|
LOCKING SCREW 6.0 X 76MM
|
Facility
|
OP
|
$965.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$482.93 |
| Rate for Payer: Aetna Commercial |
$367.02
|
| Rate for Payer: Aetna Medicare Advantage |
$289.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$246.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$246.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$246.29
|
| Rate for Payer: Cigna Commercial |
$482.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$233.74
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$212.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.60
|
|
|
LOCKING SCREW T10 3.5MMXL2.0
|
Facility
|
IP
|
$703.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.49 |
| Max. Negotiated Rate |
$170.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.19
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$154.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.49
|
|
|
LOCKING SCREW T10 3.5MMXL2.0
|
Facility
|
OP
|
$703.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$351.62 |
| Rate for Payer: Aetna Commercial |
$267.24
|
| Rate for Payer: Aetna Medicare Advantage |
$210.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$179.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$179.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$179.33
|
| Rate for Payer: Cigna Commercial |
$351.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.19
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$154.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.49
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.64
|
|
|
LOCKING SCREW T 10 3.5X 38 MM
|
Facility
|
IP
|
$2,015.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$302.25 |
| Max. Negotiated Rate |
$487.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$403.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$487.63
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$443.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$302.25
|
|
|
LOCKING SCREW T 10 3.5X 38 MM
|
Facility
|
OP
|
$2,015.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.56 |
| Max. Negotiated Rate |
$1,007.50 |
| Rate for Payer: Aetna Commercial |
$765.70
|
| Rate for Payer: Aetna Medicare Advantage |
$604.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$513.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$513.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$403.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$513.83
|
| Rate for Payer: Cigna Commercial |
$1,007.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$487.63
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$443.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$302.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.40
|
|
|
LOCKING SCREW T2 F/T 5MMX40MM
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270638645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Medicare Advantage |
$420.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$357.00
|
| Rate for Payer: Cigna Commercial |
$700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$338.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$308.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.10
|
|
|
LOCKING SCREW T2 F/T 5MMX40MM
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270638645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$338.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$338.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$308.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
|
|
LOCKING SCREW T8 2.7MMXL20
|
Facility
|
OP
|
$1,242.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.94 |
| Max. Negotiated Rate |
$621.15 |
| Rate for Payer: Aetna Commercial |
$472.07
|
| Rate for Payer: Aetna Medicare Advantage |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$316.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$316.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$316.79
|
| Rate for Payer: Cigna Commercial |
$621.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.64
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$273.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.34
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.92
|
|
|
LOCKING SCREW T8 2.7MMXL20
|
Facility
|
IP
|
$1,242.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.34 |
| Max. Negotiated Rate |
$300.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$248.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.64
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$273.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.34
|
|
|
LOCKING SCREW T8 2.7X22MM
|
Facility
|
IP
|
$1,316.85
|
|
| Hospital Charge Code |
270703217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$318.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$263.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$289.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.53
|
|
|
LOCKING SCREW T8 2.7X22MM
|
Facility
|
OP
|
$1,316.85
|
|
| Hospital Charge Code |
270703217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$658.42 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Medicare Advantage |
$395.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$335.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$335.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$263.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$335.80
|
| Rate for Payer: Cigna Commercial |
$658.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$289.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.90
|
|
|
LOCKING STRAIGHT PLATE, T1, 4H
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$855.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: Cigna Commercial |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$495.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.62
|
|
|
LOCKING STRAIGHT PLATE, T1, 4H
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$495.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
LOCKING STRAIGHT PLATE TI 6H
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$1,187.50 |
| Rate for Payer: Aetna Commercial |
$902.50
|
| Rate for Payer: Aetna Medicare Advantage |
$712.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$605.62
|
| Rate for Payer: Cigna Commercial |
$1,187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$574.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$522.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$57.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$62.94
|
|
|
LOCKING STRAIGHT PLATE TI 6H
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.25 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$574.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$522.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
|
|
LOCKNG SCREW TITANIUM 3.5MMX26
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$165.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
LOCKNG SCREW TITANIUM 3.5MMX26
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$165.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LOCK PLATE STR 1.5MM
|
Facility
|
OP
|
$2,915.00
|
|
| Hospital Charge Code |
270702794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.25 |
| Max. Negotiated Rate |
$1,457.50 |
| Rate for Payer: Aetna Commercial |
$1,107.70
|
| Rate for Payer: Aetna Medicare Advantage |
$874.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$743.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$743.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$583.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$743.33
|
| Rate for Payer: Cigna Commercial |
$1,457.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$705.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$641.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$437.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$70.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$77.25
|
|
|
LOCK PLATE STR 1.5MM
|
Facility
|
IP
|
$2,915.00
|
|
| Hospital Charge Code |
270702794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.25 |
| Max. Negotiated Rate |
$705.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$583.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$705.43
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$641.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$437.25
|
|
|
LOCK RING ALLOY
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.60 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,280.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,530.00
|
| Rate for Payer: Cigna Commercial |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,320.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$144.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$159.00
|
|
|
LOCK RING ALLOY
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,320.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
LOCK SCREW 1.5X13MM
|
Facility
|
OP
|
$687.50
|
|
| Hospital Charge Code |
270702797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$343.75 |
| Rate for Payer: Aetna Commercial |
$261.25
|
| Rate for Payer: Aetna Medicare Advantage |
$206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$175.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$175.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$175.31
|
| Rate for Payer: Cigna Commercial |
$343.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$166.38
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.22
|
|
|
LOCK SCREW 1.5X13MM
|
Facility
|
IP
|
$687.50
|
|
| Hospital Charge Code |
270702797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.12 |
| Max. Negotiated Rate |
$166.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$166.38
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.12
|
|
|
LOCK SCREW 1.5X14MM
|
Facility
|
IP
|
$687.50
|
|
| Hospital Charge Code |
270702803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.12 |
| Max. Negotiated Rate |
$166.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$166.38
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.12
|
|
|
LOCK SCREW 1.5X14MM
|
Facility
|
OP
|
$687.50
|
|
| Hospital Charge Code |
270702803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$343.75 |
| Rate for Payer: Aetna Commercial |
$261.25
|
| Rate for Payer: Aetna Medicare Advantage |
$206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$175.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$175.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$175.31
|
| Rate for Payer: Cigna Commercial |
$343.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$166.38
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.22
|
|