|
SCREW LOCKING 5MMX26MM
|
Facility
|
OP
|
$885.00
|
|
| Hospital Charge Code |
270668423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Aetna Commercial |
$336.30
|
| Rate for Payer: Aetna Medicare Advantage |
$265.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$225.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$225.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$225.68
|
| Rate for Payer: Cigna Commercial |
$442.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.13
|
|
|
SCREW LOCKING 5MMX40MM
|
Facility
|
IP
|
$885.00
|
|
| Hospital Charge Code |
270668422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$214.17 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.75
|
|
|
SCREW LOCKING 5MMX40MM
|
Facility
|
OP
|
$885.00
|
|
| Hospital Charge Code |
270668422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Aetna Commercial |
$336.30
|
| Rate for Payer: Aetna Medicare Advantage |
$265.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$225.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$225.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$177.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$225.68
|
| Rate for Payer: Cigna Commercial |
$442.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.13
|
|
|
SCREW LOCKING 5MMx42MM
|
Facility
|
OP
|
$973.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.64 |
| Max. Negotiated Rate |
$486.68 |
| Rate for Payer: Aetna Commercial |
$369.87
|
| Rate for Payer: Aetna Medicare Advantage |
$292.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$194.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.20
|
| Rate for Payer: Cigna Commercial |
$486.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.64
|
|
|
SCREW LOCKING 5MMx42MM
|
Facility
|
IP
|
$973.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$235.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$194.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.00
|
|
|
SCREW LOCKING 5 x 32MM
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$370.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$306.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$370.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.50
|
|
|
SCREW LOCKING 5 x 32MM
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Medicare Advantage |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$390.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$390.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$390.15
|
| Rate for Payer: Cigna Commercial |
$765.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$370.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$229.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.45
|
|
|
SCREW LOCKING 5 X 32 X 5 MM
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$338.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$338.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
|
|
SCREW LOCKING 5 X 32 X 5 MM
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270662869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.76 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Medicare Advantage |
$420.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$357.00
|
| Rate for Payer: Cigna Commercial |
$700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$338.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$44.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.76
|
|
|
SCREW LOCKING 5X34MM XL 25
|
Facility
|
IP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692728
|
|
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 LOCKING 5X34MM XL 25
|
Facility
|
OP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692728
|
|
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 LOCKING 5X35mm 18965035S
|
Facility
|
OP
|
$979.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$489.62 |
| Rate for Payer: Aetna Commercial |
$372.12
|
| Rate for Payer: Aetna Medicare Advantage |
$293.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$249.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$249.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$249.71
|
| Rate for Payer: Cigna Commercial |
$489.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.89
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.81
|
|
|
SCREW LOCKING 5X35mm 18965035S
|
Facility
|
IP
|
$979.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.89 |
| Max. Negotiated Rate |
$236.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.89
|
|
|
SCREW LOCKING 5x36MM
|
Facility
|
OP
|
$924.00
|
|
| Hospital Charge Code |
270665480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna Commercial |
$351.12
|
| Rate for Payer: Aetna Medicare Advantage |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.62
|
| Rate for Payer: Cigna Commercial |
$462.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.24
|
|
|
SCREW LOCKING 5x36MM
|
Facility
|
IP
|
$924.00
|
|
| Hospital Charge Code |
270665480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$223.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$184.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.60
|
|
|
SCREW LOCKING 5X36MM XL25
|
Facility
|
OP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692729
|
|
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 LOCKING 5X36MM XL25
|
Facility
|
IP
|
$888.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692729
|
|
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 LOCKING 5X50MM PART THD
|
Facility
|
OP
|
$1,545.00
|
|
| Hospital Charge Code |
270670467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$772.50 |
| Rate for Payer: Aetna Commercial |
$587.10
|
| Rate for Payer: Aetna Medicare Advantage |
$463.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$393.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$393.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$393.98
|
| Rate for Payer: Cigna Commercial |
$772.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.88
|
|
|
SCREW LOCKING 5X50MM PART THD
|
Facility
|
IP
|
$1,545.00
|
|
| Hospital Charge Code |
270670467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$373.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$309.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.75
|
|
|
SCREW LOCKING 5X60MM PART THD
|
Facility
|
IP
|
$1,545.00
|
|
| Hospital Charge Code |
270670469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$373.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$309.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.75
|
|
|
SCREW LOCKING 5X60MM PART THD
|
Facility
|
OP
|
$1,545.00
|
|
| Hospital Charge Code |
270670469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$772.50 |
| Rate for Payer: Aetna Commercial |
$587.10
|
| Rate for Payer: Aetna Medicare Advantage |
$463.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$393.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$393.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$393.98
|
| Rate for Payer: Cigna Commercial |
$772.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.88
|
|
|
SCREW LOCKING 5X75MM FULLY THD
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$355.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$294.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.50
|
|
|
SCREW LOCKING 5X75MM FULLY THD
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.75 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$558.60
|
| Rate for Payer: Aetna Medicare Advantage |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$374.85
|
| Rate for Payer: Cigna Commercial |
$735.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$355.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$220.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.75
|
|
|
SCREW LOCKING 6.0X72MM T25 SD
|
Facility
|
OP
|
$994.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$497.43 |
| Rate for Payer: Aetna Commercial |
$378.04
|
| Rate for Payer: Aetna Medicare Advantage |
$298.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$253.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$253.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$198.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$253.69
|
| Rate for Payer: Cigna Commercial |
$497.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.25
|
|
|
SCREW LOCKING 6.0X72MM T25 SD
|
Facility
|
IP
|
$994.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.23 |
| Max. Negotiated Rate |
$240.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$198.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.23
|
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