|
SCREW CORTICAL VHS 4.5x52mm
|
Facility
|
OP
|
$120.00
|
|
| Hospital Charge Code |
270641335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Medicare Advantage |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.60
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$26.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.18
|
|
|
SCREW CORT LG 5.5x55 22535555
|
Facility
|
OP
|
$570.45
|
|
| Hospital Charge Code |
270625981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$285.23 |
| Rate for Payer: Aetna Commercial |
$216.77
|
| Rate for Payer: Aetna Medicare Advantage |
$171.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$145.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$145.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$145.46
|
| Rate for Payer: Cigna Commercial |
$285.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$138.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$125.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.12
|
|
|
SCREW CORT LG 5.5x55 22535555
|
Facility
|
IP
|
$570.45
|
|
| Hospital Charge Code |
270625981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.57 |
| Max. Negotiated Rate |
$138.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$138.05
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$125.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.57
|
|
|
SCREW CORT LG 5.5x75 22537555
|
Facility
|
IP
|
$611.25
|
|
| Hospital Charge Code |
270632354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.69 |
| Max. Negotiated Rate |
$147.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$122.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$147.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$134.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.69
|
|
|
SCREW CORT LG 5.5x75 22537555
|
Facility
|
OP
|
$611.25
|
|
| Hospital Charge Code |
270632354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$305.62 |
| Rate for Payer: Aetna Commercial |
$232.28
|
| Rate for Payer: Aetna Medicare Advantage |
$183.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$155.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$155.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$122.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$155.87
|
| Rate for Payer: Cigna Commercial |
$305.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$147.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$134.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.20
|
|
|
SCREW CORT LKG NS 3.5X36MM
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LKG NS 3.5X36MM
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.76
|
|
|
SCREW CORT LKG NS 3.5X42MM
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.76
|
|
|
SCREW CORT LKG NS 3.5X42MM
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCK 2.7X12 COL2120
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270641013
|
|
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 CORT LOCK 2.7X12 COL2120
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270641013
|
|
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 CORT LOCK 2.7x18 COL2180
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270641014
|
|
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 CORT LOCK 2.7x18 COL2180
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270641014
|
|
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 CORT LOCK 3.5X36MM NS
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.76
|
|
|
SCREW CORT LOCK 3.5X36MM NS
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCK 3.5X38MM NS
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270658905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$194.81 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$161.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.81
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$177.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.75
|
|
|
SCREW CORT LOCK 3.5X38MM NS
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270658905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$402.50 |
| Rate for Payer: Aetna Commercial |
$305.90
|
| Rate for Payer: Aetna Medicare Advantage |
$241.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$205.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$205.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$161.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$205.28
|
| Rate for Payer: Cigna Commercial |
$402.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.81
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$177.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.33
|
|
|
SCREW CORT LOCK 3.5X40MM NS
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.76
|
|
|
SCREW CORT LOCK 3.5X40MM NS
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCKING 3.5x10mm
|
Facility
|
IP
|
$905.00
|
|
| Hospital Charge Code |
270669273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$219.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$199.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
|
|
SCREW CORT LOCKING 3.5x10mm
|
Facility
|
OP
|
$905.00
|
|
| Hospital Charge Code |
270669273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.81 |
| Max. Negotiated Rate |
$452.50 |
| Rate for Payer: Aetna Commercial |
$343.90
|
| Rate for Payer: Aetna Medicare Advantage |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$230.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$230.78
|
| Rate for Payer: Cigna Commercial |
$452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$199.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.98
|
|
|
SCREW CORT LOCKING 3.5x16mm
|
Facility
|
OP
|
$632.50
|
|
| Hospital Charge Code |
270701883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.76
|
|
|
SCREW CORT LOCKING 3.5x16mm
|
Facility
|
IP
|
$632.50
|
|
| Hospital Charge Code |
270701883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCKING 3.5x18mm
|
Facility
|
IP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$153.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
|
|
SCREW CORT LOCKING 3.5x18mm
|
Facility
|
OP
|
$632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Medicare Advantage |
$189.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.29
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$139.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.76
|
|