|
SCREW CANN LO PRO S/THD 4x35MM
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
270672026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$285.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
|
|
SCREW CANN LO PRO S/THD 4x35MM
|
Facility
|
OP
|
$1,180.00
|
|
| Hospital Charge Code |
270672026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.51 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna Commercial |
$448.40
|
| Rate for Payer: Aetna Medicare Advantage |
$354.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$300.90
|
| Rate for Payer: Cigna Commercial |
$590.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$37.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.51
|
|
|
SCREW CANN LO PRO S/THD 4x38MM
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
270663088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW CANN LO PRO S/THD 4x38MM
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
270663088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
SCREW CANN LO PRO S/THD 4x40MM
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW CANN LO PRO S/THD 4x40MM
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
SCREW CANN LO PRO S/THD 4x42MM
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
270671981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW CANN LO PRO S/THD 4x42MM
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
270671981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
SCREW CANN LO PRO S/THD 4x44MM
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
270671982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW CANN LO PRO S/THD 4x44MM
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
270671982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
SCREW CANN LO PRO S/THD 4x46MM
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW CANN LO PRO S/THD 4x46MM
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270663090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
SCREW CANN LO PRO S/THD 4x48MM
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
270671983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW CANN LO PRO S/THD 4x48MM
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
270671983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
SCREW CANN LO PRO S/THD 4x50MM
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW CANN LO PRO S/THD 4x50MM
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
SCREW CANN LO PRO S/THD 4x55MM
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
SCREW CANN LO PRO S/THD 4x55MM
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW CANN LO PRO S/THD 4x60MM
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
270671984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
SCREW CANN LO PRO S/THD 4x60MM
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
270671984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$199.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
SCREW CANN L/THRD 3.0x24MM
|
Facility
|
OP
|
$819.00
|
|
| Hospital Charge Code |
270676299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: Aetna Medicare Advantage |
$245.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$208.84
|
| Rate for Payer: Cigna Commercial |
$409.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.26
|
|
|
SCREW CANN L/THRD 3.0x24MM
|
Facility
|
IP
|
$819.00
|
|
| Hospital Charge Code |
270676299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$198.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$163.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.85
|
|
|
SCREW CANN L/THRD 3.0x34MM
|
Facility
|
OP
|
$819.00
|
|
| Hospital Charge Code |
270676300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: Aetna Medicare Advantage |
$245.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$208.84
|
| Rate for Payer: Cigna Commercial |
$409.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.26
|
|
|
SCREW CANN L/THRD 3.0x34MM
|
Facility
|
IP
|
$819.00
|
|
| Hospital Charge Code |
270676300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$198.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$163.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.85
|
|
|
SCREW CANN L/THRD 3.0x36MM
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: Aetna Medicare Advantage |
$245.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$208.84
|
| Rate for Payer: Cigna Commercial |
$409.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.26
|
|