|
SCREW LKG FOR IM NAIL 5.0X86MM
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: Aetna Commercial |
$1,037.40
|
| Rate for Payer: Aetna Medicare Advantage |
$819.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$546.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$696.15
|
| Rate for Payer: Cigna Commercial |
$1,365.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$660.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$409.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$86.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$77.53
|
|
|
SCREW LKG FOR IM NAIL 5.0X86MM
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$660.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$546.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$660.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$409.50
|
|
|
SCREW LKG FT T8 2.4X20MM
|
Facility
|
IP
|
$1,242.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.34 |
| Max. Negotiated Rate |
$300.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.34
|
|
|
SCREW LKG FT T8 2.4X20MM
|
Facility
|
OP
|
$1,242.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$621.15 |
| Rate for Payer: Aetna Commercial |
$472.07
|
| Rate for Payer: Aetna Medicare Advantage |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$316.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$316.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$316.79
|
| Rate for Payer: Cigna Commercial |
$621.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.34
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.28
|
|
|
SCREW LKG FT T8 2.7X12MM
|
Facility
|
OP
|
$1,242.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$621.15 |
| Rate for Payer: Aetna Commercial |
$472.07
|
| Rate for Payer: Aetna Medicare Advantage |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$316.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$316.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$316.79
|
| Rate for Payer: Cigna Commercial |
$621.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.34
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.28
|
|
|
SCREW LKG FT T8 2.7X12MM
|
Facility
|
IP
|
$1,242.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.34 |
| Max. Negotiated Rate |
$300.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.34
|
|
|
SCREW LKG HEXALOBE 3.5X16MM
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Aetna Commercial |
$267.90
|
| Rate for Payer: Aetna Medicare Advantage |
$211.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$179.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$179.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$141.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$179.78
|
| Rate for Payer: Cigna Commercial |
$352.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.02
|
|
|
SCREW LKG HEXALOBE 3.5X16MM
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$170.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$141.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.75
|
|
|
SCREW LKG HEXALOBE 3.5X40MM
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Medicare Advantage |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$275.40
|
| Rate for Payer: Cigna Commercial |
$540.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.67
|
|
|
SCREW LKG HEXALOBE 3.5X40MM
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$261.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
|
|
SCREW LKG IM NL 5 80 XL25
|
Facility
|
IP
|
$1,259.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.93 |
| Max. Negotiated Rate |
$304.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.93
|
|
|
SCREW LKG IM NL 5 80 XL25
|
Facility
|
OP
|
$1,259.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$629.75 |
| Rate for Payer: Aetna Commercial |
$478.61
|
| Rate for Payer: Aetna Medicare Advantage |
$377.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$321.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$321.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$321.17
|
| Rate for Payer: Cigna Commercial |
$629.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.77
|
|
|
SCREW LKG IM NL 5X38MM XL25
|
Facility
|
OP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.23 |
| Max. Negotiated Rate |
$444.15 |
| Rate for Payer: Aetna Commercial |
$337.55
|
| Rate for Payer: Aetna Medicare Advantage |
$266.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$226.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$226.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$226.52
|
| Rate for Payer: Cigna Commercial |
$444.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.23
|
|
|
SCREW LKG IM NL 5X38MM XL25
|
Facility
|
IP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$214.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.66
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.25
|
|
|
SCREW LKG IM NL 5X58MM XL25
|
Facility
|
IP
|
$1,259.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.93 |
| Max. Negotiated Rate |
$304.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.93
|
|
|
SCREW LKG IM NL 5X58MM XL25
|
Facility
|
OP
|
$1,259.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$629.75 |
| Rate for Payer: Aetna Commercial |
$478.61
|
| Rate for Payer: Aetna Medicare Advantage |
$377.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$321.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$321.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$321.17
|
| Rate for Payer: Cigna Commercial |
$629.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.77
|
|
|
SCREW LKG ORTHOLOC3DI 3.5X28MM
|
Facility
|
IP
|
$1,050.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.59 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.59
|
|
|
SCREW LKG ORTHOLOC3DI 3.5X28MM
|
Facility
|
OP
|
$1,050.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$525.30 |
| Rate for Payer: Aetna Commercial |
$399.23
|
| Rate for Payer: Aetna Medicare Advantage |
$315.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.90
|
| Rate for Payer: Cigna Commercial |
$525.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.84
|
|
|
SCREW LKG PERIPH 5.5X16MM
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Medicare Advantage |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.00
|
| Rate for Payer: Cigna Commercial |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.04
|
|
|
SCREW LKG PERIPH 5.5X16MM
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
|
|
SCREW LKG PERIPH 5.5X20MM
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Medicare Advantage |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.00
|
| Rate for Payer: Cigna Commercial |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.04
|
|
|
SCREW LKG PERIPH 5.5X20MM
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
|
|
SCREW LKG PERIPH 5.5X40MM
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
|
|
SCREW LKG PERIPH 5.5X40MM
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Medicare Advantage |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.00
|
| Rate for Payer: Cigna Commercial |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.04
|
|
|
SCREW LKG PT T2 SHAFT 5X35MM
|
Facility
|
IP
|
$2,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$600.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$496.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$600.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$372.00
|
|