|
SCREW SELFTAP LOCKING 5x14mm
|
Facility
|
IP
|
$603.00
|
|
| Hospital Charge Code |
270656607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$145.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
|
|
SCREW SELFTAP LOCKING 5x16mm
|
Facility
|
OP
|
$603.00
|
|
| Hospital Charge Code |
270656610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Medicare Advantage |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.76
|
| Rate for Payer: Cigna Commercial |
$301.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.98
|
|
|
SCREW SELFTAP LOCKING 5x16mm
|
Facility
|
IP
|
$603.00
|
|
| Hospital Charge Code |
270656610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$145.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
|
|
SCREW SELFTAP LOCKING 5x18MM
|
Facility
|
OP
|
$603.00
|
|
| Hospital Charge Code |
270676917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Medicare Advantage |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.76
|
| Rate for Payer: Cigna Commercial |
$301.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.98
|
|
|
SCREW SELFTAP LOCKING 5x18MM
|
Facility
|
IP
|
$603.00
|
|
| Hospital Charge Code |
270676917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$145.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
|
|
SCREW SELFTAP LOCKING 5X32mm
|
Facility
|
OP
|
$321.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Commercial |
$122.02
|
| Rate for Payer: Aetna Medicare Advantage |
$96.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$64.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$81.88
|
| Rate for Payer: Cigna Commercial |
$160.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.71
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$70.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.51
|
|
|
SCREW SELFTAP LOCKING 5X32mm
|
Facility
|
IP
|
$321.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$77.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$64.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$77.71
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$70.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.16
|
|
|
SCREW SELFTAP LOCKING 5x48mm
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Medicare Advantage |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.76
|
| Rate for Payer: Cigna Commercial |
$301.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.98
|
|
|
SCREW SELFTAP LOCKING 5x48mm
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$145.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
|
|
SCREW SELFTAP LOCKING 5x50mm
|
Facility
|
OP
|
$621.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$310.55 |
| Rate for Payer: Aetna Commercial |
$236.02
|
| Rate for Payer: Aetna Medicare Advantage |
$186.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$124.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$158.38
|
| Rate for Payer: Cigna Commercial |
$310.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$150.31
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$136.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.46
|
|
|
SCREW SELFTAP LOCKING 5x50mm
|
Facility
|
IP
|
$621.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270645545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.17 |
| Max. Negotiated Rate |
$150.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$124.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$150.31
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$136.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.17
|
|
|
SCREW SELFTAP LOCKING 5X60mm
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$145.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
|
|
SCREW SELFTAP LOCKING 5X60mm
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Medicare Advantage |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.76
|
| Rate for Payer: Cigna Commercial |
$301.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.98
|
|
|
SCREW SELFTAP LOCKING 5x70mm
|
Facility
|
IP
|
$603.00
|
|
| Hospital Charge Code |
270673439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$145.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
|
|
SCREW SELFTAP LOCKING 5x70mm
|
Facility
|
OP
|
$603.00
|
|
| Hospital Charge Code |
270673439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Medicare Advantage |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.76
|
| Rate for Payer: Cigna Commercial |
$301.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.98
|
|
|
SCREW SELFTAP LOCKING 5X75MM
|
Facility
|
IP
|
$603.00
|
|
| Hospital Charge Code |
270670454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$145.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
|
|
SCREW SELFTAP LOCKING 5X75MM
|
Facility
|
OP
|
$603.00
|
|
| Hospital Charge Code |
270670454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Medicare Advantage |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.76
|
| Rate for Payer: Cigna Commercial |
$301.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.98
|
|
|
SCREW SELFTAP LOCKING 5x80mm
|
Facility
|
IP
|
$603.00
|
|
| Hospital Charge Code |
270673438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$145.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
|
|
SCREW SELFTAP LOCKING 5x80mm
|
Facility
|
OP
|
$603.00
|
|
| Hospital Charge Code |
270673438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: Aetna Medicare Advantage |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.76
|
| Rate for Payer: Cigna Commercial |
$301.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$132.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.98
|
|
|
SCREW SELF TAPPING 3.5X14MM
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$855.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: Cigna Commercial |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$495.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.62
|
|
|
SCREW SELF TAPPING 3.5X14MM
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$495.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
SCREW SELF TAPPING 4 X 14MM VA
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$665.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$385.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.38
|
|
|
SCREW SELF TAPPING 4 X 14MM VA
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$423.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$385.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
SCREW SELF TAPPING 4 X 16MM FI
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$665.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$385.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.38
|
|
|
SCREW SELF TAPPING 4 X 16MM FI
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$423.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$385.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|