|
SCREW SYN CORT 1.5 18MM
|
Facility
|
OP
|
$67.25
|
|
| Hospital Charge Code |
270604168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
SCREW SYN CORT 1.5 18MM
|
Facility
|
IP
|
$67.25
|
|
| Hospital Charge Code |
270604168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
SCREW SYN CORT 1.5 20MM
|
Facility
|
IP
|
$67.25
|
|
| Hospital Charge Code |
270604169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
SCREW SYN CORT 1.5 20MM
|
Facility
|
OP
|
$67.25
|
|
| Hospital Charge Code |
270604169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
SCREW SYN CORT 1.5 4 400.734
|
Facility
|
IP
|
$231.25
|
|
| Hospital Charge Code |
270619570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$55.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.96
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$50.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.69
|
|
|
SCREW SYN CORT 1.5 4 400.734
|
Facility
|
OP
|
$231.25
|
|
| Hospital Charge Code |
270619570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$115.62 |
| Rate for Payer: Aetna Commercial |
$87.88
|
| Rate for Payer: Aetna Medicare Advantage |
$69.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.97
|
| Rate for Payer: Cigna Commercial |
$115.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.96
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$50.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.13
|
|
|
SCREW SYN CORT 1.5 6 400.736
|
Facility
|
IP
|
$231.25
|
|
| Hospital Charge Code |
270619571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$55.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.96
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$50.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.69
|
|
|
SCREW SYN CORT 1.5 6 400.736
|
Facility
|
OP
|
$231.25
|
|
| Hospital Charge Code |
270619571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$115.62 |
| Rate for Payer: Aetna Commercial |
$87.88
|
| Rate for Payer: Aetna Medicare Advantage |
$69.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.97
|
| Rate for Payer: Cigna Commercial |
$115.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.96
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$50.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.13
|
|
|
SCREW SYN CORT 1.5 6MM 200.06
|
Facility
|
OP
|
$67.25
|
|
| Hospital Charge Code |
270604159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
SCREW SYN CORT 1.5 6MM 200.06
|
Facility
|
IP
|
$67.25
|
|
| Hospital Charge Code |
270604159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
SCREW SYN CORT 1.5 7MM
|
Facility
|
OP
|
$67.25
|
|
| Hospital Charge Code |
270604160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
SCREW SYN CORT 1.5 7MM
|
Facility
|
IP
|
$67.25
|
|
| Hospital Charge Code |
270604160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
SCREW SYN CORT 1.5 8MM
|
Facility
|
OP
|
$67.25
|
|
| Hospital Charge Code |
270604161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
SCREW SYN CORT 1.5 8MM
|
Facility
|
IP
|
$67.25
|
|
| Hospital Charge Code |
270604161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
SCREW SYN CORT 1.7 4 400.654
|
Facility
|
IP
|
$358.45
|
|
| Hospital Charge Code |
270617338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.77 |
| Max. Negotiated Rate |
$86.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.74
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$78.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.77
|
|
|
SCREW SYN CORT 1.7 4 400.654
|
Facility
|
OP
|
$358.45
|
|
| Hospital Charge Code |
270617338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$179.22 |
| Rate for Payer: Aetna Commercial |
$136.21
|
| Rate for Payer: Aetna Medicare Advantage |
$107.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$71.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.40
|
| Rate for Payer: Cigna Commercial |
$179.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.74
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$78.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.77
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.50
|
|
|
SCREW SYN CORT 2.0 10MM 201.10
|
Facility
|
IP
|
$67.25
|
|
| Hospital Charge Code |
270604172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
SCREW SYN CORT 2.0 10MM 201.10
|
Facility
|
OP
|
$67.25
|
|
| Hospital Charge Code |
270604172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
SCREW SYN CORT 2.0 22MM 201.22
|
Facility
|
OP
|
$67.25
|
|
| Hospital Charge Code |
270604178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
SCREW SYN CORT 2.0 22MM 201.22
|
Facility
|
IP
|
$67.25
|
|
| Hospital Charge Code |
270604178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
SCREW SYN CORT 2.0 24MM 201.24
|
Facility
|
OP
|
$67.25
|
|
| Hospital Charge Code |
270604179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
SCREW SYN CORT 2.0 24MM 201.24
|
Facility
|
IP
|
$67.25
|
|
| Hospital Charge Code |
270604179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
SCREW SYN CORT 2.0 26MM 201.26
|
Facility
|
OP
|
$67.25
|
|
| Hospital Charge Code |
270604180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|
|
SCREW SYN CORT 2.0 26MM 201.26
|
Facility
|
IP
|
$67.25
|
|
| Hospital Charge Code |
270604180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
SCREW SYN CORT 2.0 28MM 201.28
|
Facility
|
OP
|
$67.25
|
|
| Hospital Charge Code |
270604181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$14.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.78
|
|