|
3.0LOCKING SCREW 12MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674085
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
3.0LOCKING SCREW 12MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674085
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
3.0 LOCKING SCREW 16MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270666082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
3.0 LOCKING SCREW 16MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270666082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
3.0MM ASNIS MICRO CANN COUNTER
|
Facility
|
IP
|
$1,783.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.47 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$356.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$431.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.47
|
|
|
3.0MM ASNIS MICRO CANN COUNTER
|
Facility
|
OP
|
$1,783.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.64 |
| Max. Negotiated Rate |
$891.58 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Aetna Medicare Advantage |
$534.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$454.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$454.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$356.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$454.70
|
| Rate for Payer: Cigna Commercial |
$891.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$431.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.47
|
| Rate for Payer: UnitedHealthcare Community & State |
$56.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.64
|
|
|
3.0MM CANN SCREWSHORT THREAD 3
|
Facility
|
IP
|
$868.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.33 |
| Max. Negotiated Rate |
$210.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$210.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$130.33
|
|
|
3.0MM CANN SCREWSHORT THREAD 3
|
Facility
|
OP
|
$868.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$434.43 |
| Rate for Payer: Aetna Commercial |
$330.16
|
| Rate for Payer: Aetna Medicare Advantage |
$260.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$221.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$221.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$221.56
|
| Rate for Payer: Cigna Commercial |
$434.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$210.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$130.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.68
|
|
|
3.0MM CANN SCREWSHORT THREAD 4
|
Facility
|
IP
|
$868.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.33 |
| Max. Negotiated Rate |
$210.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$210.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$130.33
|
|
|
3.0MM CANN SCREWSHORT THREAD 4
|
Facility
|
OP
|
$868.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$434.43 |
| Rate for Payer: Aetna Commercial |
$330.16
|
| Rate for Payer: Aetna Medicare Advantage |
$260.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$221.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$221.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$221.56
|
| Rate for Payer: Cigna Commercial |
$434.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$210.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$130.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.68
|
|
|
3.0MM CAN SCREWSHORT THREAD 16
|
Facility
|
OP
|
$868.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$434.43 |
| Rate for Payer: Aetna Commercial |
$330.16
|
| Rate for Payer: Aetna Medicare Advantage |
$260.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$221.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$221.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$221.56
|
| Rate for Payer: Cigna Commercial |
$434.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$210.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$130.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.68
|
|
|
3.0MM CAN SCREWSHORT THREAD 16
|
Facility
|
IP
|
$868.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.33 |
| Max. Negotiated Rate |
$210.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$173.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$210.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$130.33
|
|
|
3.0MM LOCK SCREW 12MM L
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270703227
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
3.0MM LOCK SCREW 12MM L
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270703227
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| 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) 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.50
|
|
|
3.0MM LOCK SCREW 14MM L
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
270703228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
3.0MM LOCK SCREW 14MM L
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
270703228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$570.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.60
|
|
|
3.0MM LOCK SCREW 16MM L
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270703229
|
|
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
|
|
|
3.0MM LOCK SCREW 16MM L
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270703229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.50
|
|
|
3.0MM LOCK SCREW 20MM L
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270703230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.50
|
|
|
3.0MM LOCK SCREW 20MM L
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270703230
|
|
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
|
|
|
30MM ROD
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$760.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.80
|
|
|
30MM ROD
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
3.0MM ROUBD FLUTED AGGRESSIVE
|
Facility
|
OP
|
$621.00
|
|
| Hospital Charge Code |
270702558
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: Aetna Medicare Advantage |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$158.35
|
| Rate for Payer: Cigna Commercial |
$310.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.46
|
| Rate for Payer: Oxford Commercial |
$124.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.64
|
|
|
3.0MM ROUBD FLUTED AGGRESSIVE
|
Facility
|
IP
|
$621.00
|
|
| Hospital Charge Code |
270702558
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
|
|
3.0X16MM VAL SCREW,TI
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$211.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|