|
SCREW RECON TI 6.5x75mm
|
Facility
|
OP
|
$957.00
|
|
| Hospital Charge Code |
270656663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Aetna Commercial |
$363.66
|
| Rate for Payer: Aetna Medicare Advantage |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$244.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$244.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$244.03
|
| Rate for Payer: Cigna Commercial |
$478.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.59
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$210.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$143.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.36
|
|
|
SCREW RECON TI 6.5x75mm
|
Facility
|
IP
|
$957.00
|
|
| Hospital Charge Code |
270656663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.55 |
| Max. Negotiated Rate |
$231.59 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$191.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.59
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$210.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$143.55
|
|
|
SCREW RED MAS RELINE 3.5X35MM
|
Facility
|
IP
|
$6,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.25 |
| Max. Negotiated Rate |
$1,663.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,663.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,512.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,031.25
|
|
|
SCREW RED MAS RELINE 3.5X35MM
|
Facility
|
OP
|
$6,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.69 |
| Max. Negotiated Rate |
$3,437.50 |
| Rate for Payer: Aetna Commercial |
$2,612.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,062.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,753.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,753.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,753.12
|
| Rate for Payer: Cigna Commercial |
$3,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,663.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,512.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,031.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$165.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$182.19
|
|
|
SCREW REDUCTION 6.5X50MM
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.55 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,090.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$132.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$145.75
|
|
|
SCREW REDUCTION 6.5X50MM
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
SCREW REDUCTION 6.5X55MM
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.55 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,090.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$132.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$145.75
|
|
|
SCREW REDUCTION 6.5X55MM
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
SCREW REDUCTION 7.5X70MM
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
SCREW REDUCTION 7.5X70MM
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.55 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,090.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$132.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$145.75
|
|
|
SCREW REDUCTION 8.5X100MM
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.55 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,090.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$132.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$145.75
|
|
|
SCREW REDUCTION 8.5X100MM
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
SCREW REDUCTION 8.5X80MM
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
SCREW REDUCTION 8.5X80MM
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.55 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,090.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$132.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$145.75
|
|
|
SCREW REFORM 8.5X45MM
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.02 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$836.00
|
| Rate for Payer: Aetna Medicare Advantage |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$561.00
|
| Rate for Payer: Cigna Commercial |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$58.30
|
|
|
SCREW REFORM 8.5X45MM
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$532.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$440.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$532.40
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.00
|
|
|
SCREW REFORM POLYAX 3.5X30MM
|
Facility
|
OP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.43 |
| Max. Negotiated Rate |
$3,370.00 |
| Rate for Payer: Aetna Commercial |
$2,561.20
|
| Rate for Payer: Aetna Medicare Advantage |
$2,022.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$3,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,482.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$162.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$178.61
|
|
|
SCREW REFORM POLYAX 3.5X30MM
|
Facility
|
IP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$1,631.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,482.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW REFORM POLYAX 3.5X35MM
|
Facility
|
IP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$1,631.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,482.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW REFORM POLYAX 3.5X35MM
|
Facility
|
OP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.43 |
| Max. Negotiated Rate |
$3,370.00 |
| Rate for Payer: Aetna Commercial |
$2,561.20
|
| Rate for Payer: Aetna Medicare Advantage |
$2,022.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$3,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,482.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$162.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$178.61
|
|
|
SCREW REFORM TI MOD 6.5X40MM
|
Facility
|
OP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.43 |
| Max. Negotiated Rate |
$3,370.00 |
| Rate for Payer: Aetna Commercial |
$2,561.20
|
| Rate for Payer: Aetna Medicare Advantage |
$2,022.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$3,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,482.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$162.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$178.61
|
|
|
SCREW REFORM TI MOD 6.5X40MM
|
Facility
|
IP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$1,631.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,482.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW REFORM TI MOD 6.5X45MM
|
Facility
|
IP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.00 |
| Max. Negotiated Rate |
$1,631.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,482.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
|
|
SCREW REFORM TI MOD 6.5X45MM
|
Facility
|
OP
|
$6,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.43 |
| Max. Negotiated Rate |
$3,370.00 |
| Rate for Payer: Aetna Commercial |
$2,561.20
|
| Rate for Payer: Aetna Medicare Advantage |
$2,022.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,348.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$3,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,631.08
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,482.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,011.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$162.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$178.61
|
|
|
SCREW REFORM TI PED 5.5X30MM
|
Facility
|
OP
|
$6,470.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.93 |
| Max. Negotiated Rate |
$3,235.00 |
| Rate for Payer: Aetna Commercial |
$2,458.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,941.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,649.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,649.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,294.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,649.85
|
| Rate for Payer: Cigna Commercial |
$3,235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,565.74
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,423.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$970.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$155.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$171.46
|
|