|
SCREW TFNA 90MM STERILE
|
Facility
|
OP
|
$3,136.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.45 |
| Max. Negotiated Rate |
$1,568.17 |
| Rate for Payer: Aetna Commercial |
$940.90
|
| Rate for Payer: Aetna Medicare Advantage |
$940.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$799.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$799.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$627.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$799.77
|
| Rate for Payer: Cigna Commercial |
$1,568.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$759.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$470.45
|
|
|
SCREW THD 4.0 MM X 34 MM
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
270702806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare Advantage |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$238.43
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 34 MM
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
270702805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare Advantage |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$238.43
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 34 MM
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
270702806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$226.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 34 MM
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
270702805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$226.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 44 MM
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
270702807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$226.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 44 MM
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
270702807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare Advantage |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$238.43
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 48 MM
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
270702808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$226.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 48 MM
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
270702808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare Advantage |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$238.43
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 50 MM
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
270702810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare Advantage |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$238.43
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 50 MM
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
270702810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$226.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 60 MM
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
270702811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare Advantage |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$238.43
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD 4.0 MM X 60 MM
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
270702811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$226.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$187.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$226.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
SCREW THD CAN HDLS 4X28MM
|
Facility
|
OP
|
$1,251.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.69 |
| Max. Negotiated Rate |
$625.62 |
| Rate for Payer: Aetna Commercial |
$375.38
|
| Rate for Payer: Aetna Medicare Advantage |
$375.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$319.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$319.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$319.07
|
| Rate for Payer: Cigna Commercial |
$625.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.69
|
|
|
SCREW THD CAN HDLS 4X28MM
|
Facility
|
IP
|
$1,251.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.69 |
| Max. Negotiated Rate |
$302.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.69
|
|
|
SCREW THD CAN HDLS 4X32MM
|
Facility
|
OP
|
$1,251.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.69 |
| Max. Negotiated Rate |
$625.62 |
| Rate for Payer: Aetna Commercial |
$375.38
|
| Rate for Payer: Aetna Medicare Advantage |
$375.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$319.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$319.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$319.07
|
| Rate for Payer: Cigna Commercial |
$625.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.69
|
|
|
SCREW THD CAN HDLS 4X32MM
|
Facility
|
IP
|
$1,251.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.69 |
| Max. Negotiated Rate |
$302.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.69
|
|
|
SCREW THD COMPRESSION 30X22MM
|
Facility
|
OP
|
$1,410.00
|
|
| Hospital Charge Code |
270670540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Medicare Advantage |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$359.55
|
| Rate for Payer: Cigna Commercial |
$705.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
|
|
SCREW THD COMPRESSION 30X22MM
|
Facility
|
IP
|
$1,410.00
|
|
| Hospital Charge Code |
270670540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$341.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
|
|
SCREW THD FULL HD 2.5 X 44MM
|
Facility
|
IP
|
$962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270270922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$232.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW THD FULL HD 2.5 X 44MM
|
Facility
|
IP
|
$192.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$46.59 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.88
|
|
|
SCREW THD FULL HD 2.5 X 44MM
|
Facility
|
OP
|
$192.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$96.25 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare Advantage |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.09
|
| Rate for Payer: Cigna Commercial |
$96.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.88
|
|
|
SCREW THD FULL HD 2.5 X 44MM
|
Facility
|
OP
|
$962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270270922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$481.25 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Aetna Medicare Advantage |
$288.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$245.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$192.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$245.44
|
| Rate for Payer: Cigna Commercial |
$481.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.38
|
|
|
SCREW THD HDLS 2 X 18MM
|
Facility
|
OP
|
$1,141.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$570.62 |
| Rate for Payer: Aetna Commercial |
$342.38
|
| Rate for Payer: Aetna Medicare Advantage |
$342.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$291.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$291.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$291.02
|
| Rate for Payer: Cigna Commercial |
$570.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$276.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.19
|
|
|
SCREW THD HDLS 2 X 18MM
|
Facility
|
IP
|
$1,141.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$276.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$276.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.19
|
|