|
SCREW METAPHYSEAL T8 2.7x22MM
|
Facility
|
IP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$48.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
|
|
SCREW METAPHYSEAL T8 2.7x24MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270676866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.53
|
|
|
SCREW METAPHYSEAL T8 2.7x24MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270676866
|
|
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 2.7x26MM
|
Facility
|
OP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.13
|
| Rate for Payer: Cigna Commercial |
$100.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.69
|
|
|
SCREW METAPHYSEAL T8 2.7x26MM
|
Facility
|
IP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$48.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
|
|
SCREW METAPHYSEAL T8 2.7x28MM
|
Facility
|
OP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.13
|
| Rate for Payer: Cigna Commercial |
$100.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.69
|
|
|
SCREW METAPHYSEAL T8 2.7x28MM
|
Facility
|
IP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$48.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
|
|
SCREW METAPHYSEAL T8 2.7x38MM
|
Facility
|
IP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$48.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
|
|
SCREW METAPHYSEAL T8 2.7x38MM
|
Facility
|
OP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.13
|
| Rate for Payer: Cigna Commercial |
$100.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.69
|
|
|
SCREW METAPHYSEAL T8 2.7x40MM
|
Facility
|
IP
|
$194.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673552
|
|
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 2.7x40MM
|
Facility
|
OP
|
$194.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.53
|
|
|
SCREW METAPHYSEAL T8 2.7x42MM
|
Facility
|
OP
|
$215.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$107.90 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Medicare Advantage |
$64.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$55.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$55.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$43.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$55.03
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.13
|
|
|
SCREW METAPHYSEAL T8 2.7x42MM
|
Facility
|
IP
|
$215.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$52.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$43.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.37
|
|
|
SCREW METAPHYSEAL T8 2.7x48MM
|
Facility
|
OP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.13
|
| Rate for Payer: Cigna Commercial |
$100.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.69
|
|
|
SCREW METAPHYSEAL T8 2.7x48MM
|
Facility
|
IP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$48.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
|
|
SCREW METAPHYSEAL T8 2.7x50MM
|
Facility
|
OP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.13
|
| Rate for Payer: Cigna Commercial |
$100.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.69
|
|
|
SCREW METAPHYSEAL T8 2.7x50MM
|
Facility
|
IP
|
$200.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$48.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$40.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.07
|
|
|
SCREW METAPHYSEAL T8 2.7x52MM
|
Facility
|
IP
|
$194.65
|
|
| Hospital Charge Code |
270673551
|
|
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 2.7x52MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270673551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.53
|
|
|
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 |
$5.53 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.53
|
|
|
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 2.7x56MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270669501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.53
|
|
|
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 2.7x58MM
|
Facility
|
OP
|
$194.65
|
|
| Hospital Charge Code |
270677651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna Commercial |
$73.97
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.53
|
|