|
SCREW CANN 4.0X40MMHEADLSSCOMP
|
Facility
|
IP
|
$2,132.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.80 |
| Max. Negotiated Rate |
$515.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$426.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$515.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.80
|
|
|
SCREW CANN 4.0X44MMHEADLSSCOMP
|
Facility
|
OP
|
$2,132.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.55 |
| Max. Negotiated Rate |
$1,066.00 |
| Rate for Payer: Aetna Commercial |
$810.16
|
| Rate for Payer: Aetna Medicare Advantage |
$639.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$543.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$543.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$426.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$543.66
|
| Rate for Payer: Cigna Commercial |
$1,066.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$515.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.55
|
|
|
SCREW CANN 4.0X44MMHEADLSSCOMP
|
Facility
|
IP
|
$2,132.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.80 |
| Max. Negotiated Rate |
$515.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$426.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$515.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.80
|
|
|
SCREW CANN 4.0x46mm SHORT THRD
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270644816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$326.55
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.41
|
|
|
SCREW CANN 4.0x46mm SHORT THRD
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270644816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN 4.0x48mm LONG THRD
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN 4.0x48mm LONG THRD
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$326.55
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.41
|
|
|
SCREW CANN 4.0x50mm SHORT THRD
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$326.55
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.41
|
|
|
SCREW CANN 4.0x50mm SHORT THRD
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270646924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$326.55
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.41
|
|
|
SCREW CANN 4.0x50mm SHORT THRD
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270646924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN 4.0x50mm SHORT THRD
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN 4.0X52MMHEADLSSCOMP
|
Facility
|
OP
|
$2,132.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.55 |
| Max. Negotiated Rate |
$1,066.00 |
| Rate for Payer: Aetna Commercial |
$810.16
|
| Rate for Payer: Aetna Medicare Advantage |
$639.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$543.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$543.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$426.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$543.66
|
| Rate for Payer: Cigna Commercial |
$1,066.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$515.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.55
|
|
|
SCREW CANN 4.0X52MMHEADLSSCOMP
|
Facility
|
IP
|
$2,132.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.80 |
| Max. Negotiated Rate |
$515.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$426.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$515.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.80
|
|
|
SCREW CANN 4.0X60MMHEADLSSCOMP
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$949.00 |
| Rate for Payer: Aetna Commercial |
$721.24
|
| Rate for Payer: Aetna Medicare Advantage |
$569.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$483.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$483.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$379.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$483.99
|
| Rate for Payer: Cigna Commercial |
$949.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$459.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.90
|
|
|
SCREW CANN 4.0X60MMHEADLSSCOMP
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$459.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$379.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$459.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.70
|
|
|
SCREW CANN 4X38MM STERILE
|
Facility
|
OP
|
$931.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$465.60 |
| Rate for Payer: Aetna Commercial |
$353.86
|
| Rate for Payer: Aetna Medicare Advantage |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$237.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$237.46
|
| Rate for Payer: Cigna Commercial |
$465.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.45
|
|
|
SCREW CANN 4X38MM STERILE
|
Facility
|
IP
|
$931.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$225.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.68
|
|
|
SCREW CANN 4X38MM THD 13MM
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$329.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
|
|
SCREW CANN 4X38MM THD 13MM
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna Medicare Advantage |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$346.80
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.62
|
|
|
SCREW CANN 4x40MM TL 16 SH THD
|
Facility
|
OP
|
$790.00
|
|
| Hospital Charge Code |
270667927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Medicare Advantage |
$237.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$158.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.45
|
| Rate for Payer: Cigna Commercial |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$191.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.44
|
|
|
SCREW CANN 4x40MM TL 16 SH THD
|
Facility
|
IP
|
$790.00
|
|
| Hospital Charge Code |
270667927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$191.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$158.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$191.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.50
|
|
|
SCREW CANN 4X50MM TITANIUM
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$647.50 |
| Rate for Payer: Aetna Commercial |
$492.10
|
| Rate for Payer: Aetna Medicare Advantage |
$388.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$330.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$330.23
|
| Rate for Payer: Cigna Commercial |
$647.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$40.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.78
|
|
|
SCREW CANN 4X50MM TITANIUM
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$313.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$259.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.25
|
|
|
SCREW CANN 6.50X50MM
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
SCREW CANN 6.50X50MM
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.30 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$4,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$339.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$305.30
|
|