|
WASHER SMN ACFX 6 17 7207033
|
Facility
|
IP
|
$737.65
|
|
| Hospital Charge Code |
270617673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.65 |
| Max. Negotiated Rate |
$178.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$178.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.65
|
|
|
WASHER SMN ACFX 6 17 7207033
|
Facility
|
OP
|
$737.65
|
|
| Hospital Charge Code |
270617673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.65 |
| Max. Negotiated Rate |
$368.82 |
| Rate for Payer: Aetna Commercial |
$221.29
|
| Rate for Payer: Aetna Medicare Advantage |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$188.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$188.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$188.10
|
| Rate for Payer: Cigna Commercial |
$368.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$178.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.65
|
|
|
WASHER SPIKED 13.5MM/4.0MM
|
Facility
|
OP
|
$504.00
|
|
| Hospital Charge Code |
270656315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Medicare Advantage |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.52
|
| Rate for Payer: Cigna Commercial |
$252.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.60
|
|
|
WASHER SPIKED 13.5MM/4.0MM
|
Facility
|
IP
|
$504.00
|
|
| Hospital Charge Code |
270656315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$121.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.60
|
|
|
WASHER SPIKED 13.5x5.5mm
|
Facility
|
OP
|
$528.35
|
|
| Hospital Charge Code |
270625495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: Aetna Commercial |
$158.50
|
| Rate for Payer: Aetna Medicare Advantage |
$158.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$134.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$134.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$134.73
|
| Rate for Payer: Cigna Commercial |
$264.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.25
|
|
|
WASHER SPIKED 13.5x5.5mm
|
Facility
|
IP
|
$528.35
|
|
| Hospital Charge Code |
270625495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$127.86 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.25
|
|
|
WASHER SYN MINI SCREW 21997
|
Facility
|
OP
|
$121.65
|
|
| Hospital Charge Code |
270604290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$60.83 |
| Rate for Payer: Aetna Commercial |
$36.49
|
| Rate for Payer: Aetna Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.02
|
| Rate for Payer: Cigna Commercial |
$60.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.25
|
|
|
WASHER SYN MINI SCREW 21997
|
Facility
|
IP
|
$121.65
|
|
| Hospital Charge Code |
270604290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.25
|
|
|
WASHER SYN SM SCREW 21998
|
Facility
|
IP
|
$121.65
|
|
| Hospital Charge Code |
270604291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.25
|
|
|
WASHER SYN SM SCREW 21998
|
Facility
|
OP
|
$121.65
|
|
| Hospital Charge Code |
270604291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$60.83 |
| Rate for Payer: Aetna Commercial |
$36.49
|
| Rate for Payer: Aetna Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.02
|
| Rate for Payer: Cigna Commercial |
$60.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.25
|
|
|
WASHER SYN SPIKE 13.5 6 21995S
|
Facility
|
IP
|
$224.00
|
|
| Hospital Charge Code |
270621125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$54.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.60
|
|
|
WASHER SYN SPIKE 13.5 6 21995S
|
Facility
|
OP
|
$224.00
|
|
| Hospital Charge Code |
270621125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$67.20
|
| Rate for Payer: Aetna Medicare Advantage |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$44.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.12
|
| Rate for Payer: Cigna Commercial |
$112.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.60
|
|
|
WASHER SYN SPIKE 13.5MM 21994S
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
270604289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$61.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.40
|
|
|
WASHER SYN SPIKE 13.5MM 21994S
|
Facility
|
OP
|
$256.00
|
|
| Hospital Charge Code |
270604289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$76.80
|
| Rate for Payer: Aetna Medicare Advantage |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.28
|
| Rate for Payer: Cigna Commercial |
$128.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.40
|
|
|
WASHER SYN SPIKE 8.0MM 21993S
|
Facility
|
OP
|
$259.25
|
|
| Hospital Charge Code |
270604288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.89 |
| Max. Negotiated Rate |
$129.62 |
| Rate for Payer: Aetna Commercial |
$77.78
|
| Rate for Payer: Aetna Medicare Advantage |
$77.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.11
|
| Rate for Payer: Cigna Commercial |
$129.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.89
|
|
|
WASHER SYN SPIKE 8.0MM 21993S
|
Facility
|
IP
|
$259.25
|
|
| Hospital Charge Code |
270604288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.89 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.89
|
|
|
WASHER SYN TITANIUM *******
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
1603919
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare Advantage |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.28
|
| Rate for Payer: Cigna Commercial |
$28.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
|
|
WASHER SYN TITANIUM *******
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
1603919
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.40
|
|
|
WASHER TI
|
Facility
|
IP
|
$162.95
|
|
| Hospital Charge Code |
270664978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.44
|
|
|
WASHER TI
|
Facility
|
OP
|
$162.95
|
|
| Hospital Charge Code |
270664978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$81.47 |
| Rate for Payer: Aetna Commercial |
$48.88
|
| Rate for Payer: Aetna Medicare Advantage |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.55
|
| Rate for Payer: Cigna Commercial |
$81.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.18
|
| Rate for Payer: Oxford Commercial |
$81.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$81.47
|
|
|
WASHER TI 7MM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
270674275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
|
|
WASHER TI 7MM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
270674275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Commercial |
$52.50
|
| Rate for Payer: Aetna Medicare Advantage |
$52.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.62
|
| Rate for Payer: Cigna Commercial |
$87.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.75
|
| Rate for Payer: Oxford Commercial |
$87.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$87.50
|
|
|
WASHER TI BONE GRAFT 15MM
|
Facility
|
OP
|
$1,610.00
|
|
| Hospital Charge Code |
270670734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna Commercial |
$483.00
|
| Rate for Payer: Aetna Medicare Advantage |
$483.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$410.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$410.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$322.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$410.55
|
| Rate for Payer: Cigna Commercial |
$805.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$389.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$241.50
|
|
|
WASHER TI BONE GRAFT 15MM
|
Facility
|
IP
|
$1,610.00
|
|
| Hospital Charge Code |
270670734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$389.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$322.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$389.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$241.50
|
|
|
WASHER TITANIUM 10MM
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270669796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$139.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|