|
SCREW NON LCKNG LG HD 2.7x18MM
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Medicare Advantage |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$145.35
|
| Rate for Payer: Cigna Commercial |
$285.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.50
|
|
|
SCREW NON LCKNG LG HD 2.7x22MM
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Medicare Advantage |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$145.35
|
| Rate for Payer: Cigna Commercial |
$285.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.50
|
|
|
SCREW NON LCKNG LG HD 2.7x22MM
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$137.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.50
|
|
|
SCREW NONLKG FT ST 3DI 4X40MM
|
Facility
|
OP
|
$1,365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare Advantage |
$409.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$348.07
|
| Rate for Payer: Cigna Commercial |
$682.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
SCREW NONLKG FT ST 3DI 4X40MM
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$330.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
SCREW NONLKG LP 3.5X32MM
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$330.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
SCREW NONLKG LP 3.5X32MM
|
Facility
|
OP
|
$1,365.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare Advantage |
$409.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$348.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$348.07
|
| Rate for Payer: Cigna Commercial |
$682.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.75
|
|
|
SCREW NON LKG R3CON 3.5X18MM
|
Facility
|
IP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.12 |
| Max. Negotiated Rate |
$219.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
|
|
SCREW NON LKG R3CON 3.5X18MM
|
Facility
|
OP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.12 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$272.25
|
| Rate for Payer: Aetna Medicare Advantage |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.41
|
| Rate for Payer: Cigna Commercial |
$453.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
|
|
SCREW NON LOCK 2.7 X 10 MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Medicare Advantage |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.85
|
| Rate for Payer: Cigna Commercial |
$135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.50
|
|
|
SCREW NON LOCK 2.7 X 10 MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$65.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.50
|
|
|
SCREW NON LOCK 2.7x15MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Medicare Advantage |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.85
|
| Rate for Payer: Cigna Commercial |
$135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.50
|
|
|
SCREW NON LOCK 2.7x15MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$65.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.50
|
|
|
SCREW NON LOCK 2.7x16MM
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Medicare Advantage |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.85
|
| Rate for Payer: Cigna Commercial |
$135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.50
|
|
|
SCREW NON LOCK 2.7x16MM
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$65.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.50
|
|
|
SCREW NON LOCK 2.7x16MM
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW NON LOCK 2.7x16MM
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW NON LOCK 2.7x18 MM
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW NON LOCK 2.7x18 MM
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW NON LOCK 2.7x20 MM
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
270701892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW NON LOCK 2.7x20 MM
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
270701892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW NONLOCK 3.5X20MM
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.00 |
| Max. Negotiated Rate |
$295.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$295.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.00
|
|
|
SCREW NONLOCK 3.5X20MM
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.00 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna Commercial |
$366.00
|
| Rate for Payer: Aetna Medicare Advantage |
$366.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$311.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$311.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$244.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$311.10
|
| Rate for Payer: Cigna Commercial |
$610.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$295.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.00
|
|
|
SCREW NON LOCK F/THD 3.5x34MM
|
Facility
|
IP
|
$354.90
|
|
| Hospital Charge Code |
270674951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$85.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.23
|
|
|
SCREW NON LOCK F/THD 3.5x34MM
|
Facility
|
OP
|
$354.90
|
|
| Hospital Charge Code |
270674951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$177.45 |
| Rate for Payer: Aetna Commercial |
$106.47
|
| Rate for Payer: Aetna Medicare Advantage |
$106.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.50
|
| Rate for Payer: Cigna Commercial |
$177.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$85.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.23
|
|