|
SCREW LOCKING 3.5x26MM
|
Facility
|
OP
|
$740.00
|
|
| Hospital Charge Code |
270660766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$281.20
|
| Rate for Payer: Aetna Medicare Advantage |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$148.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$188.70
|
| Rate for Payer: Cigna Commercial |
$370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.02
|
|
|
SCREW LOCKING 3.5x26MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5x26MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5x26MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING 3.5 X 28MM
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
270665939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$304.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.72
|
|
|
SCREW LOCKING 3.5 X 28MM
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
270665939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$193.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
SCREW LOCKING 3.5x28MM
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.89
|
|
|
SCREW LOCKING 3.5x28MM
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
270656785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5x28MM
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
270656785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING 3.5x28MM
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5X28MM
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$390.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$323.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$390.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$242.25
|
|
|
SCREW LOCKING 3.5X28MM
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.87 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: Aetna Commercial |
$613.70
|
| Rate for Payer: Aetna Medicare Advantage |
$484.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$411.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$411.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$323.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$411.82
|
| Rate for Payer: Cigna Commercial |
$807.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$390.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$242.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.87
|
|
|
SCREW LOCKING 3.5x30mm
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
669262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.89
|
|
|
SCREW LOCKING 3.5x30mm
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
669262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5x30MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING 3.5x30MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5x30MM
|
Facility
|
OP
|
$740.00
|
|
| Hospital Charge Code |
270660764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$281.20
|
| Rate for Payer: Aetna Medicare Advantage |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$148.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$188.70
|
| Rate for Payer: Cigna Commercial |
$370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.02
|
|
|
SCREW LOCKING 3.5x30MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING 3.5x30MM
|
Facility
|
IP
|
$740.00
|
|
| Hospital Charge Code |
270660764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$179.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$148.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.00
|
|
|
SCREW LOCKING 3.5x30MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5X30MM
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW LOCKING 3.5X30MM
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.52
|
|
|
SCREW LOCKING 3.5x32mm
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
270671861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW LOCKING 3.5x32mm
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
270671861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.89
|
|
|
SCREW LOCKING 3.5x32MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|