|
SCREW SYN CANN PT THD 4.0/10MM
|
Facility
|
OP
|
$76.85
|
|
| Hospital Charge Code |
270601878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Medicare Advantage |
$23.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.60
|
| Rate for Payer: Cigna Commercial |
$38.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/14MM
|
Facility
|
IP
|
$76.85
|
|
| Hospital Charge Code |
270601880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/14MM
|
Facility
|
OP
|
$76.85
|
|
| Hospital Charge Code |
270601880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Medicare Advantage |
$23.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.60
|
| Rate for Payer: Cigna Commercial |
$38.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/16MM
|
Facility
|
OP
|
$77.65
|
|
| Hospital Charge Code |
270601881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$38.83 |
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Medicare Advantage |
$23.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.80
|
| Rate for Payer: Cigna Commercial |
$38.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
|
|
SCREW SYN CANN PT THD 4.0/16MM
|
Facility
|
IP
|
$77.65
|
|
| Hospital Charge Code |
270601881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$18.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
|
|
SCREW SYN CANN PT THD 4.0/18MM
|
Facility
|
OP
|
$76.85
|
|
| Hospital Charge Code |
270601882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Medicare Advantage |
$23.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.60
|
| Rate for Payer: Cigna Commercial |
$38.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/18MM
|
Facility
|
IP
|
$76.85
|
|
| Hospital Charge Code |
270601882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/24MM
|
Facility
|
OP
|
$76.85
|
|
| Hospital Charge Code |
270601886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Medicare Advantage |
$23.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.60
|
| Rate for Payer: Cigna Commercial |
$38.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/24MM
|
Facility
|
IP
|
$76.85
|
|
| Hospital Charge Code |
270601886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/26MM
|
Facility
|
IP
|
$100.85
|
|
| Hospital Charge Code |
270601887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$24.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.13
|
|
|
SCREW SYN CANN PT THD 4.0/26MM
|
Facility
|
OP
|
$100.85
|
|
| Hospital Charge Code |
270601887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$50.42 |
| Rate for Payer: Aetna Commercial |
$30.25
|
| Rate for Payer: Aetna Medicare Advantage |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.72
|
| Rate for Payer: Cigna Commercial |
$50.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.13
|
|
|
SCREW SYN CANN PT THD 4.0/28MM
|
Facility
|
OP
|
$77.65
|
|
| Hospital Charge Code |
270601888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$38.83 |
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Medicare Advantage |
$23.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.80
|
| Rate for Payer: Cigna Commercial |
$38.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
|
|
SCREW SYN CANN PT THD 4.0/28MM
|
Facility
|
IP
|
$77.65
|
|
| Hospital Charge Code |
270601888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$18.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
|
|
SCREW SYN CANN PT THD 4.0/30MM
|
Facility
|
IP
|
$76.85
|
|
| Hospital Charge Code |
270601889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/30MM
|
Facility
|
OP
|
$76.85
|
|
| Hospital Charge Code |
270601889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Medicare Advantage |
$23.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.60
|
| Rate for Payer: Cigna Commercial |
$38.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/32MM
|
Facility
|
OP
|
$76.85
|
|
| Hospital Charge Code |
270601890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Medicare Advantage |
$23.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.60
|
| Rate for Payer: Cigna Commercial |
$38.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/32MM
|
Facility
|
IP
|
$76.85
|
|
| Hospital Charge Code |
270601890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/35MM
|
Facility
|
IP
|
$77.65
|
|
| Hospital Charge Code |
270601891
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$18.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
|
|
SCREW SYN CANN PT THD 4.0/35MM
|
Facility
|
OP
|
$77.65
|
|
| Hospital Charge Code |
270601891
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$38.83 |
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Medicare Advantage |
$23.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.80
|
| Rate for Payer: Cigna Commercial |
$38.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.65
|
|
|
SCREW SYN CANN PT THD 4.0/50MM
|
Facility
|
IP
|
$76.85
|
|
| Hospital Charge Code |
270601894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.0/50MM
|
Facility
|
OP
|
$76.85
|
|
| Hospital Charge Code |
270601894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Medicare Advantage |
$23.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.60
|
| Rate for Payer: Cigna Commercial |
$38.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.53
|
|
|
SCREW SYN CANN PT THD 4.5/24MM
|
Facility
|
IP
|
$775.25
|
|
| Hospital Charge Code |
270604878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.29 |
| Max. Negotiated Rate |
$187.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.29
|
|
|
SCREW SYN CANN PT THD 4.5/24MM
|
Facility
|
OP
|
$775.25
|
|
| Hospital Charge Code |
270604878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.29 |
| Max. Negotiated Rate |
$387.62 |
| Rate for Payer: Aetna Commercial |
$232.57
|
| Rate for Payer: Aetna Medicare Advantage |
$232.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.69
|
| Rate for Payer: Cigna Commercial |
$387.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.29
|
|
|
SCREW SYN CANN PT THD 4.5/28MM
|
Facility
|
IP
|
$775.25
|
|
| Hospital Charge Code |
270604880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.29 |
| Max. Negotiated Rate |
$187.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.29
|
|
|
SCREW SYN CANN PT THD 4.5/28MM
|
Facility
|
OP
|
$775.25
|
|
| Hospital Charge Code |
270604880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.29 |
| Max. Negotiated Rate |
$387.62 |
| Rate for Payer: Aetna Commercial |
$232.57
|
| Rate for Payer: Aetna Medicare Advantage |
$232.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.69
|
| Rate for Payer: Cigna Commercial |
$387.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.29
|
|