|
SCREW SYN CORT 4.5/85MM 214.85
|
Facility
|
IP
|
$111.25
|
|
| Hospital Charge Code |
270603752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$26.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.69
|
|
|
SCREW SYN CORT 4.5/90MM 214.90
|
Facility
|
OP
|
$111.25
|
|
| Hospital Charge Code |
270603753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$55.62 |
| Rate for Payer: Aetna Commercial |
$33.38
|
| Rate for Payer: Aetna Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.37
|
| Rate for Payer: Cigna Commercial |
$55.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.69
|
|
|
SCREW SYN CORT 4.5/90MM 214.90
|
Facility
|
IP
|
$111.25
|
|
| Hospital Charge Code |
270603753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$26.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.69
|
|
|
SCREW SYN CORT 4.5/95MM 214.95
|
Facility
|
OP
|
$111.25
|
|
| Hospital Charge Code |
270603754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$55.62 |
| Rate for Payer: Aetna Commercial |
$33.38
|
| Rate for Payer: Aetna Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.37
|
| Rate for Payer: Cigna Commercial |
$55.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.69
|
|
|
SCREW SYN CORT 4.5/95MM 214.95
|
Facility
|
IP
|
$111.25
|
|
| Hospital Charge Code |
270603754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$26.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$22.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.69
|
|
|
SCREW SYN CORT TITN 1.5/10MM**
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
270602975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
|
|
SCREW SYN CORT TITN 1.5/10MM**
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
270602975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Medicare Advantage |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.12
|
| Rate for Payer: Cigna Commercial |
$37.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.25
|
|
|
SCREW SYN CORT TITN 1.5/14MM
|
Facility
|
OP
|
$192.85
|
|
| Hospital Charge Code |
270602979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Aetna Medicare Advantage |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.18
|
| Rate for Payer: Cigna Commercial |
$96.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/14MM
|
Facility
|
IP
|
$192.85
|
|
| Hospital Charge Code |
270602979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/16MM
|
Facility
|
IP
|
$192.85
|
|
| Hospital Charge Code |
270602980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/16MM
|
Facility
|
OP
|
$192.85
|
|
| Hospital Charge Code |
270602980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Aetna Medicare Advantage |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.18
|
| Rate for Payer: Cigna Commercial |
$96.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/18MM
|
Facility
|
OP
|
$192.85
|
|
| Hospital Charge Code |
270602981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Aetna Medicare Advantage |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.18
|
| Rate for Payer: Cigna Commercial |
$96.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/18MM
|
Facility
|
IP
|
$192.85
|
|
| Hospital Charge Code |
270602981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/20MM
|
Facility
|
IP
|
$192.85
|
|
| Hospital Charge Code |
270602982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/20MM
|
Facility
|
OP
|
$192.85
|
|
| Hospital Charge Code |
270602982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Aetna Medicare Advantage |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.18
|
| Rate for Payer: Cigna Commercial |
$96.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/22MM
|
Facility
|
IP
|
$192.85
|
|
| Hospital Charge Code |
270602983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/22MM
|
Facility
|
OP
|
$192.85
|
|
| Hospital Charge Code |
270602983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Aetna Medicare Advantage |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.18
|
| Rate for Payer: Cigna Commercial |
$96.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/24MM
|
Facility
|
IP
|
$192.85
|
|
| Hospital Charge Code |
270602984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/24MM
|
Facility
|
OP
|
$192.85
|
|
| Hospital Charge Code |
270602984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Aetna Medicare Advantage |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.18
|
| Rate for Payer: Cigna Commercial |
$96.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/8MM
|
Facility
|
OP
|
$192.85
|
|
| Hospital Charge Code |
270603950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Aetna Medicare Advantage |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.18
|
| Rate for Payer: Cigna Commercial |
$96.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/8MM
|
Facility
|
IP
|
$192.85
|
|
| Hospital Charge Code |
270603950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/9MM
|
Facility
|
OP
|
$192.85
|
|
| Hospital Charge Code |
270602974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Aetna Medicare Advantage |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.18
|
| Rate for Payer: Cigna Commercial |
$96.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 1.5/9MM
|
Facility
|
IP
|
$192.85
|
|
| Hospital Charge Code |
270602974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 2.0/8MM
|
Facility
|
IP
|
$192.85
|
|
| Hospital Charge Code |
270603029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|
|
SCREW SYN CORT TITN 2.0/8MM
|
Facility
|
OP
|
$192.85
|
|
| Hospital Charge Code |
270603029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Aetna Medicare Advantage |
$57.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$49.18
|
| Rate for Payer: Cigna Commercial |
$96.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.93
|
|