|
80X4.0CANCELLOUS SCREW
|
Facility
|
IP
|
$145.00
|
|
| Hospital Charge Code |
270656464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$35.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.09
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$31.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
|
|
80X4.0CANCELLOUS SCREW
|
Facility
|
OP
|
$145.00
|
|
| Hospital Charge Code |
270656464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$72.50 |
| Rate for Payer: Aetna Commercial |
$55.10
|
| Rate for Payer: Aetna Medicare Advantage |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.98
|
| Rate for Payer: Cigna Commercial |
$72.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.09
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$31.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.84
|
|
|
8.23MM BIOCOMPOSITE SCREW
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.14
|
|
|
8.23MM BIOCOMPOSITE SCREW
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$258.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
8.5X35MM GRAFT BOLT
|
Facility
|
IP
|
$5,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.75 |
| Max. Negotiated Rate |
$1,240.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,025.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,240.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,127.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$768.75
|
|
|
8.5X35MM GRAFT BOLT
|
Facility
|
OP
|
$5,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.51 |
| Max. Negotiated Rate |
$2,562.50 |
| Rate for Payer: Aetna Commercial |
$1,947.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,537.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,306.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,306.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,025.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,306.88
|
| Rate for Payer: Cigna Commercial |
$2,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,240.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,127.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$768.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$123.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.81
|
|
|
8.5X35MM SCREW
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$440.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
8.5X35MM SCREW
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$760.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$440.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.00
|
|
|
.86 K-WIRE
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
270656150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
.86 K-WIRE
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
270656150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.00
|
| Rate for Payer: Oxford Commercial |
$10.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.32
|
|
|
88141,PAP W/MD INTERP
|
Facility
|
OP
|
$139.25
|
|
|
Service Code
|
HCPCS 88141
|
| Hospital Charge Code |
39900310
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$52.91
|
| Rate for Payer: Aetna Medicare Advantage |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.51
|
| Rate for Payer: Cigna Commercial |
$69.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.77
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.69
|
|
|
88141,PAP W/MD INTERP
|
Facility
|
IP
|
$139.25
|
|
|
Service Code
|
HCPCS 88141
|
| Hospital Charge Code |
39900310
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.89
|
|
|
8 FR DIGNITY MID-SIZED CT PORT
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270680658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$361.00
|
| Rate for Payer: Aetna Medicare Advantage |
$285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$242.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$242.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$242.25
|
| Rate for Payer: Cigna Commercial |
$475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$209.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.18
|
|
|
8 FR DIGNITY MID-SIZED CT PORT
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270680658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$209.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.50
|
|
|
8 FR PRO-FUSECT PORT
|
Facility
|
OP
|
$8.82
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270680569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna Medicare Advantage |
$2.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.25
|
| Rate for Payer: Cigna Commercial |
$4.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
8 FR PRO-FUSECT PORT
|
Facility
|
IP
|
$8.82
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
270680569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.32
|
|
|
8 FR PRO-FUSECT PORT
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270680659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$361.00
|
| Rate for Payer: Aetna Medicare Advantage |
$285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$242.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$242.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$242.25
|
| Rate for Payer: Cigna Commercial |
$475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$209.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.18
|
|
|
8 FR PRO-FUSECT PORT
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
270680659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$209.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.50
|
|
|
8 HOLE LAP PLATE
|
Facility
|
OP
|
$5,345.80
|
|
| Hospital Charge Code |
270656667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.83 |
| Max. Negotiated Rate |
$2,672.90 |
| Rate for Payer: Aetna Commercial |
$2,031.40
|
| Rate for Payer: Aetna Medicare Advantage |
$1,603.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,363.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,363.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,069.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,363.18
|
| Rate for Payer: Cigna Commercial |
$2,672.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,293.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,176.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$801.87
|
| Rate for Payer: UnitedHealthcare Community & State |
$128.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$141.66
|
|
|
8 HOLE LAP PLATE
|
Facility
|
IP
|
$5,345.80
|
|
| Hospital Charge Code |
270656667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.87 |
| Max. Negotiated Rate |
$1,293.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,069.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,293.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,176.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$801.87
|
|
|
8 HOLE PERI PROX HUMERUS
|
Facility
|
OP
|
$7,511.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.02 |
| Max. Negotiated Rate |
$3,755.57 |
| Rate for Payer: Aetna Commercial |
$2,854.24
|
| Rate for Payer: Aetna Medicare Advantage |
$2,253.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,915.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,915.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,502.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,915.34
|
| Rate for Payer: Cigna Commercial |
$3,755.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,817.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,652.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,126.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$181.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$199.05
|
|
|
8 HOLE PERI PROX HUMERUS
|
Facility
|
IP
|
$7,511.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.67 |
| Max. Negotiated Rate |
$1,817.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,502.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,817.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,652.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,126.67
|
|
|
8 HOLE VDF PLATE
|
Facility
|
OP
|
$5,430.00
|
|
| Hospital Charge Code |
270665463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.86 |
| Max. Negotiated Rate |
$2,715.00 |
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Medicare Advantage |
$1,629.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,384.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,384.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,086.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,384.65
|
| Rate for Payer: Cigna Commercial |
$2,715.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,314.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,194.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$814.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$130.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$143.90
|
|
|
8 HOLE VDF PLATE
|
Facility
|
IP
|
$5,430.00
|
|
| Hospital Charge Code |
270665463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$814.50 |
| Max. Negotiated Rate |
$1,314.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,086.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,314.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,194.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$814.50
|
|
|
8MM 10DEG ZAVATION CAGE
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.47 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$1,805.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,211.25
|
| Rate for Payer: Cigna Commercial |
$2,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,149.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,045.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$712.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$114.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$125.88
|
|