|
SCREW VA LCKNG S/TAP 2.7x46MM
|
Facility
|
IP
|
$623.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.57 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$124.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$150.96
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$137.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.57
|
|
|
SCREW VA LCKNG S/TAP 2.7x48MM
|
Facility
|
OP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$302.82 |
| Rate for Payer: Aetna Commercial |
$230.15
|
| Rate for Payer: Aetna Medicare Advantage |
$181.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.44
|
| Rate for Payer: Cigna Commercial |
$302.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.05
|
|
|
SCREW VA LCKNG S/TAP 2.7x48MM
|
Facility
|
IP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$146.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
|
|
SCREW VA LCKNG S/TAP 2.7x50MM
|
Facility
|
OP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$302.82 |
| Rate for Payer: Aetna Commercial |
$230.15
|
| Rate for Payer: Aetna Medicare Advantage |
$181.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.44
|
| Rate for Payer: Cigna Commercial |
$302.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.05
|
|
|
SCREW VA LCKNG S/TAP 2.7x50MM
|
Facility
|
IP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$146.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
|
|
SCREW VA LCKNG S/TAP 2.7x52MM
|
Facility
|
OP
|
$605.65
|
|
| Hospital Charge Code |
270677602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$302.82 |
| Rate for Payer: Aetna Commercial |
$230.15
|
| Rate for Payer: Aetna Medicare Advantage |
$181.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.44
|
| Rate for Payer: Cigna Commercial |
$302.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.05
|
|
|
SCREW VA LCKNG S/TAP 2.7x52MM
|
Facility
|
IP
|
$605.65
|
|
| Hospital Charge Code |
270677602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$146.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
|
|
SCREW VA LCKNG S/TAP 2.7x54MM
|
Facility
|
OP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$302.82 |
| Rate for Payer: Aetna Commercial |
$230.15
|
| Rate for Payer: Aetna Medicare Advantage |
$181.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.44
|
| Rate for Payer: Cigna Commercial |
$302.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.05
|
|
|
SCREW VA LCKNG S/TAP 2.7x54MM
|
Facility
|
IP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$146.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
|
|
SCREW VA LCKNG S/TAP 2.7x56MM
|
Facility
|
IP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$146.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
|
|
SCREW VA LCKNG S/TAP 2.7x56MM
|
Facility
|
OP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$302.82 |
| Rate for Payer: Aetna Commercial |
$230.15
|
| Rate for Payer: Aetna Medicare Advantage |
$181.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.44
|
| Rate for Payer: Cigna Commercial |
$302.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.05
|
|
|
SCREW VA LCKNG S/TAP 2.7x58MM
|
Facility
|
OP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$302.82 |
| Rate for Payer: Aetna Commercial |
$230.15
|
| Rate for Payer: Aetna Medicare Advantage |
$181.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.44
|
| Rate for Payer: Cigna Commercial |
$302.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.05
|
|
|
SCREW VA LCKNG S/TAP 2.7x58MM
|
Facility
|
IP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$146.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
|
|
SCREW VA LCKNG S/TAP 2.7x60MM
|
Facility
|
IP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$146.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
|
|
SCREW VA LCKNG S/TAP 2.7x60MM
|
Facility
|
OP
|
$605.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$302.82 |
| Rate for Payer: Aetna Commercial |
$230.15
|
| Rate for Payer: Aetna Medicare Advantage |
$181.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$121.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.44
|
| Rate for Payer: Cigna Commercial |
$302.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$133.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.05
|
|
|
SCREW VALENCIA MIS 6.5X35MM
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,365.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
SCREW VALENCIA MIS 6.5X35MM
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.07 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$4,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,365.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$259.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$284.88
|
|
|
SCREW VALENCI PEDICLE 6.5X45MM
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.07 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$4,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,365.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$259.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$284.88
|
|
|
SCREW VALENCI PEDICLE 6.5X45MM
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,365.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
SCREW VA LKG ST 2.7x12MM
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270653055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$425.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$352.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$425.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$387.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$264.00
|
|
|
SCREW VA LKG ST 2.7x12MM
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270653055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna Commercial |
$668.80
|
| Rate for Payer: Aetna Medicare Advantage |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$352.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.80
|
| Rate for Payer: Cigna Commercial |
$880.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$425.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$387.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$264.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.64
|
|
|
SCREW VA LKG ST 2.7x16MM
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna Commercial |
$668.80
|
| Rate for Payer: Aetna Medicare Advantage |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$448.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$448.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$352.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$448.80
|
| Rate for Payer: Cigna Commercial |
$880.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$425.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$387.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$264.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.64
|
|
|
SCREW VA LKG ST 2.7x16MM
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$425.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$352.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$425.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$387.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$264.00
|
|
|
SCREW VA LKG ST T6 SD 2.0X13MM
|
Facility
|
IP
|
$5,325.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.75 |
| Max. Negotiated Rate |
$1,288.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,065.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,288.65
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,171.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$798.75
|
|
|
SCREW VA LKG ST T6 SD 2.0X13MM
|
Facility
|
OP
|
$5,325.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$2,662.50 |
| Rate for Payer: Aetna Commercial |
$2,023.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,597.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,357.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,357.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,065.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,357.88
|
| Rate for Payer: Cigna Commercial |
$2,662.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,288.65
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,171.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$798.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$128.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$141.11
|
|