|
SCREW CORTICAL LOCKNG 3.5x13MM
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$106.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$88.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$106.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.30
|
|
|
SCREW CORTICAL LOCKNG 3.5x13MM
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna Medicare Advantage |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$112.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$112.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$88.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$112.71
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$106.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.55
|
|
|
SCREW CORTICAL LO PRO 2.4x10MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
SCREW CORTICAL LO PRO 2.4x10MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORTICAL LO PRO 2.4x12MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
SCREW CORTICAL LO PRO 2.4x12MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORTICAL LO PRO 2.4x14MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORTICAL LO PRO 2.4x14MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
SCREW CORTICAL LO PRO 2.4X18MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
SCREW CORTICAL LO PRO 2.4X18MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORTICAL LO PRO 2.4X20MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORTICAL LO PRO 2.4X20MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
SCREW CORTICAL LO PRO 2.4X22MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORTICAL LO PRO 2.4X22MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
SCREW CORTICAL LOW PROFILE 3.5
|
Facility
|
IP
|
$370.00
|
|
| Hospital Charge Code |
270665191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$89.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$89.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.50
|
|
|
SCREW CORTICAL LOW PROFILE 3.5
|
Facility
|
OP
|
$370.00
|
|
| Hospital Charge Code |
270665191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna Commercial |
$140.60
|
| Rate for Payer: Aetna Medicare Advantage |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.35
|
| Rate for Payer: Cigna Commercial |
$185.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$89.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.51
|
|
|
SCREW CORTICAL LP 2.4X8MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW CORTICAL LP 2.4X8MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
SCREW CORTICAL MSP 2.4X18MM
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$399.00
|
| Rate for Payer: Aetna Medicare Advantage |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.75
|
| Rate for Payer: Cigna Commercial |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.82
|
|
|
SCREW CORTICAL MSP 2.4X18MM
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|
|
SCREW CORTICAL NL 3.5X11MM
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$194.94
|
| Rate for Payer: Aetna Medicare Advantage |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$130.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$130.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$130.81
|
| Rate for Payer: Cigna Commercial |
$256.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$124.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.57
|
|
|
SCREW CORTICAL NL 3.5X11MM
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$102.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$124.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$76.95
|
|
|
SCREW CORTICAL NONLCK 3.5x16MM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.77 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Medicare Advantage |
$156.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.60
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.77
|
|
|
SCREW CORTICAL NONLCK 3.5x16MM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$125.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$104.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
|
|
SCREW CORTICAL TI 5X22MM
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.50
|
|