|
SCREW CANN VA LCKG 5.0x30MM
|
Facility
|
IP
|
$1,050.60
|
|
| Hospital Charge Code |
270678077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.59 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$231.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.59
|
|
|
SCREW CANN VA LCKG 5.0x30MM
|
Facility
|
OP
|
$1,050.60
|
|
| Hospital Charge Code |
270678077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.32 |
| Max. Negotiated Rate |
$525.30 |
| Rate for Payer: Aetna Commercial |
$399.23
|
| Rate for Payer: Aetna Medicare Advantage |
$315.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$210.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.90
|
| Rate for Payer: Cigna Commercial |
$525.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$231.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.84
|
|
|
SCREW CANN VA LCKG 5.0x35MM
|
Facility
|
IP
|
$1,082.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270649685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$261.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$238.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.31
|
|
|
SCREW CANN VA LCKG 5.0x35MM
|
Facility
|
OP
|
$1,082.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270649685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$541.05 |
| Rate for Payer: Aetna Commercial |
$411.20
|
| Rate for Payer: Aetna Medicare Advantage |
$324.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$275.94
|
| Rate for Payer: Cigna Commercial |
$541.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$238.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.68
|
|
|
SCREW CANN VA LCKG 5.0x50MM
|
Facility
|
IP
|
$1,082.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$261.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$238.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.31
|
|
|
SCREW CANN VA LCKG 5.0x50MM
|
Facility
|
OP
|
$1,082.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$541.05 |
| Rate for Payer: Aetna Commercial |
$411.20
|
| Rate for Payer: Aetna Medicare Advantage |
$324.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$275.94
|
| Rate for Payer: Cigna Commercial |
$541.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$238.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.68
|
|
|
SCREW CANN VA LCKG 5.0x55MM
|
Facility
|
OP
|
$1,082.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$541.05 |
| Rate for Payer: Aetna Commercial |
$411.20
|
| Rate for Payer: Aetna Medicare Advantage |
$324.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$275.94
|
| Rate for Payer: Cigna Commercial |
$541.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$238.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.68
|
|
|
SCREW CANN VA LCKG 5.0x55MM
|
Facility
|
IP
|
$1,082.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$261.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$238.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.31
|
|
|
SCREW CANN VA LCKG 5.0x65MM
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$387.60
|
| Rate for Payer: Aetna Medicare Advantage |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$260.10
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.03
|
|
|
SCREW CANN VA LCKG 5.0x65MM
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$246.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$204.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$224.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$153.00
|
|
|
SCREW CANN VA LCKG 5.0x75MM
|
Facility
|
IP
|
$1,082.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270649686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$261.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$238.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.31
|
|
|
SCREW CANN VA LCKG 5.0x75MM
|
Facility
|
OP
|
$1,082.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270649686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$541.05 |
| Rate for Payer: Aetna Commercial |
$411.20
|
| Rate for Payer: Aetna Medicare Advantage |
$324.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$216.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$275.94
|
| Rate for Payer: Cigna Commercial |
$541.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$238.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.68
|
|
|
SCREW CANN VAL OPTILINK 5X30MM
|
Facility
|
OP
|
$3,215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.48 |
| Max. Negotiated Rate |
$1,607.50 |
| Rate for Payer: Aetna Commercial |
$1,221.70
|
| Rate for Payer: Aetna Medicare Advantage |
$964.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$819.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$819.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$643.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$819.83
|
| Rate for Payer: Cigna Commercial |
$1,607.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$778.03
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$707.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$482.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$77.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$85.20
|
|
|
SCREW CANN VAL OPTILINK 5X30MM
|
Facility
|
IP
|
$3,215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.25 |
| Max. Negotiated Rate |
$778.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$643.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$778.03
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$707.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$482.25
|
|
|
SCREW CANN VAL OPTILINK 5X70MM
|
Facility
|
OP
|
$3,215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.48 |
| Max. Negotiated Rate |
$1,607.50 |
| Rate for Payer: Aetna Commercial |
$1,221.70
|
| Rate for Payer: Aetna Medicare Advantage |
$964.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$819.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$819.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$643.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$819.83
|
| Rate for Payer: Cigna Commercial |
$1,607.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$778.03
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$707.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$482.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$77.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$85.20
|
|
|
SCREW CANN VAL OPTILINK 5X70MM
|
Facility
|
IP
|
$3,215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.25 |
| Max. Negotiated Rate |
$778.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$643.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$778.03
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$707.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$482.25
|
|
|
SCREW CANN VAL OPTLNK 5.0X55MM
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.00 |
| Max. Negotiated Rate |
$740.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$612.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$740.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$673.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.00
|
|
|
SCREW CANN VAL OPTLNK 5.0X55MM
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,162.80
|
| Rate for Payer: Aetna Medicare Advantage |
$918.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$780.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$780.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$780.30
|
| Rate for Payer: Cigna Commercial |
$1,530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$740.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$673.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$73.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81.09
|
|
|
SCREW CANN VAL OPTLNK 5.0X65MM
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,162.80
|
| Rate for Payer: Aetna Medicare Advantage |
$918.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$780.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$780.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$780.30
|
| Rate for Payer: Cigna Commercial |
$1,530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$740.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$673.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$73.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81.09
|
|
|
SCREW CANN VAL OPTLNK 5.0X65MM
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.00 |
| Max. Negotiated Rate |
$740.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$612.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$740.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$673.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.00
|
|
|
SCREW CANN VAL OPTLNK 5.0X75MM
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.00 |
| Max. Negotiated Rate |
$740.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$612.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$740.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$673.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.00
|
|
|
SCREW CANN VAL OPTLNK 5.0X75MM
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,162.80
|
| Rate for Payer: Aetna Medicare Advantage |
$918.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$780.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$780.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$780.30
|
| Rate for Payer: Cigna Commercial |
$1,530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$740.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$673.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$73.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81.09
|
|
|
SCREW CANN VAL OPTLNK 5.0X80MM
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.00 |
| Max. Negotiated Rate |
$740.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$612.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$740.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$673.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.00
|
|
|
SCREW CANN VAL OPTLNK 5.0X80MM
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,162.80
|
| Rate for Payer: Aetna Medicare Advantage |
$918.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$780.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$780.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$780.30
|
| Rate for Payer: Cigna Commercial |
$1,530.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$740.52
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$673.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$73.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81.09
|
|
|
SCREW CAN PART 4.0x30 11424130
|
Facility
|
OP
|
$505.65
|
|
| Hospital Charge Code |
270629616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$252.82 |
| Rate for Payer: Aetna Commercial |
$192.15
|
| Rate for Payer: Aetna Medicare Advantage |
$151.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$101.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.94
|
| Rate for Payer: Cigna Commercial |
$252.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$122.37
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$111.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.40
|
|