|
BONE SCREW 3.5x12MM
|
Facility
|
OP
|
$354.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664088
|
|
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
|
|
|
BONE SCREW 3.5x12MM
|
Facility
|
IP
|
$354.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664088
|
|
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
|
|
|
BONE SCREW 5X25MM
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270702844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
BONE SCREW 5X25MM
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270702844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
BONE SCREW 6/5MM TAPER 110/50
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna Commercial |
$246.00
|
| Rate for Payer: Aetna Medicare Advantage |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$164.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$209.10
|
| Rate for Payer: Cigna Commercial |
$410.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
|
|
BONE SCREW 6/5MM TAPER 110/50
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$198.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$164.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
|
|
BONE SCREW 6/5MM TAPER 120/40
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$198.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$164.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
|
|
BONE SCREW 6/5MM TAPER 120/40
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna Commercial |
$246.00
|
| Rate for Payer: Aetna Medicare Advantage |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$164.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$209.10
|
| Rate for Payer: Cigna Commercial |
$410.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
|
|
BONE SCREW 6/5MM TAPER 130/30
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$198.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$164.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
|
|
BONE SCREW 6/5MM TAPER 130/30
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna Commercial |
$246.00
|
| Rate for Payer: Aetna Medicare Advantage |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$209.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$164.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$209.10
|
| Rate for Payer: Cigna Commercial |
$410.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
|
|
BONE SCREW 6.5X 15
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$37.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
BONE SCREW 6.5X 15
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$30.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
BONE SCREW 6.5x20MM
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|
|
BONE SCREW 6.5x20MM
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$121.12
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|
|
BONE SCREW 6.5 X 20SELF TAP
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$30.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
BONE SCREW 6.5 X 20SELF TAP
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$37.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
BONE SCREW 6.5X25
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$30.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
BONE SCREW 6.5X25
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$37.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
BONE SCREW 6.5x25MM
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|
|
BONE SCREW 6.5x25MM
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$121.12
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|
|
BONE SCREW 6.5 X 25 SELF TAP
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$37.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
BONE SCREW 6.5 X 25 SELF TAP
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$30.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
BONE SCREW 6.5X25 SELF TAP
|
Facility
|
IP
|
$117.80
|
|
| Hospital Charge Code |
270662347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$28.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.67
|
|
|
BONE SCREW 6.5X25 SELF TAP
|
Facility
|
OP
|
$117.80
|
|
| Hospital Charge Code |
270662347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$35.34
|
| Rate for Payer: Aetna Medicare Advantage |
$35.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.04
|
| Rate for Payer: Cigna Commercial |
$58.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.67
|
|
|
BONE SCREW 6.5X 30
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$30.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|