|
HAMMERLOCK 2 LG PROXIMAL 15x7m
|
Facility
|
IP
|
$7,250.00
|
|
| Hospital Charge Code |
270672147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,754.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,754.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,087.50
|
|
|
HAMMERLOCK 2 LG PROXIMAL 15x7m
|
Facility
|
OP
|
$7,250.00
|
|
| Hospital Charge Code |
270672147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$3,625.00 |
| Rate for Payer: Aetna Commercial |
$2,755.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,848.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,848.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,848.75
|
| Rate for Payer: Cigna Commercial |
$3,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,754.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,087.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$229.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$205.90
|
|
|
HAMMERLOCK 2 SM PROXIMAL 12x5m
|
Facility
|
IP
|
$7,250.00
|
|
| Hospital Charge Code |
270672150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$1,754.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,754.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,087.50
|
|
|
HAMMERLOCK 2 SM PROXIMAL 12x5m
|
Facility
|
OP
|
$7,250.00
|
|
| Hospital Charge Code |
270672150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$3,625.00 |
| Rate for Payer: Aetna Commercial |
$2,755.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,848.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,848.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,848.75
|
| Rate for Payer: Cigna Commercial |
$3,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,754.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,087.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$229.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$205.90
|
|
|
HAMMERTOE IMPL 2.4x16MM 0 DEG
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270663198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
HAMMERTOE IMPL 2.4x16MM 0 DEG
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270663198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.49 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$94.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$84.49
|
|
|
HAMMERTOE IMPL 2x13MM 0 DEG
|
Facility
|
IP
|
$2,975.00
|
|
| Hospital Charge Code |
270661603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
HAMMERTOE IMPL 2x13MM 0 DEG
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270667356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
HAMMERTOE IMPL 2x13MM 0 DEG
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270667356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.49 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$94.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$84.49
|
|
|
HAMMERTOE IMPL 2x13MM 0 DEG
|
Facility
|
OP
|
$2,975.00
|
|
| Hospital Charge Code |
270661603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.49 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$94.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$84.49
|
|
|
HAMMERTOE IMPL 3.2x16MM 0 DEG
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270669816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
|
|
HAMMERTOE IMPL 3.2x16MM 0 DEG
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270669816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.49 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Medicare Advantage |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$595.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$758.62
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$719.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$446.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$94.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$84.49
|
|
|
HAMMER TOE IMPLANT 3.4x3.0x6mm
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
HAMMER TOE IMPLANT 3.4x3.0x6mm
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
HAMMERTOE OP ONE TOE TA
|
Facility
|
OP
|
$10,580.92
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
16000176
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$300.50 |
| Max. Negotiated Rate |
$14,100.89 |
| Rate for Payer: Aetna Commercial |
$10,573.24
|
| Rate for Payer: Aetna Medicare Advantage |
$12,594.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14,100.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,887.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14,100.89
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,887.22
|
| Rate for Payer: Clover Medicare Advantage |
$3,692.86
|
| Rate for Payer: EmblemHealth Commercial |
$11,661.66
|
| Rate for Payer: Humana Medicare Advantage |
$4,003.84
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,887.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,751.04
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,587.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$334.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,887.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$300.50
|
|
|
HAMMERTOE OP ONE TOE TA
|
Facility
|
IP
|
$10,580.92
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
16000176
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,587.14 |
| Max. Negotiated Rate |
$1,587.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,587.14
|
|
|
HAMMERTOE PEEK FIXATION SYST
|
Facility
|
IP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$1,391.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
HAMMERTOE PEEK FIXATION SYST
|
Facility
|
OP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.30 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,185.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$181.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$163.30
|
|
|
HAMMERTOE PEEK FIXATION SYSTEM
|
Facility
|
OP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270705391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.30 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,185.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$181.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$163.30
|
|
|
HAMMERTOE PEEK FIXATION SYSTEM
|
Facility
|
IP
|
$5,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270705391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$1,391.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,391.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
HAMMERTOESYST2.5X16MMSTRIMPKIT
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.25 |
| Max. Negotiated Rate |
$2,413.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,413.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,496.25
|
|
|
HAMMERTOESYST2.5X16MMSTRIMPKIT
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.29 |
| Max. Negotiated Rate |
$4,987.50 |
| Rate for Payer: Aetna Commercial |
$3,790.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,992.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,543.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,543.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,543.62
|
| Rate for Payer: Cigna Commercial |
$4,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,413.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,496.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$315.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$283.29
|
|
|
HAMMERTUBE IMPL 2.75X14MM 0D
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$180.29 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.75
|
|
|
HAMMERTUBE IMPL 2.75X14MM 0D
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$372.50 |
| Rate for Payer: Aetna Commercial |
$283.10
|
| Rate for Payer: Aetna Medicare Advantage |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.97
|
| Rate for Payer: Cigna Commercial |
$372.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.16
|
|
|
HAMMER TUBE SYSTEM
|
Facility
|
IP
|
$5,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.25 |
| Max. Negotiated Rate |
$1,373.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,373.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$851.25
|
|