|
SCREW BIO-COMPRESSION 3.5x22MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x22MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x24MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x24MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x26MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x26MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x28MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x28MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x30MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x30MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x32MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x32MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x16MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x16MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x18MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x18MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x20MM
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x20MM
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x22MM
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x22MM
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x24MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270661621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x24MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270661621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x26MM
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$592.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x26MM
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO IFIX TAPR 6-8 254623
|
Facility
|
IP
|
$917.65
|
|
| Hospital Charge Code |
270635267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.65 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$183.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$222.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$137.65
|
|