|
SCREW PYRENEES SLF TPNG 4X18MM
|
Facility
|
OP
|
$1,465.00
|
|
| Hospital Charge Code |
270670338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.75 |
| Max. Negotiated Rate |
$732.50 |
| Rate for Payer: Aetna Commercial |
$439.50
|
| Rate for Payer: Aetna Medicare Advantage |
$439.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$373.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$373.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$293.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$373.57
|
| Rate for Payer: Cigna Commercial |
$732.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$354.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$219.75
|
|
|
SCREW PYREN SLF TPNG 4.35X10MM
|
Facility
|
OP
|
$1,710.00
|
|
| Hospital Charge Code |
270670340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Medicare Advantage |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$436.05
|
| Rate for Payer: Cigna Commercial |
$855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.35X10MM
|
Facility
|
IP
|
$1,710.00
|
|
| Hospital Charge Code |
270670340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.35X12MM
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.35X12MM
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Medicare Advantage |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$436.05
|
| Rate for Payer: Cigna Commercial |
$855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.35X14MM
|
Facility
|
IP
|
$1,710.00
|
|
| Hospital Charge Code |
270670342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.35X14MM
|
Facility
|
OP
|
$1,710.00
|
|
| Hospital Charge Code |
270670342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Medicare Advantage |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$436.05
|
| Rate for Payer: Cigna Commercial |
$855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.35X16MM
|
Facility
|
OP
|
$1,710.00
|
|
| Hospital Charge Code |
270670343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Medicare Advantage |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$436.05
|
| Rate for Payer: Cigna Commercial |
$855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.35X16MM
|
Facility
|
IP
|
$1,710.00
|
|
| Hospital Charge Code |
270670343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.5X12MM
|
Facility
|
IP
|
$1,710.00
|
|
| Hospital Charge Code |
270670345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.5X12MM
|
Facility
|
OP
|
$1,710.00
|
|
| Hospital Charge Code |
270670345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Medicare Advantage |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$436.05
|
| Rate for Payer: Cigna Commercial |
$855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.5X14MM
|
Facility
|
IP
|
$1,710.00
|
|
| Hospital Charge Code |
270670346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.5X14MM
|
Facility
|
OP
|
$1,710.00
|
|
| Hospital Charge Code |
270670346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Medicare Advantage |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$436.05
|
| Rate for Payer: Cigna Commercial |
$855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.5X16MM
|
Facility
|
OP
|
$1,710.00
|
|
| Hospital Charge Code |
270670347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Medicare Advantage |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$436.05
|
| Rate for Payer: Cigna Commercial |
$855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.5X16MM
|
Facility
|
IP
|
$1,710.00
|
|
| Hospital Charge Code |
270670347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.5X18MM
|
Facility
|
IP
|
$1,710.00
|
|
| Hospital Charge Code |
270670348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW PYREN SLF TPNG 4.5X18MM
|
Facility
|
OP
|
$1,710.00
|
|
| Hospital Charge Code |
270670348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Medicare Advantage |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$436.05
|
| Rate for Payer: Cigna Commercial |
$855.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.50
|
|
|
SCREW QCKFX TI CANN 2X12MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$210.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW QCKFX TI CANN 2X12MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW QUICKFIX CAN PT 3.0 X 36
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
SCREW QUICKFIX CAN PT 3.0 X 36
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
SCREW QUICKFIX P/THD 3x20MM
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
SCREW QUICKFIX P/THD 3x20MM
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
SCREW QUICKFIX P/THD 4x26MM
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW QUICKFIX P/THD 4x26MM
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|