|
SCREW METAPHYSEAL T8 2.7x54MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270677650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x54MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270677650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Aetna Medicare Advantage |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.64
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x56MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270669501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Aetna Medicare Advantage |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.64
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x56MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270669501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x58MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270677651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Aetna Medicare Advantage |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.64
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x58MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270677651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x60MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270677652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x60MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270677652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Aetna Medicare Advantage |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.64
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x62MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270677653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x62MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270677653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Aetna Medicare Advantage |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.64
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x64MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270677654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Aetna Medicare Advantage |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.64
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x64MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270677654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x66MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270677655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Aetna Medicare Advantage |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.64
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x66MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270677655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x68MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270677656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Aetna Medicare Advantage |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.64
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x68MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270677656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x70MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270677657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Aetna Medicare Advantage |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.64
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW METAPHYSEAL T8 2.7x70MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270677657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.20
|
|
|
SCREW MICA 4X36MM FULL THREAD
|
Facility
|
IP
|
$2,860.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$692.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$572.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$692.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$429.00
|
|
|
SCREW MICA 4X36MM FULL THREAD
|
Facility
|
OP
|
$2,860.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$858.00
|
| Rate for Payer: Aetna Medicare Advantage |
$858.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$729.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$729.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$572.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$729.30
|
| Rate for Payer: Cigna Commercial |
$1,430.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$692.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$429.00
|
|
|
SCREW MILAGRO 8 X 30MM
|
Facility
|
IP
|
$2,290.00
|
|
| Hospital Charge Code |
270668385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.50 |
| Max. Negotiated Rate |
$554.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$458.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$554.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.50
|
|
|
SCREW MILAGRO 8 X 30MM
|
Facility
|
OP
|
$2,290.00
|
|
| Hospital Charge Code |
270668385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.50 |
| Max. Negotiated Rate |
$1,145.00 |
| Rate for Payer: Aetna Commercial |
$687.00
|
| Rate for Payer: Aetna Medicare Advantage |
$687.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$583.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$583.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$458.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$583.95
|
| Rate for Payer: Cigna Commercial |
$1,145.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$554.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.50
|
|
|
SCREW MILAGRO ADVANCE 8 X 30 M
|
Facility
|
OP
|
$2,290.00
|
|
| Hospital Charge Code |
270667707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.50 |
| Max. Negotiated Rate |
$1,145.00 |
| Rate for Payer: Aetna Commercial |
$687.00
|
| Rate for Payer: Aetna Medicare Advantage |
$687.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$583.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$583.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$458.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$583.95
|
| Rate for Payer: Cigna Commercial |
$1,145.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$554.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.50
|
|
|
SCREW MILAGRO ADVANCE 8 X 30 M
|
Facility
|
IP
|
$2,290.00
|
|
| Hospital Charge Code |
270667707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.50 |
| Max. Negotiated Rate |
$554.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$458.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$554.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$343.50
|
|
|
SCREW MINIMON HDLS 2.5X30MM
|
Facility
|
IP
|
$1,141.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$276.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$276.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.19
|
|