|
SCREW LKG T6 2.0X6MM
|
Facility
|
OP
|
$1,242.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700507
|
|
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 T6 2.0X6MM
|
Facility
|
IP
|
$1,242.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700507
|
|
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 T6 VARIAX 2X10MM
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$175.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$145.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
SCREW LKG T6 VARIAX 2X10MM
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.59 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$145.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.59
|
|
|
SCREW LKG T6 VARIAX 2X11MM
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna Commercial |
$471.20
|
| Rate for Payer: Aetna Medicare Advantage |
$372.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$316.20
|
| Rate for Payer: Cigna Commercial |
$620.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.22
|
|
|
SCREW LKG T6 VARIAX 2X11MM
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$300.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.00
|
|
|
SCREW LKG T6 VARIAX 2X9MM
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$300.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.00
|
|
|
SCREW LKG T6 VARIAX 2X9MM
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna Commercial |
$471.20
|
| Rate for Payer: Aetna Medicare Advantage |
$372.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$316.20
|
| Rate for Payer: Cigna Commercial |
$620.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.22
|
|
|
SCREW LKG TI CORT 3.5X12MM
|
Facility
|
OP
|
$6,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.50 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna Commercial |
$2,375.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,875.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,593.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,593.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,593.75
|
| Rate for Payer: Cigna Commercial |
$3,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,512.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$937.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$197.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$177.50
|
|
|
SCREW LKG TI CORT 3.5X12MM
|
Facility
|
IP
|
$6,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$1,512.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,512.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$937.50
|
|
|
SCREW LKG TI HD DT ST 2.5X12MM
|
Facility
|
OP
|
$1,050.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$525.27 |
| Rate for Payer: Aetna Commercial |
$399.21
|
| Rate for Payer: Aetna Medicare Advantage |
$315.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.89
|
| Rate for Payer: Cigna Commercial |
$525.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.84
|
|
|
SCREW LKG TI HD DT ST 2.5X12MM
|
Facility
|
IP
|
$1,050.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.58 |
| Max. Negotiated Rate |
$254.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.58
|
|
|
SCREW LKG TI R3CON 3.5X10MM
|
Facility
|
OP
|
$841.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.90 |
| Max. Negotiated Rate |
$420.75 |
| Rate for Payer: Aetna Commercial |
$319.77
|
| Rate for Payer: Aetna Medicare Advantage |
$252.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$214.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$214.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$214.58
|
| Rate for Payer: Cigna Commercial |
$420.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$203.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.22
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.90
|
|
|
SCREW LKG TI R3CON 3.5X10MM
|
Facility
|
IP
|
$841.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$203.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$168.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$203.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.22
|
|
|
SCREW LKG TI R3CON 3.5X16MM
|
Facility
|
OP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Medicare Advantage |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.41
|
| Rate for Payer: Cigna Commercial |
$453.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.77
|
|
|
SCREW LKG TI R3CON 3.5X16MM
|
Facility
|
IP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.12 |
| Max. Negotiated Rate |
$219.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
|
|
SCREW LKG TI R3CON 4.2X10MM
|
Facility
|
OP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Medicare Advantage |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.41
|
| Rate for Payer: Cigna Commercial |
$453.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.77
|
|
|
SCREW LKG TI R3CON 4.2X10MM
|
Facility
|
IP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.12 |
| Max. Negotiated Rate |
$219.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
|
|
SCREW LKG TI R3CON 4.2X14MM
|
Facility
|
OP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Medicare Advantage |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.41
|
| Rate for Payer: Cigna Commercial |
$453.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.77
|
|
|
SCREW LKG TI R3CON 4.2X14MM
|
Facility
|
IP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.12 |
| Max. Negotiated Rate |
$219.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
|
|
SCREW LKG TI R3CON 4.2X16MM
|
Facility
|
OP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Medicare Advantage |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.41
|
| Rate for Payer: Cigna Commercial |
$453.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.77
|
|
|
SCREW LKG TI R3CON 4.2X16MM
|
Facility
|
IP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.12 |
| Max. Negotiated Rate |
$219.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
|
|
SCREW LKG TI R3CON 4.2X18MM
|
Facility
|
OP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Medicare Advantage |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.41
|
| Rate for Payer: Cigna Commercial |
$453.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.77
|
|
|
SCREW LKG TI R3CON 4.2X18MM
|
Facility
|
IP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.12 |
| Max. Negotiated Rate |
$219.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
|
|
SCREW LKG VARIAX FT 3.5X12MM
|
Facility
|
IP
|
$1,257.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.67 |
| Max. Negotiated Rate |
$304.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.67
|
|