|
SCREW VA LCKG 2.0x18MM
|
Facility
|
OP
|
$543.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$271.93 |
| Rate for Payer: Aetna Commercial |
$206.66
|
| Rate for Payer: Aetna Medicare Advantage |
$163.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$138.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$138.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$108.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$138.68
|
| Rate for Payer: Cigna Commercial |
$271.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$131.61
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$119.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.41
|
|
|
SCREW VA LCKG 2.0x20MM
|
Facility
|
OP
|
$543.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$271.93 |
| Rate for Payer: Aetna Commercial |
$206.66
|
| Rate for Payer: Aetna Medicare Advantage |
$163.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$138.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$138.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$108.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$138.68
|
| Rate for Payer: Cigna Commercial |
$271.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$131.61
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$119.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.41
|
|
|
SCREW VA LCKG 2.0x20MM
|
Facility
|
IP
|
$543.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$131.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$108.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$131.61
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$119.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.58
|
|
|
SCREW VA LCKG 2.0x22MM
|
Facility
|
IP
|
$543.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$131.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$108.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$131.61
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$119.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.58
|
|
|
SCREW VA LCKG 2.0x22MM
|
Facility
|
OP
|
$543.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$271.93 |
| Rate for Payer: Aetna Commercial |
$206.66
|
| Rate for Payer: Aetna Medicare Advantage |
$163.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$138.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$138.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$108.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$138.68
|
| Rate for Payer: Cigna Commercial |
$271.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$131.61
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$119.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.41
|
|
|
SCREW VA LCKG 2.0x8MM
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$200.64
|
| Rate for Payer: Aetna Medicare Advantage |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$134.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$134.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$134.64
|
| Rate for Payer: Cigna Commercial |
$264.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$116.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.99
|
|
|
SCREW VA LCKG 2.0x8MM
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$127.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$116.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.20
|
|
|
SCREW VA LCKG 5.0x10MM STER
|
Facility
|
OP
|
$1,294.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$647.35 |
| Rate for Payer: Aetna Commercial |
$491.99
|
| Rate for Payer: Aetna Medicare Advantage |
$388.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$330.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$330.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$258.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$330.15
|
| Rate for Payer: Cigna Commercial |
$647.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.32
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$284.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.31
|
|
|
SCREW VA LCKG 5.0x10MM STER
|
Facility
|
IP
|
$1,294.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.21 |
| Max. Negotiated Rate |
$313.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$258.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.32
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$284.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.21
|
|
|
SCREW VA LCKG 5.0x12MM STER
|
Facility
|
OP
|
$1,294.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$647.35 |
| Rate for Payer: Aetna Commercial |
$491.99
|
| Rate for Payer: Aetna Medicare Advantage |
$388.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$330.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$330.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$258.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$330.15
|
| Rate for Payer: Cigna Commercial |
$647.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.32
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$284.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.31
|
|
|
SCREW VA LCKG 5.0x12MM STER
|
Facility
|
IP
|
$1,294.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.21 |
| Max. Negotiated Rate |
$313.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$258.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.32
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$284.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$194.21
|
|
|
SCREW VA LCKG S/TPNG 3.5x16MM
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.30
|
|
|
SCREW VA LCKG S/TPNG 3.5x16MM
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270659114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna Commercial |
$251.56
|
| Rate for Payer: Aetna Medicare Advantage |
$198.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.81
|
| Rate for Payer: Cigna Commercial |
$331.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.54
|
|
|
SCREW VA LCKG S/TPNG 3.5x18MM
|
Facility
|
IP
|
$642.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678045
|
|
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 VA LCKG S/TPNG 3.5x18MM
|
Facility
|
OP
|
$642.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$321.35 |
| Rate for Payer: Aetna Commercial |
$244.23
|
| Rate for Payer: Aetna Medicare Advantage |
$192.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$163.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$163.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$128.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$163.89
|
| Rate for Payer: Cigna Commercial |
$321.35
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.03
|
|
|
SCREW VA LCKG S/TPNG 3.5x190MM
|
Facility
|
IP
|
$642.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686780
|
|
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 VA LCKG S/TPNG 3.5x190MM
|
Facility
|
OP
|
$642.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$321.35 |
| Rate for Payer: Aetna Commercial |
$244.23
|
| Rate for Payer: Aetna Medicare Advantage |
$192.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$163.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$163.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$128.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$163.89
|
| Rate for Payer: Cigna Commercial |
$321.35
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.03
|
|
|
SCREW VA LCKG S/TPNG 3.5x22MM
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.30
|
|
|
SCREW VA LCKG S/TPNG 3.5x22MM
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna Commercial |
$251.56
|
| Rate for Payer: Aetna Medicare Advantage |
$198.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.81
|
| Rate for Payer: Cigna Commercial |
$331.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.54
|
|
|
SCREW VA LCKG S/TPNG 3.5x24MM
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna Commercial |
$251.56
|
| Rate for Payer: Aetna Medicare Advantage |
$198.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.81
|
| Rate for Payer: Cigna Commercial |
$331.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.54
|
|
|
SCREW VA LCKG S/TPNG 3.5x24MM
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.30
|
|
|
SCREW VA LCKG S/TPNG 3.5x26MM
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna Commercial |
$251.56
|
| Rate for Payer: Aetna Medicare Advantage |
$198.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.81
|
| Rate for Payer: Cigna Commercial |
$331.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.54
|
|
|
SCREW VA LCKG S/TPNG 3.5x26MM
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.30
|
|
|
SCREW VA LCKG S/TPNG 3.5x28MM
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.30
|
|
|
SCREW VA LCKG S/TPNG 3.5x28MM
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna Commercial |
$251.56
|
| Rate for Payer: Aetna Medicare Advantage |
$198.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.81
|
| Rate for Payer: Cigna Commercial |
$331.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.54
|
|
