|
SCREW BONE N/LOCKING 2.3x16mm
|
Facility
|
IP
|
$507.00
|
|
| Hospital Charge Code |
270672689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$122.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.05
|
|
|
SCREW BONE N/LOCKING 2.3x18mm
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$122.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.05
|
|
|
SCREW BONE N/LOCKING 2.3x18mm
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: Aetna Commercial |
$192.66
|
| Rate for Payer: Aetna Medicare Advantage |
$152.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$129.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$129.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$129.28
|
| Rate for Payer: Cigna Commercial |
$253.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.40
|
|
|
SCREW BONE N/LOCKING 2.7x16mm
|
Facility
|
IP
|
$207.00
|
|
| Hospital Charge Code |
270643446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$50.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
|
|
SCREW BONE N/LOCKING 2.7x16mm
|
Facility
|
OP
|
$207.00
|
|
| Hospital Charge Code |
270643446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: Aetna Medicare Advantage |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.78
|
| Rate for Payer: Cigna Commercial |
$103.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.88
|
|
|
SCREW BONE N/LOCKING 2.7x20
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
270660618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Medicare Advantage |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$172.12
|
| Rate for Payer: Cigna Commercial |
$337.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.17
|
|
|
SCREW BONE N/LOCKING 2.7x20
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
270660618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$101.25
|
|
|
SCREW BONE NON LOCKIN 3.5X50MM
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$327.50 |
| Rate for Payer: Aetna Commercial |
$248.90
|
| Rate for Payer: Aetna Medicare Advantage |
$196.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$167.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$167.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$131.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$167.03
|
| Rate for Payer: Cigna Commercial |
$327.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$158.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$98.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.60
|
|
|
SCREW BONE NON LOCKIN 3.5X50MM
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$158.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$131.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$158.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$98.25
|
|
|
SCREW BONE SELF TAP 2.7x12MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$342.50 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Medicare Advantage |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$174.68
|
| Rate for Payer: Cigna Commercial |
$342.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.45
|
|
|
SCREW BONE SELF TAP 2.7x12MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$165.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
|
|
SCREW BONE SELF TAP 2.7x24MM
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$342.50 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Medicare Advantage |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$174.68
|
| Rate for Payer: Cigna Commercial |
$342.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.45
|
|
|
SCREW BONE SELF TAP 2.7x24MM
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$165.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
|
|
SCREW BONE SELF TAP 3.5x12mm
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
SCREW BONE SELF TAP 3.5x12mm
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.33
|
|
|
SCREW BONE SELF TAP 3.5x14mm
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$165.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
|
|
SCREW BONE SELF TAP 3.5x14mm
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$342.50 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Medicare Advantage |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$174.68
|
| Rate for Payer: Cigna Commercial |
$342.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.45
|
|
|
SCREW BONE SELF TAP 3.5x16mm
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$342.50 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Medicare Advantage |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$174.68
|
| Rate for Payer: Cigna Commercial |
$342.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.45
|
|
|
SCREW BONE SELF TAP 3.5x16mm
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$165.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
|
|
SCREW BONE SELF TAP 3.5x18mm
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$342.50 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Medicare Advantage |
$205.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$174.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$174.68
|
| Rate for Payer: Cigna Commercial |
$342.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.45
|
|
|
SCREW BONE SELF TAP 3.5x18mm
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$165.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$165.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$102.75
|
|
|
SCREW BONE SELFTAP 6.5x25mm
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.55
|
|
|
SCREW BONE SELFTAP 6.5x25mm
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663510
|
|
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
|
|
|
SCREW BONE SELFTAP 6.5x35mm
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270626109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.55
|
|
|
SCREW BONE SELFTAP 6.5x35mm
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270626109
|
|
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
|
|