|
SCREW SYN CANC TTN 4.0 40MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 40MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 45MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 45MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 45MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 45MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 50MM**
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
270603218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.65
|
| Rate for Payer: Cigna Commercial |
$15.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
|
|
SCREW SYN CANC TTN 4.0 50MM**
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
270603218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
|
|
SCREW SYN CANC TTN 4.0 55MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 55MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 55MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 55MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 60MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 60MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 65MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 65MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 65MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 65MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 70MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 70MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 70MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 70MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 75MM**
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
270603330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 75MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SCREW SYN CANC TTN 4.0 75MM**
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
270603330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.39
|
| Rate for Payer: Cigna Commercial |
$14.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|