|
SCREW BIOCOMPOSITE 10 X 23MM
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
SCREW BIO COMPOSITE 9X28MM
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
SCREW BIO COMPOSITE 9X28MM
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
SCREW BIO-COMPRESSION 3.5x16MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x16MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3.5x18MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x18MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3.5x20MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x20MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3.5x22MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x22MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3.5x24MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3.5x24MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x26MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x26MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3.5x28MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3.5x28MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x30MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3.5x30MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3.5x32MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3.5x32MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x16MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|
|
SCREW BIO-COMPRESSION 3x16MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3x18MM
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
270675015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$987.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Medicare Advantage |
$592.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$503.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$503.62
|
| Rate for Payer: Cigna Commercial |
$987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.34
|
|
|
SCREW BIO-COMPRESSION 3x18MM
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
270675015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$296.25 |
| Max. Negotiated Rate |
$477.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$477.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$434.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$296.25
|
|