|
SCREW 6.5X35MM
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
SCREW 6.5X35MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704152
|
|
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
|
|
|
SCREW 6.5X35MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704152
|
|
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
|
|
|
SCREW 6.5X35MM
|
Facility
|
IP
|
$4,500.00
|
|
| Hospital Charge Code |
270703134
|
|
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 6.5X35MM
|
Facility
|
IP
|
$5,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$817.50 |
| Max. Negotiated Rate |
$1,318.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,090.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,318.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$817.50
|
|
|
SCREW 6.5 X 40 MM
|
Facility
|
IP
|
$9,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$2,238.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,238.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,387.50
|
|
|
SCREW 6.5 X 40 MM
|
Facility
|
OP
|
$9,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.70 |
| Max. Negotiated Rate |
$4,625.00 |
| Rate for Payer: Aetna Commercial |
$3,515.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,775.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,358.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,358.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,358.75
|
| Rate for Payer: Cigna Commercial |
$4,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,238.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,387.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$292.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$262.70
|
|
|
SCREW 6.5 X 40 MM
|
Facility
|
OP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.42 |
| Max. Negotiated Rate |
$3,370.00 |
| Rate for Payer: Aetna Commercial |
$2,561.20
|
| Rate for Payer: Aetna Medicare Advantage |
$2,022.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$3,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$212.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$191.42
|
|
|
SCREW 6.5 X 40 MM
|
Facility
|
IP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$1,631.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW 6.5X40MM
|
Facility
|
OP
|
$4,500.00
|
|
| Hospital Charge Code |
270703135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$142.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$127.80
|
|
|
SCREW 6.5X40MM
|
Facility
|
OP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.42 |
| Max. Negotiated Rate |
$3,370.00 |
| Rate for Payer: Aetna Commercial |
$2,561.20
|
| Rate for Payer: Aetna Medicare Advantage |
$2,022.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$3,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$212.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$191.42
|
|
|
SCREW 6.5X40MM
|
Facility
|
IP
|
$4,500.00
|
|
| Hospital Charge Code |
270703135
|
|
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 6.5X40MM
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$532.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
|
|
SCREW 6.5X40MM
|
Facility
|
IP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$1,631.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW 6.5X40MM
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$532.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
|
|
SCREW 6.5X40MM
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.48 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$836.00
|
| Rate for Payer: Aetna Medicare Advantage |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$561.00
|
| Rate for Payer: Cigna Commercial |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$62.48
|
|
|
SCREW 6.5X40MM
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.48 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$836.00
|
| Rate for Payer: Aetna Medicare Advantage |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$561.00
|
| Rate for Payer: Cigna Commercial |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$62.48
|
|
|
SCREW 6.5X40MM #11-4640
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.50 |
| Max. Negotiated Rate |
$1,028.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,028.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$637.50
|
|
|
SCREW 6.5X40MM #11-4640
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Aetna Commercial |
$1,615.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,083.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,083.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,083.75
|
| Rate for Payer: Cigna Commercial |
$2,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,028.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$637.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$134.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$120.70
|
|
|
SCREW 6.5X40MM 39SK6540
|
Facility
|
IP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$1,631.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW 6.5X40MM 39SK6540
|
Facility
|
OP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.42 |
| Max. Negotiated Rate |
$3,370.00 |
| Rate for Payer: Aetna Commercial |
$2,561.20
|
| Rate for Payer: Aetna Medicare Advantage |
$2,022.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$3,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$212.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$191.42
|
|
|
SCREW 6.5 X 45HDLESS COMP THD
|
Facility
|
IP
|
$1,468.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.25 |
| Max. Negotiated Rate |
$355.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$293.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.25
|
|
|
SCREW 6.5 X 45HDLESS COMP THD
|
Facility
|
OP
|
$1,468.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$734.17 |
| Rate for Payer: Aetna Commercial |
$557.97
|
| Rate for Payer: Aetna Medicare Advantage |
$440.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$374.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$374.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$293.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$374.43
|
| Rate for Payer: Cigna Commercial |
$734.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.70
|
|
|
SCREW 6.5 X 45 MM
|
Facility
|
OP
|
$9,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.90 |
| Max. Negotiated Rate |
$4,875.00 |
| Rate for Payer: Aetna Commercial |
$3,705.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,486.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,486.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,486.25
|
| Rate for Payer: Cigna Commercial |
$4,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,359.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,462.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$308.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.90
|
|
|
SCREW 6.5 X 45 MM
|
Facility
|
IP
|
$9,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.50 |
| Max. Negotiated Rate |
$2,359.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,359.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,462.50
|
|