|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$61.70
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3038533C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.26
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$160.85
|
|
|
Service Code
|
HCPCS 83945
|
| Hospital Charge Code |
3038533A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$24.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.13
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$152.65
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
3038533L
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$22.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.90
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$268.50
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3038533H
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.27
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$268.50
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3038533H
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Aetna Commercial |
$6.12
|
| Rate for Payer: Aetna Medicare Advantage |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.12
|
| Rate for Payer: Cigna Commercial |
$134.25
|
| Rate for Payer: Cigna Medicare Advantage |
$2.25
|
| Rate for Payer: Clover Medicare Advantage |
$2.14
|
| Rate for Payer: EmblemHealth Commercial |
$6.75
|
| Rate for Payer: Humana Medicare Advantage |
$2.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.55
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.12
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$153.65
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3038533I
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
3038533J
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: Aetna Medicare Advantage |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.77
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6.03
|
| Rate for Payer: Clover Medicare Advantage |
$5.73
|
| Rate for Payer: EmblemHealth Commercial |
$18.09
|
| Rate for Payer: Humana Medicare Advantage |
$6.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.38
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
3038533D
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.76
|
| Rate for Payer: Aetna Medicare Advantage |
$16.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.27
|
| Rate for Payer: Cigna Commercial |
$36.42
|
| Rate for Payer: Cigna Medicare Advantage |
$5.06
|
| Rate for Payer: Clover Medicare Advantage |
$4.81
|
| Rate for Payer: EmblemHealth Commercial |
$15.18
|
| Rate for Payer: Humana Medicare Advantage |
$5.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.86
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.93
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$91.25
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
3038533O
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.69
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$338.45
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
3038533K
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$169.22 |
| Rate for Payer: Aetna Commercial |
$75.62
|
| Rate for Payer: Aetna Medicare Advantage |
$90.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$100.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$100.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$77.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$100.35
|
| Rate for Payer: Cigna Commercial |
$169.22
|
| Rate for Payer: Cigna Medicare Advantage |
$27.80
|
| Rate for Payer: Clover Medicare Advantage |
$26.41
|
| Rate for Payer: EmblemHealth Commercial |
$83.40
|
| Rate for Payer: Humana Medicare Advantage |
$28.63
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$27.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.53
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.97
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$152.65
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
3038533L
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Medicare Advantage |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.70
|
| Rate for Payer: Cigna Commercial |
$76.33
|
| Rate for Payer: Cigna Medicare Advantage |
$5.18
|
| Rate for Payer: Clover Medicare Advantage |
$4.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.05
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$91.25
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
3038533O
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Medicare Advantage |
$22.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.62
|
| Rate for Payer: Cigna Commercial |
$45.62
|
| Rate for Payer: Cigna Medicare Advantage |
$6.82
|
| Rate for Payer: Clover Medicare Advantage |
$6.48
|
| Rate for Payer: EmblemHealth Commercial |
$20.46
|
| Rate for Payer: Humana Medicare Advantage |
$7.02
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.38
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.46
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.42
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$63.25
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
3038533F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$13.82
|
| Rate for Payer: Aetna Medicare Advantage |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.34
|
| Rate for Payer: Cigna Commercial |
$31.62
|
| Rate for Payer: Cigna Medicare Advantage |
$5.08
|
| Rate for Payer: Clover Medicare Advantage |
$4.83
|
| Rate for Payer: EmblemHealth Commercial |
$15.24
|
| Rate for Payer: Humana Medicare Advantage |
$5.23
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.98
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.68
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$63.25
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
3038533F
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$153.65
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3038533I
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$62.51
|
| Rate for Payer: Aetna Medicare Advantage |
$74.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.95
|
| Rate for Payer: Cigna Commercial |
$76.83
|
| Rate for Payer: Cigna Medicare Advantage |
$22.98
|
| Rate for Payer: Clover Medicare Advantage |
$21.83
|
| Rate for Payer: EmblemHealth Commercial |
$68.94
|
| Rate for Payer: Humana Medicare Advantage |
$23.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$22.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.09
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.07
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
3038533J
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.80
|
|
|
24 HOUR URINE FOR KIDNEY STONE
|
Facility
|
OP
|
$152.65
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
3038533M
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Medicare Advantage |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.70
|
| Rate for Payer: Cigna Commercial |
$76.33
|
| Rate for Payer: Cigna Medicare Advantage |
$5.18
|
| Rate for Payer: Clover Medicare Advantage |
$4.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.80
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.05
|
|
|
2.4 LOCK VOLAR PLATE LEFT
|
Facility
|
IP
|
$4,194.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.22 |
| Max. Negotiated Rate |
$1,015.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$838.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,015.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$922.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$629.22
|
|
|
2.4 LOCK VOLAR PLATE LEFT
|
Facility
|
OP
|
$4,194.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.09 |
| Max. Negotiated Rate |
$2,097.40 |
| Rate for Payer: Aetna Commercial |
$1,594.02
|
| Rate for Payer: Aetna Medicare Advantage |
$1,258.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,069.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,069.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$838.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,069.67
|
| Rate for Payer: Cigna Commercial |
$2,097.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,015.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$922.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$629.22
|
| Rate for Payer: UnitedHealthcare Community & State |
$101.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$111.16
|
|
|
2.4MM CAN SCREWSHORT THREAD 18
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.71 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$326.55
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$189.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.77
|
|
|
2.4MM CAN SCREWSHORT THREAD 18
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$189.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
2.4MM VA-LCP 2-CLMN PL 7H HD/4
|
Facility
|
IP
|
$4,535.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$680.30 |
| Max. Negotiated Rate |
$1,097.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$907.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,097.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$997.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$680.30
|
|
|
2.4MM VA-LCP 2-CLMN PL 7H HD/4
|
Facility
|
OP
|
$4,535.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.30 |
| Max. Negotiated Rate |
$2,267.68 |
| Rate for Payer: Aetna Commercial |
$1,723.43
|
| Rate for Payer: Aetna Medicare Advantage |
$1,360.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,156.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,156.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$907.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,156.51
|
| Rate for Payer: Cigna Commercial |
$2,267.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,097.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$997.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$680.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$109.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$120.19
|
|
|
2.4 MM VA LOCKING SCREWSTARDDR
|
Facility
|
OP
|
$695.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$347.80 |
| Rate for Payer: Aetna Commercial |
$264.33
|
| Rate for Payer: Aetna Medicare Advantage |
$208.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$177.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$177.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$177.38
|
| Rate for Payer: Cigna Commercial |
$347.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$168.34
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$153.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.34
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.43
|
|
|
2.4 MM VA LOCKING SCREWSTARDDR
|
Facility
|
IP
|
$695.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.34 |
| Max. Negotiated Rate |
$168.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$168.34
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$153.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.34
|
|
