|
SCREW 3.5MM CORTEX 38MM
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270651357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
SCREW 3.5MM CORTEX 80MM
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
270651358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$60.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.00
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
SCREW 3.5MM CORTEX 80MM
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
270651358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
OP
|
$87.75
|
|
| Hospital Charge Code |
270656834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare Advantage |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.38
|
| Rate for Payer: Cigna Commercial |
$43.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
OP
|
$87.75
|
|
| Hospital Charge Code |
270656831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare Advantage |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.38
|
| Rate for Payer: Cigna Commercial |
$43.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
OP
|
$87.75
|
|
| Hospital Charge Code |
270656835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare Advantage |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.38
|
| Rate for Payer: Cigna Commercial |
$43.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
OP
|
$87.75
|
|
| Hospital Charge Code |
270656829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare Advantage |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.38
|
| Rate for Payer: Cigna Commercial |
$43.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
OP
|
$87.75
|
|
| Hospital Charge Code |
270656841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare Advantage |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.38
|
| Rate for Payer: Cigna Commercial |
$43.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
OP
|
$87.75
|
|
| Hospital Charge Code |
270656839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare Advantage |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.38
|
| Rate for Payer: Cigna Commercial |
$43.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
OP
|
$87.75
|
|
| Hospital Charge Code |
270656840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare Advantage |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.38
|
| Rate for Payer: Cigna Commercial |
$43.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
OP
|
$87.75
|
|
| Hospital Charge Code |
270656921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare Advantage |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.38
|
| Rate for Payer: Cigna Commercial |
$43.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
OP
|
$87.75
|
|
| Hospital Charge Code |
270656838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$43.88 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare Advantage |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.38
|
| Rate for Payer: Cigna Commercial |
$43.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|
|
SCREW 3.5MM CORTEX SELF TAP
|
Facility
|
IP
|
$87.75
|
|
| Hospital Charge Code |
270656925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.16
|
|