|
SCREW BIO-COMPRESSION 3x16MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.09
|
|
|
SCREW BIO-COMPRESSION 3x16MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x18MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.09
|
|
|
SCREW BIO-COMPRESSION 3x18MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x20MM
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.09
|
|
|
SCREW BIO-COMPRESSION 3x20MM
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x22MM
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.09
|
|
|
SCREW BIO-COMPRESSION 3x22MM
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x24MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270661621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.09
|
|
|
SCREW BIO-COMPRESSION 3x24MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270661621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x26MM
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$62.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.09
|
|
|
SCREW BIO-COMPRESSION 3x26MM
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-INTERFERENCE 9X23MM
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270621136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$171.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$142.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$106.50
|
|
|
SCREW BIO-INTERFERENCE 9X23MM
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270621136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna Commercial |
$269.80
|
| Rate for Payer: Aetna Medicare Advantage |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$181.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$181.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$142.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$181.05
|
| Rate for Payer: Cigna Commercial |
$355.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$106.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.16
|
|
|
SCREW BIO RCI-HA 8x20
|
Facility
|
OP
|
$1,310.00
|
|
| Hospital Charge Code |
270635331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: Aetna Commercial |
$497.80
|
| Rate for Payer: Aetna Medicare Advantage |
$393.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$334.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$334.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$262.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$334.05
|
| Rate for Payer: Cigna Commercial |
$655.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$317.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$41.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.20
|
|
|
SCREW BIO RCI-HA 8x20
|
Facility
|
IP
|
$1,310.00
|
|
| Hospital Charge Code |
270635331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.50 |
| Max. Negotiated Rate |
$317.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$262.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$317.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.50
|
|
|
SCREW BITE LONG THREAD 2X10MM
|
Facility
|
OP
|
$1,069.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$534.88 |
| Rate for Payer: Aetna Commercial |
$406.50
|
| Rate for Payer: Aetna Medicare Advantage |
$320.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$213.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$272.79
|
| Rate for Payer: Cigna Commercial |
$534.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$258.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.46
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.38
|
|
|
SCREW BITE LONG THREAD 2X10MM
|
Facility
|
IP
|
$1,069.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.46 |
| Max. Negotiated Rate |
$258.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$213.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$258.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.46
|
|
|
SCREW BLADE LOCKING 5.2MM S/P
|
Facility
|
OP
|
$41.25
|
|
| Hospital Charge Code |
270669561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$15.68
|
| Rate for Payer: Aetna Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.52
|
| Rate for Payer: Cigna Commercial |
$20.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.72
|
| Rate for Payer: Oxford Commercial |
$8.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.17
|
|
|
SCREW BLADE LOCKING 5.2MM S/P
|
Facility
|
IP
|
$41.25
|
|
| Hospital Charge Code |
270669561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.19
|
|
|
SCREW BLADE RETEN 3.4MM S/P
|
Facility
|
OP
|
$37.92
|
|
| Hospital Charge Code |
270669560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$18.96 |
| Rate for Payer: Aetna Commercial |
$14.41
|
| Rate for Payer: Aetna Medicare Advantage |
$11.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.67
|
| Rate for Payer: Cigna Commercial |
$18.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.86
|
| Rate for Payer: Oxford Commercial |
$7.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.08
|
|
|
SCREW BLADE RETEN 3.4MM S/P
|
Facility
|
IP
|
$37.92
|
|
| Hospital Charge Code |
270669560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.69
|
|
|
SCREW BMT CORT 4.5 36MM 235136
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270613968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$37.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.25
|
|
|
SCREW BMT CORT 4.5 36MM 235136
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270613968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna Medicare Advantage |
$46.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.52
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.40
|
|
|
SCREW BMT CORT 4.5 40MM 235140
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270612182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna Medicare Advantage |
$46.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.52
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.40
|
|