|
SCREW SCHANZ 5.0x150mm BLUNTED
|
Facility
|
IP
|
$404.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270639898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.72 |
| Max. Negotiated Rate |
$97.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.72
|
|
|
SCREW SCHANZ 5.0x150mm BLUNTED
|
Facility
|
OP
|
$404.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270639898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.72 |
| Max. Negotiated Rate |
$202.40 |
| Rate for Payer: Aetna Commercial |
$121.44
|
| Rate for Payer: Aetna Medicare Advantage |
$121.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$103.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$103.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$103.22
|
| Rate for Payer: Cigna Commercial |
$202.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.72
|
|
|
SCREW SCHANZ 5.0x175 60MM THRD
|
Facility
|
OP
|
$806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270638914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.97 |
| Max. Negotiated Rate |
$403.25 |
| Rate for Payer: Aetna Commercial |
$241.95
|
| Rate for Payer: Aetna Medicare Advantage |
$241.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$205.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$205.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$161.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$205.66
|
| Rate for Payer: Cigna Commercial |
$403.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.97
|
|
|
SCREW SCHANZ 5.0x175 60MM THRD
|
Facility
|
IP
|
$806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270638914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.97 |
| Max. Negotiated Rate |
$195.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$161.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.97
|
|
|
SCREW SCHANZ 5.0x200mm BLUNTED
|
Facility
|
OP
|
$469.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270639899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.45 |
| Max. Negotiated Rate |
$234.85 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Aetna Medicare Advantage |
$140.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$119.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$119.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$119.77
|
| Rate for Payer: Cigna Commercial |
$234.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$113.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.45
|
|
|
SCREW SCHANZ 5.0x200mm BLUNTED
|
Facility
|
IP
|
$469.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270639899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.45 |
| Max. Negotiated Rate |
$113.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$113.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.45
|
|
|
SCREW SCHANZ 5.0X250MM BLUNT
|
Facility
|
OP
|
$668.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$334.18 |
| Rate for Payer: Aetna Commercial |
$200.50
|
| Rate for Payer: Aetna Medicare Advantage |
$200.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.43
|
| Rate for Payer: Cigna Commercial |
$334.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.25
|
|
|
SCREW SCHANZ 5.0X250MM BLUNT
|
Facility
|
IP
|
$668.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.25
|
|
|
SCREW SCHANZ 5.0x250mm BLUNTED
|
Facility
|
OP
|
$469.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270639900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.45 |
| Max. Negotiated Rate |
$234.85 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Aetna Medicare Advantage |
$140.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$119.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$119.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$119.77
|
| Rate for Payer: Cigna Commercial |
$234.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$113.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.45
|
|
|
SCREW SCHANZ 5.0x250mm BLUNTED
|
Facility
|
IP
|
$469.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270639900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.45 |
| Max. Negotiated Rate |
$113.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$113.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.45
|
|
|
SCREW SCHANZ 5.0x60x150mm
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.65 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Aetna Medicare Advantage |
$267.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$227.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$227.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$227.21
|
| Rate for Payer: Cigna Commercial |
$445.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$215.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.65
|
|
|
SCREW SCHANZ 5.0x60x150mm
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.65 |
| Max. Negotiated Rate |
$215.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$178.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$215.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.65
|
|
|
SCREW SCHANZ 5.0x80MM SLF DRIL
|
Facility
|
IP
|
$830.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$201.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.61
|
|
|
SCREW SCHANZ 5.0x80MM SLF DRIL
|
Facility
|
OP
|
$830.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$415.35 |
| Rate for Payer: Aetna Commercial |
$249.21
|
| Rate for Payer: Aetna Medicare Advantage |
$249.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$211.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$211.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$211.83
|
| Rate for Payer: Cigna Commercial |
$415.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.61
|
|
|
SCREW SCHANZ 6.0/160MM SPADE
|
Facility
|
OP
|
$408.00
|
|
| Hospital Charge Code |
270676407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Medicare Advantage |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$104.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$104.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$104.04
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.20
|
|
|
SCREW SCHANZ 6.0/160MM SPADE
|
Facility
|
IP
|
$408.00
|
|
| Hospital Charge Code |
270676407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$98.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$81.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.20
|
|
|
SCREW SCHANZ 9.0mm THD 105mm
|
Facility
|
IP
|
$713.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270630580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.07 |
| Max. Negotiated Rate |
$172.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$142.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$172.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.07
|
|
|
SCREW SCHANZ 9.0mm THD 105mm
|
Facility
|
OP
|
$713.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270630580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.07 |
| Max. Negotiated Rate |
$356.90 |
| Rate for Payer: Aetna Commercial |
$214.14
|
| Rate for Payer: Aetna Medicare Advantage |
$214.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$182.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$182.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$142.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$182.02
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$172.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.07
|
|
|
SCREW SCHANZ BLUNT PT 5x170MM
|
Facility
|
OP
|
$483.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.57 |
| Max. Negotiated Rate |
$241.90 |
| Rate for Payer: Aetna Commercial |
$145.14
|
| Rate for Payer: Aetna Medicare Advantage |
$145.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$123.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$123.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$96.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$123.37
|
| Rate for Payer: Cigna Commercial |
$241.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.57
|
|
|
SCREW SCHANZ BLUNT PT 5x170MM
|
Facility
|
IP
|
$483.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.57 |
| Max. Negotiated Rate |
$117.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$96.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$72.57
|
|
|
SCREW SCHANZ EXT FIX 4X120MM
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
SCREW SCHANZ EXT FIX 4X120MM
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,350.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
SCREW SCHANZ EXT FIX 4X150MM
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Medicare Advantage |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.75
|
| Rate for Payer: Cigna Commercial |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
|
|
SCREW SCHANZ EXT FIX 4X150MM
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$90.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$108.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
|
|
SCREW SCHANZ SD 4.0X125 SS
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$151.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.75
|
|