
|
$6,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$1,687.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
SCREW NAUTILUS POLYAX 8.5X90MM
|
Facility
|
OP
|
$6,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$3,487.50 |
| Rate for Payer: Aetna Medicare Advantage |
$2,092.50
|
| Rate for Payer: Aetna Commercial |
$2,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,778.62
|
| Rate for Payer: Cigna Commercial |
$3,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
SCREW NCB 5X60MM SELF TAP
|
Facility
|
OP
|
$1,223.40
|
|
| Hospital Charge Code |
270702812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$611.70 |
| Rate for Payer: Aetna Commercial |
$367.02
|
| Rate for Payer: Aetna Medicare Advantage |
$367.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$311.97
|
| Rate for Payer: Cigna Commercial |
$611.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB 5X60MM SELF TAP
|
Facility
|
IP
|
$1,223.40
|
|
| Hospital Charge Code |
270702812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$296.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB 5X70MM SELF TAP
|
Facility
|
IP
|
$1,223.40
|
|
| Hospital Charge Code |
270702813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$296.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB 5X70MM SELF TAP
|
Facility
|
OP
|
$1,223.40
|
|
| Hospital Charge Code |
270702813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$611.70 |
| Rate for Payer: Aetna Commercial |
$367.02
|
| Rate for Payer: Aetna Medicare Advantage |
$367.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$311.97
|
| Rate for Payer: Cigna Commercial |
$611.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB 5X80MM SELF TAP
|
Facility
|
IP
|
$1,223.40
|
|
| Hospital Charge Code |
270702814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$296.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB 5X80MM SELF TAP
|
Facility
|
OP
|
$1,223.40
|
|
| Hospital Charge Code |
270702814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$611.70 |
| Rate for Payer: Aetna Commercial |
$367.02
|
| Rate for Payer: Aetna Medicare Advantage |
$367.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$311.97
|
| Rate for Payer: Cigna Commercial |
$611.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB 5X85MM SELF TAP
|
Facility
|
IP
|
$1,045.00
|
|
| Hospital Charge Code |
270702815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$252.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$209.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$252.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$156.75
|
|
|
SCREW NCB 5X85MM SELF TAP
|
Facility
|
OP
|
$1,045.00
|
|
| Hospital Charge Code |
270702815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$522.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$313.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$266.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$266.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$209.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$266.48
|
| Rate for Payer: Cigna Commercial |
$522.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$252.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$156.75
|
|
|
SCREW NCB CORT 5.0X55MM
|
Facility
|
OP
|
$1,223.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$611.70 |
| Rate for Payer: Aetna Commercial |
$367.02
|
| Rate for Payer: Aetna Medicare Advantage |
$367.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$311.97
|
| Rate for Payer: Cigna Commercial |
$611.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB CORT 5.0X55MM
|
Facility
|
IP
|
$1,223.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$296.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB CORT 5.0X75MM
|
Facility
|
OP
|
$1,223.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$611.70 |
| Rate for Payer: Aetna Commercial |
$367.02
|
| Rate for Payer: Aetna Medicare Advantage |
$367.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$311.97
|
| Rate for Payer: Cigna Commercial |
$611.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB CORT 5.0X75MM
|
Facility
|
IP
|
$1,223.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$296.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB ST 5.0X30MM
|
Facility
|
IP
|
$1,223.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$296.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB ST 5.0X30MM
|
Facility
|
OP
|
$1,223.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$611.70 |
| Rate for Payer: Aetna Commercial |
$367.02
|
| Rate for Payer: Aetna Medicare Advantage |
$367.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$311.97
|
| Rate for Payer: Cigna Commercial |
$611.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB ST 5.0X32MM
|
Facility
|
IP
|
$1,223.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$296.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|
|
SCREW NCB ST 5.0X32MM
|
Facility
|
OP
|
$1,223.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.51 |
| Max. Negotiated Rate |
$611.70 |
| Rate for Payer: Aetna Commercial |
$367.02
|
| Rate for Payer: Aetna Medicare Advantage |
$367.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$311.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$311.97
|
| Rate for Payer: Cigna Commercial |
$611.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.51
|
|