|
SCREW LOCKING 3.5 X 20MM
|
Facility
|
IP
|
$642.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.41 |
| Max. Negotiated Rate |
$155.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$128.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$155.53
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$141.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.41
|
|
|
SCREW LOCKING 3.5x20MM
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Medicare Advantage |
$351.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$298.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$298.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$298.35
|
| Rate for Payer: Cigna Commercial |
$585.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$257.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.00
|
|
|
SCREW LOCKING 3.5x20MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$246.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5x20MM
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$283.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$234.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.14
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$257.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.50
|
|
|
SCREW LOCKING 3.5x20MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$246.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.68
|
|
|
SCREW LOCKING 3.5X20MM
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$348.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$348.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$316.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.00
|
|
|
SCREW LOCKING 3.5X20MM
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$547.20
|
| Rate for Payer: Aetna Medicare Advantage |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$367.20
|
| Rate for Payer: Cigna Commercial |
$720.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$348.48
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$316.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.16
|
|
|
SCREW LOCKING 3.5X20MM
|
Facility
|
OP
|
$1,180.00
|
|
| Hospital Charge Code |
270665784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna Commercial |
$448.40
|
| Rate for Payer: Aetna Medicare Advantage |
$354.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$300.90
|
| Rate for Payer: Cigna Commercial |
$590.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$259.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.27
|
|
|
SCREW LOCKING 3.5X20MM
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
270665784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$285.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$236.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$285.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$259.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
|
|
SCREW LOCKING 3.5x20mm 30-0261
|
Facility
|
IP
|
$400.00
|
|
| Hospital Charge Code |
270646206
|
|
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 LOCKING 3.5x20mm 30-0261
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
270646206
|
|
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 LOCKING 3.5 X 22MM
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$110.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$91.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.11
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$100.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.25
|
|
|
SCREW LOCKING 3.5 X 22MM
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Medicare Advantage |
$136.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$91.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$116.03
|
| Rate for Payer: Cigna Commercial |
$227.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.11
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$100.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.06
|
|
|
SCREW LOCKING 3.5 X 22MM
|
Facility
|
OP
|
$5,625.00
|
|
| Hospital Charge Code |
270662031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.56 |
| Max. Negotiated Rate |
$2,812.50 |
| Rate for Payer: Aetna Commercial |
$2,137.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,687.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,434.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,434.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,434.38
|
| Rate for Payer: Cigna Commercial |
$2,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,361.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,237.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$843.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$135.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$149.06
|
|
|
SCREW LOCKING 3.5 X 22MM
|
Facility
|
IP
|
$5,625.00
|
|
| Hospital Charge Code |
270662031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.75 |
| Max. Negotiated Rate |
$1,361.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,361.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,237.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$843.75
|
|
|
SCREW LOCKING 3.5x22MM
|
Facility
|
IP
|
$405.00
|
|
| Hospital Charge Code |
270676766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.75 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$81.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$89.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.75
|
|
|
SCREW LOCKING 3.5x22MM
|
Facility
|
OP
|
$405.00
|
|
| Hospital Charge Code |
270676766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Medicare Advantage |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$103.28
|
| Rate for Payer: Cigna Commercial |
$202.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$89.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.73
|
|
|
SCREW LOCKING 3.5x22MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$246.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5x22MM
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
270668296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$246.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.68
|
|
|
SCREW LOCKING 3.5x22MM
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
270668296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$246.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING 3.5x22MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$246.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.68
|
|
|
SCREW LOCKING 3.5x22mm 30-0239
|
Facility
|
IP
|
$625.00
|
|
| Hospital Charge Code |
270646204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$151.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$137.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.75
|
|
|
SCREW LOCKING 3.5x22mm 30-0239
|
Facility
|
OP
|
$625.00
|
|
| Hospital Charge Code |
270646204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$312.50 |
| Rate for Payer: Aetna Commercial |
$237.50
|
| Rate for Payer: Aetna Medicare Advantage |
$187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$159.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$159.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$159.38
|
| Rate for Payer: Cigna Commercial |
$312.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$151.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$137.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.56
|
|
|
SCREW LOCKING 3.5x24mm
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$138.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.70
|
|
|
SCREW LOCKING 3.5x24mm
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$138.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|