|
SCREW HEADLESS 3.5 X 44MM
|
Facility
|
IP
|
$1,141.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$276.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$276.18
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$251.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.19
|
|
|
SCREW HEADLESS 4.3 X30MM
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$412.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
SCREW HEADLESS 4.3 X30MM
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Medicare Advantage |
$562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$478.12
|
| Rate for Payer: Cigna Commercial |
$937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$412.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$49.69
|
|
|
SCREW HEADLESS 4.3X30MM
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$412.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
SCREW HEADLESS 4.3X30MM
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Medicare Advantage |
$562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$478.12
|
| Rate for Payer: Cigna Commercial |
$937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$412.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$49.69
|
|
|
SCREW HEADLESS 4.3 X 38 MM
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$396.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$328.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$396.88
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$360.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$246.00
|
|
|
SCREW HEADLESS 4.3 X 38 MM
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$820.00 |
| Rate for Payer: Aetna Commercial |
$623.20
|
| Rate for Payer: Aetna Medicare Advantage |
$492.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$418.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$418.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$328.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$418.20
|
| Rate for Payer: Cigna Commercial |
$820.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$396.88
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$360.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$246.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.46
|
|
|
SCREW HEADLESS 4.3 X 50 MM
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Medicare Advantage |
$562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$478.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$478.12
|
| Rate for Payer: Cigna Commercial |
$937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$412.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$49.69
|
|
|
SCREW HEADLESS 4.3 X 50 MM
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$453.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$412.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$281.25
|
|
|
SCREW HEADLESS 4.3X55MM
|
Facility
|
IP
|
$1,931.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.69 |
| Max. Negotiated Rate |
$467.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$386.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$467.36
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$424.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.69
|
|
|
SCREW HEADLESS 4.3X55MM
|
Facility
|
OP
|
$1,931.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$965.62 |
| Rate for Payer: Aetna Commercial |
$733.88
|
| Rate for Payer: Aetna Medicare Advantage |
$579.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$492.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$492.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$386.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$492.47
|
| Rate for Payer: Cigna Commercial |
$965.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$467.36
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$424.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$51.18
|
|
|
SCREW HEADLESS 5 3.0
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$290.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$240.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$290.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$264.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$180.00
|
|
|
SCREW HEADLESS 5 3.0
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$456.00
|
| Rate for Payer: Aetna Medicare Advantage |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$306.00
|
| Rate for Payer: Cigna Commercial |
$600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$290.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$264.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$180.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.80
|
|
|
SCREW HEADLESS 6.5 X110MM
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.25 |
| Max. Negotiated Rate |
$695.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
|
|
SCREW HEADLESS 6.5 X110MM
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$1,437.50 |
| Rate for Payer: Aetna Commercial |
$1,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$862.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$733.12
|
| Rate for Payer: Cigna Commercial |
$1,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.19
|
|
|
SCREW HEADLESS 6.5X45MM CANN
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.25 |
| Max. Negotiated Rate |
$695.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
|
|
SCREW HEADLESS 6.5X45MM CANN
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$1,437.50 |
| Rate for Payer: Aetna Commercial |
$1,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$862.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$733.12
|
| Rate for Payer: Cigna Commercial |
$1,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.19
|
|
|
SCREW HEADLESS 6.5X50MM CANN
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$1,437.50 |
| Rate for Payer: Aetna Commercial |
$1,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$862.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$733.12
|
| Rate for Payer: Cigna Commercial |
$1,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.19
|
|
|
SCREW HEADLESS 6.5X50MM CANN
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.25 |
| Max. Negotiated Rate |
$695.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
|
|
SCREW HEADLESS 6.5X 55 MM SHOR
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.25 |
| Max. Negotiated Rate |
$695.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
|
|
SCREW HEADLESS 6.5X 55 MM SHOR
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$1,437.50 |
| Rate for Payer: Aetna Commercial |
$1,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$862.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$733.12
|
| Rate for Payer: Cigna Commercial |
$1,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.19
|
|
|
SCREW HEADLESS 6.5X65MM CANN
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$1,437.50 |
| Rate for Payer: Aetna Commercial |
$1,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$862.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$733.12
|
| Rate for Payer: Cigna Commercial |
$1,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.19
|
|
|
SCREW HEADLESS 6.5X65MM CANN
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270685923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.25 |
| Max. Negotiated Rate |
$695.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
|
|
SCREW HEADLESS 6.5X 80MM
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$1,437.50 |
| Rate for Payer: Aetna Commercial |
$1,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$862.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$733.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$733.12
|
| Rate for Payer: Cigna Commercial |
$1,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.19
|
|
|
SCREW HEADLESS 6.5X 80MM
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.25 |
| Max. Negotiated Rate |
$695.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$695.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$632.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$431.25
|
|