|
SCREW 2.4X16 LAG CANNULATED
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
270648906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$193.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$176.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
SCREW 2.4X16MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.57
|
|
|
SCREW 2.4X16MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW 2.4x18 LAG CANNULATED
|
Facility
|
OP
|
$23,495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.23 |
| Max. Negotiated Rate |
$11,747.50 |
| Rate for Payer: Aetna Commercial |
$8,928.10
|
| Rate for Payer: Aetna Medicare Advantage |
$7,048.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,991.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,991.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,699.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,991.23
|
| Rate for Payer: Cigna Commercial |
$11,747.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,685.79
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,168.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,524.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$566.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$622.62
|
|
|
SCREW 2.4x18 LAG CANNULATED
|
Facility
|
IP
|
$23,495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,524.25 |
| Max. Negotiated Rate |
$5,685.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,699.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,685.79
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,168.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,524.25
|
|
|
SCREW 2.4 X19 HCS LONG THREAD
|
Facility
|
IP
|
$1,709.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.37 |
| Max. Negotiated Rate |
$413.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$341.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.61
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$376.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.37
|
|
|
SCREW 2.4 X19 HCS LONG THREAD
|
Facility
|
OP
|
$1,709.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.19 |
| Max. Negotiated Rate |
$854.58 |
| Rate for Payer: Aetna Commercial |
$649.48
|
| Rate for Payer: Aetna Medicare Advantage |
$512.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$435.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$435.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$435.83
|
| Rate for Payer: Cigna Commercial |
$854.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$413.61
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$376.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$41.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.29
|
|
|
SCREW 2.4X26MM
|
Facility
|
IP
|
$1,035.00
|
|
| Hospital Charge Code |
270702594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.25 |
| Max. Negotiated Rate |
$250.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$207.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$250.47
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$227.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.25
|
|
|
SCREW 2.4X26MM
|
Facility
|
OP
|
$1,035.00
|
|
| Hospital Charge Code |
270702594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Medicare Advantage |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$263.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$263.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$207.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$263.93
|
| Rate for Payer: Cigna Commercial |
$517.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$250.47
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$227.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.43
|
|
|
SCREW 2.4 X 26MM HEADLESS LONG
|
Facility
|
OP
|
$1,410.00
|
|
| Hospital Charge Code |
270664493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.98 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Aetna Commercial |
$535.80
|
| Rate for Payer: Aetna Medicare Advantage |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$359.55
|
| Rate for Payer: Cigna Commercial |
$705.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$310.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.37
|
|
|
SCREW 2.4 X 26MM HEADLESS LONG
|
Facility
|
IP
|
$1,410.00
|
|
| Hospital Charge Code |
270664493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$341.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$310.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
|
|
SCREW 2.4 X 30 LOCKING
|
Facility
|
IP
|
$1,035.00
|
|
| Hospital Charge Code |
270702596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.25 |
| Max. Negotiated Rate |
$250.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$207.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$250.47
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$227.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.25
|
|
|
SCREW 2.4 X 30 LOCKING
|
Facility
|
OP
|
$1,035.00
|
|
| Hospital Charge Code |
270702596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Medicare Advantage |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$263.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$263.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$207.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$263.93
|
| Rate for Payer: Cigna Commercial |
$517.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$250.47
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$227.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$155.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.43
|
|
|
SCREW 25MM
|
Facility
|
OP
|
$5,210.00
|
|
| Hospital Charge Code |
270702578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.56 |
| Max. Negotiated Rate |
$2,605.00 |
| Rate for Payer: Aetna Commercial |
$1,979.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,563.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,328.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,328.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,042.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,328.55
|
| Rate for Payer: Cigna Commercial |
$2,605.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,260.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,146.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$781.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$125.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$138.06
|
|
|
SCREW 25MM
|
Facility
|
IP
|
$5,210.00
|
|
| Hospital Charge Code |
270702578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.50 |
| Max. Negotiated Rate |
$1,260.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,042.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,260.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,146.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$781.50
|
|
|
SCREW 2.5MM 3 FLUTED DRILL BIT
|
Facility
|
OP
|
$954.00
|
|
| Hospital Charge Code |
270657061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$477.00 |
| Rate for Payer: Aetna Commercial |
$362.52
|
| Rate for Payer: Aetna Medicare Advantage |
$286.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$243.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$243.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$243.27
|
| Rate for Payer: Cigna Commercial |
$477.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$209.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$143.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.28
|
|
|
SCREW 2.5MM 3 FLUTED DRILL BIT
|
Facility
|
IP
|
$954.00
|
|
| Hospital Charge Code |
270657061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.10 |
| Max. Negotiated Rate |
$230.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$209.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$143.10
|
|
|
SCREW 25 MM TRIO VERSAFITCUP
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$55.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.62
|
|
|
SCREW 25 MM TRIO VERSAFITCUP
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$60.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$55.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
SCREW 2.5MM X 18MM CANNULATED
|
Facility
|
OP
|
$745.00
|
|
| Hospital Charge Code |
270661795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$372.50 |
| Rate for Payer: Aetna Commercial |
$283.10
|
| Rate for Payer: Aetna Medicare Advantage |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.97
|
| Rate for Payer: Cigna Commercial |
$372.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$163.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.74
|
|
|
SCREW 2.5MM X 18MM CANNULATED
|
Facility
|
IP
|
$745.00
|
|
| Hospital Charge Code |
270661795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$180.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$163.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.75
|
|
|
SCREW 2.5MM X 20MM CANNULATED
|
Facility
|
OP
|
$745.00
|
|
| Hospital Charge Code |
270661797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$372.50 |
| Rate for Payer: Aetna Commercial |
$283.10
|
| Rate for Payer: Aetna Medicare Advantage |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.97
|
| Rate for Payer: Cigna Commercial |
$372.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$163.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.74
|
|
|
SCREW 2.5MM X 20MM CANNULATED
|
Facility
|
IP
|
$745.00
|
|
| Hospital Charge Code |
270661797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$180.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.29
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$163.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.75
|
|
|
SCREW2.5TIHDLSCANCOMPLT20MM
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.35 |
| Max. Negotiated Rate |
$1,127.50 |
| Rate for Payer: Aetna Commercial |
$856.90
|
| Rate for Payer: Aetna Medicare Advantage |
$676.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$575.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$575.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$451.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$575.02
|
| Rate for Payer: Cigna Commercial |
$1,127.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$545.71
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$496.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$338.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.76
|
|
|
SCREW2.5TIHDLSCANCOMPLT20MM
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$545.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$451.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$545.71
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$496.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$338.25
|
|