|
SCREW 6.5MM CANCELLOUS 75MM
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
270656185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANCELLOUS 80MM
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
270656186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANCELLOUS 80MM
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
270656186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANCELLOUS 85MM
|
Facility
|
OP
|
$145.50
|
|
| Hospital Charge Code |
270656187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Aetna Commercial |
$43.65
|
| Rate for Payer: Aetna Medicare Advantage |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.10
|
| Rate for Payer: Cigna Commercial |
$72.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.82
|
|
|
SCREW 6.5MM CANCELLOUS 85MM
|
Facility
|
IP
|
$145.50
|
|
| Hospital Charge Code |
270656187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$35.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.82
|
|
|
SCREW 6.5MM CANCELLOUS 90MM
|
Facility
|
OP
|
$145.50
|
|
| Hospital Charge Code |
270656188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Aetna Commercial |
$43.65
|
| Rate for Payer: Aetna Medicare Advantage |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.10
|
| Rate for Payer: Cigna Commercial |
$72.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.82
|
|
|
SCREW 6.5MM CANCELLOUS 90MM
|
Facility
|
IP
|
$145.50
|
|
| Hospital Charge Code |
270656188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$35.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.82
|
|
|
SCREW 6.5MM CANCELLOUS 95MM
|
Facility
|
IP
|
$145.50
|
|
| Hospital Charge Code |
270656189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$35.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.82
|
|
|
SCREW 6.5MM CANCELLOUS 95MM
|
Facility
|
OP
|
$145.50
|
|
| Hospital Charge Code |
270656189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Aetna Commercial |
$43.65
|
| Rate for Payer: Aetna Medicare Advantage |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.10
|
| Rate for Payer: Cigna Commercial |
$72.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.82
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
OP
|
$143.75
|
|
| Hospital Charge Code |
272656204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$71.88 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna Medicare Advantage |
$43.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.66
|
| Rate for Payer: Cigna Commercial |
$71.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.56
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
270656201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
270656202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
IP
|
$143.75
|
|
| Hospital Charge Code |
272656204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$28.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.56
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
270656193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
270656193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
270656202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
270656199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
270656199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
270656204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
270656197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
270656197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
270656204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
270656201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL THREAD
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
270656196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 6.5MM CANC FULL THREAD
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
270656196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|