|
SCREW 5X20MM
|
Facility
|
OP
|
$2,500.00
|
|
| Hospital Charge Code |
270701766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$950.00
|
| Rate for Payer: Aetna Medicare Advantage |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$605.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$550.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$60.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$66.25
|
|
|
SCREW 5X20MM
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$220.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
SCREW 5X20MM
|
Facility
|
IP
|
$2,500.00
|
|
| Hospital Charge Code |
270701766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$605.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$550.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
|
|
SCREW 5X25MM
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$570.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$330.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.75
|
|
|
SCREW 5X25MM
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$380.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$220.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
SCREW 5X25MM
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$950.00
|
| Rate for Payer: Aetna Medicare Advantage |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$605.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$550.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$60.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$66.25
|
|
|
SCREW 5X25MM
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$330.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
SCREW 5X25MM
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$220.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
SCREW 5X25MM
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$605.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$550.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
|
|
SCREW 5X25MM
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705786
|
|
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
|
|
|
SCREW 5X25MM
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705786
|
|
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
|
|
|
SCREW 5X28MM
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$330.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
SCREW 5X28MM
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$570.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$330.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.75
|
|
|
SCREW 5x30mm 14-405030
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270640416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$198.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW 5x30mm 14-405030
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270640416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$342.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$198.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.85
|
|
|
SCREW 5X30MM SELF TAPPING
|
Facility
|
IP
|
$907.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.18 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$199.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.18
|
|
|
SCREW 5X30MM SELF TAPPING
|
Facility
|
OP
|
$907.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$453.93 |
| Rate for Payer: Aetna Commercial |
$344.98
|
| Rate for Payer: Aetna Medicare Advantage |
$272.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.50
|
| Rate for Payer: Cigna Commercial |
$453.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$199.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.18
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.06
|
|
|
SCREW 5X30MM SELF TAPPING
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.47 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna Commercial |
$858.80
|
| Rate for Payer: Aetna Medicare Advantage |
$678.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$452.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$576.30
|
| Rate for Payer: Cigna Commercial |
$1,130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$497.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$339.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.89
|
|
|
SCREW 5X30MM SELF TAPPING
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$546.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$452.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$497.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$339.00
|
|
|
SCREW 5X40
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$2,117.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,925.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
|
|
SCREW 5X40
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.88 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Aetna Commercial |
$3,325.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,625.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,231.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,231.25
|
| Rate for Payer: Cigna Commercial |
$4,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,117.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,925.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,312.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$210.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$231.88
|
|
|
SCREW 60MM LOW PROFILE
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270648242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$84.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$77.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
SCREW 60MM LOW PROFILE
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270648242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$70.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$77.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.28
|
|
|
SCREW 6.5 120 CCHS LONG THD 12
|
Facility
|
OP
|
$3,198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$1,599.00 |
| Rate for Payer: Aetna Commercial |
$1,215.24
|
| Rate for Payer: Aetna Medicare Advantage |
$959.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$815.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$815.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$639.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$815.49
|
| Rate for Payer: Cigna Commercial |
$1,599.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$773.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$703.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$479.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$77.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$84.75
|
|
|
SCREW 6.5 120 CCHS LONG THD 12
|
Facility
|
IP
|
$3,198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.70 |
| Max. Negotiated Rate |
$773.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$639.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$773.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$703.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$479.70
|
|