|
SCREW COUNTER SINK 1.5- 2.0MM
|
Facility
|
OP
|
$624.20
|
|
| Hospital Charge Code |
270663617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$312.10 |
| Rate for Payer: Aetna Commercial |
$237.20
|
| Rate for Payer: Aetna Medicare Advantage |
$187.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$159.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$159.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$124.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$159.17
|
| Rate for Payer: Cigna Commercial |
$312.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$137.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.63
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.54
|
|
|
SCREW C PT THD 5.0x46 11425146
|
Facility
|
OP
|
$530.75
|
|
| Hospital Charge Code |
270631229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$265.38 |
| Rate for Payer: Aetna Commercial |
$201.69
|
| Rate for Payer: Aetna Medicare Advantage |
$159.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$135.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$135.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$135.34
|
| Rate for Payer: Cigna Commercial |
$265.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.44
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$116.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.06
|
|
|
SCREW C PT THD 5.0x46 11425146
|
Facility
|
IP
|
$530.75
|
|
| Hospital Charge Code |
270631229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.61 |
| Max. Negotiated Rate |
$128.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.44
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$116.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.61
|
|
|
SCREW CREO 6.5X30MM MODULAR
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$1,235.00
|
| Rate for Payer: Aetna Medicare Advantage |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$828.75
|
| Rate for Payer: Cigna Commercial |
$1,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.12
|
|
|
SCREW CREO 6.5X30MM MODULAR
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$786.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
|
|
SCREW CREO AMP 5.5MM POLYAX TU
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$907.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$825.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
|
|
SCREW CREO AMP 5.5MM POLYAX TU
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,425.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$956.25
|
| Rate for Payer: Cigna Commercial |
$1,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$907.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$825.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$90.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$99.38
|
|
|
SCREW CREO AMP 6.5X35MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$786.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
|
|
SCREW CREO AMP 6.5X35MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$1,235.00
|
| Rate for Payer: Aetna Medicare Advantage |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$828.75
|
| Rate for Payer: Cigna Commercial |
$1,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.12
|
|
|
SCREW CREO AMP 6.5X40MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$1,235.00
|
| Rate for Payer: Aetna Medicare Advantage |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$828.75
|
| Rate for Payer: Cigna Commercial |
$1,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.12
|
|
|
SCREW CREO AMP 6.5X40MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$1,235.00
|
| Rate for Payer: Aetna Medicare Advantage |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$828.75
|
| Rate for Payer: Cigna Commercial |
$1,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.12
|
|
|
SCREW CREO AMP 6.5X40MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$786.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
|
|
SCREW CREO AMP 6.5X40MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$786.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
|
|
SCREW CREO AMP CANMOD 6.5X40MM
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$1,812.50 |
| Rate for Payer: Aetna Commercial |
$1,377.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$924.38
|
| Rate for Payer: Cigna Commercial |
$1,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$797.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$87.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.06
|
|
|
SCREW CREO AMP CANMOD 6.5X40MM
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$877.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$797.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
|
|
SCREW CREO AMP CANMOD 6.5X45MM
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$877.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$797.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
|
|
SCREW CREO AMP CANMOD 6.5X45MM
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$1,812.50 |
| Rate for Payer: Aetna Commercial |
$1,377.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$924.38
|
| Rate for Payer: Cigna Commercial |
$1,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$797.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$87.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.06
|
|
|
SCREW CREO AMP MOD 7.5X40MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Commercial |
$1,235.00
|
| Rate for Payer: Aetna Medicare Advantage |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$828.75
|
| Rate for Payer: Cigna Commercial |
$1,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$86.12
|
|
|
SCREW CREO AMP MOD 7.5X40MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$786.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$487.50
|
|
|
SCREW CREO MOD CANN 5.5X40MM
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$1,812.50 |
| Rate for Payer: Aetna Commercial |
$1,377.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$924.38
|
| Rate for Payer: Cigna Commercial |
$1,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$797.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$87.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.06
|
|
|
SCREW CREO MOD CANN 5.5X40MM
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697448
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$877.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$797.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
|
|
SCREW CREO MOD CANN 7.5X40MM
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$877.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$797.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
|
|
SCREW CREO MOD CANN 7.5X40MM
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$1,812.50 |
| Rate for Payer: Aetna Commercial |
$1,377.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$924.38
|
| Rate for Payer: Cigna Commercial |
$1,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$797.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$87.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.06
|
|
|
SCREW CREO MOD FEN 6.5X45MM
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$880.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$96.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$106.00
|
|
|
SCREW CREO MOD FEN 6.5X45MM
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$880.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|