|
SCREW LKG 5.0 TI ST 3MM 36MM
|
Facility
|
OP
|
$1,047.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.24 |
| Max. Negotiated Rate |
$523.67 |
| Rate for Payer: Aetna Commercial |
$397.99
|
| Rate for Payer: Aetna Medicare Advantage |
$314.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$267.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$267.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$209.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$267.07
|
| Rate for Payer: Cigna Commercial |
$523.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$253.46
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$230.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.75
|
|
|
SCREW LKG 5.0 VAL ST SD 32MM
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$546.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$452.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$497.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$339.00
|
|
|
SCREW LKG 5.0 VAL ST SD 32MM
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.47 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna Commercial |
$858.80
|
| Rate for Payer: Aetna Medicare Advantage |
$678.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$452.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$576.30
|
| Rate for Payer: Cigna Commercial |
$1,130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$497.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$339.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.89
|
|
|
SCREW LKG 5.0X26MM
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$546.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$452.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$497.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$339.00
|
|
|
SCREW LKG 5.0X26MM
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.47 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna Commercial |
$858.80
|
| Rate for Payer: Aetna Medicare Advantage |
$678.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$452.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$576.30
|
| Rate for Payer: Cigna Commercial |
$1,130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$546.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$497.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$339.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.89
|
|
|
SCREW LKG 5.0X90MM XL25
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: Aetna Commercial |
$1,037.40
|
| Rate for Payer: Aetna Medicare Advantage |
$819.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$546.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$696.15
|
| Rate for Payer: Cigna Commercial |
$1,365.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$660.66
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$600.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$409.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$65.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$72.34
|
|
|
SCREW LKG 5.0X90MM XL25
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$660.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$546.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$660.66
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$600.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$409.50
|
|
|
SCREW LKG 5X25MM
|
Facility
|
OP
|
$2,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.77 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Aetna Commercial |
$942.40
|
| Rate for Payer: Aetna Medicare Advantage |
$744.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$632.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$632.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$496.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$632.40
|
| Rate for Payer: Cigna Commercial |
$1,240.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$600.16
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$545.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$372.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$65.72
|
|
|
SCREW LKG 5X25MM
|
Facility
|
IP
|
$2,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$600.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$496.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$600.16
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$545.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$372.00
|
|
|
SCREW LKG AXSOS 4.0X18MM
|
Facility
|
OP
|
$1,136.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$568.42 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Medicare Advantage |
$341.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$289.90
|
| Rate for Payer: Cigna Commercial |
$568.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$250.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.13
|
|
|
SCREW LKG AXSOS 4.0X18MM
|
Facility
|
IP
|
$1,136.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.53 |
| Max. Negotiated Rate |
$275.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$250.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.53
|
|
|
SCREW LKG AXSOS 4.0X22MM
|
Facility
|
OP
|
$1,136.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$568.42 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Medicare Advantage |
$341.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$289.90
|
| Rate for Payer: Cigna Commercial |
$568.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$250.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.13
|
|
|
SCREW LKG AXSOS 4.0X22MM
|
Facility
|
IP
|
$1,136.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.53 |
| Max. Negotiated Rate |
$275.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$250.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.53
|
|
|
SCREW LKG AXSOS 4.0X24MM
|
Facility
|
OP
|
$1,136.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$568.42 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Medicare Advantage |
$341.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$289.90
|
| Rate for Payer: Cigna Commercial |
$568.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$250.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.13
|
|
|
SCREW LKG AXSOS 4.0X24MM
|
Facility
|
IP
|
$1,136.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.53 |
| Max. Negotiated Rate |
$275.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$250.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.53
|
|
|
SCREW LKG AXSOS 4.0X26MM
|
Facility
|
OP
|
$1,136.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$568.42 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Medicare Advantage |
$341.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$289.90
|
| Rate for Payer: Cigna Commercial |
$568.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$250.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.13
|
|
|
SCREW LKG AXSOS 4.0X26MM
|
Facility
|
IP
|
$1,136.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.53 |
| Max. Negotiated Rate |
$275.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$250.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.53
|
|
|
SCREW LKG AXSOS 4.0X28MM
|
Facility
|
IP
|
$1,136.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.53 |
| Max. Negotiated Rate |
$275.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$250.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.53
|
|
|
SCREW LKG AXSOS 4.0X28MM
|
Facility
|
OP
|
$1,136.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$568.42 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Medicare Advantage |
$341.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$289.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$227.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$289.90
|
| Rate for Payer: Cigna Commercial |
$568.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.12
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$250.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$170.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.13
|
|
|
SCREW LKG CORT TAP 2.7X10MM
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$96.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$88.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
SCREW LKG CORT TAP 2.7X10MM
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$152.00
|
| Rate for Payer: Aetna Medicare Advantage |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$88.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.60
|
|
|
SCREW LKG FASTP 2.7MMX12/14MM
|
Facility
|
OP
|
$2,725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.67 |
| Max. Negotiated Rate |
$1,362.50 |
| Rate for Payer: Aetna Commercial |
$1,035.50
|
| Rate for Payer: Aetna Medicare Advantage |
$817.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$694.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$694.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$545.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$694.88
|
| Rate for Payer: Cigna Commercial |
$1,362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$659.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$599.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$408.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$65.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$72.21
|
|
|
SCREW LKG FASTP 2.7MMX12/14MM
|
Facility
|
IP
|
$2,725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.75 |
| Max. Negotiated Rate |
$659.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$545.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$659.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$599.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$408.75
|
|
|
SCREW LKG FOR IM NAIL 5.0X54MM
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: Aetna Commercial |
$1,037.40
|
| Rate for Payer: Aetna Medicare Advantage |
$819.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$546.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$696.15
|
| Rate for Payer: Cigna Commercial |
$1,365.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$660.66
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$600.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$409.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$65.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$72.34
|
|
|
SCREW LKG FOR IM NAIL 5.0X54MM
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$660.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$546.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$660.66
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$600.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$409.50
|
|