|
SCREW 3.5MM CRTX LOW PROF HD
|
Facility
|
OP
|
$148.50
|
|
| Hospital Charge Code |
270660894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Aetna Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.87
|
| Rate for Payer: Cigna Commercial |
$74.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.27
|
|
|
SCREW 3.5MM CRTX/LOW PROF HD
|
Facility
|
IP
|
$148.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$35.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.27
|
|
|
SCREW 3.5MM CRTX/LOW PROF HD
|
Facility
|
OP
|
$148.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Aetna Commercial |
$44.55
|
| Rate for Payer: Aetna Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.87
|
| Rate for Payer: Cigna Commercial |
$74.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.27
|
|
|
SCREW 3.5MM LOCKING SELF
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$267.27 |
| Rate for Payer: Aetna Commercial |
$160.37
|
| Rate for Payer: Aetna Medicare Advantage |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.31
|
| Rate for Payer: Cigna Commercial |
$267.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$129.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
IP
|
$519.00
|
|
| Hospital Charge Code |
270656814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$125.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
OP
|
$519.00
|
|
| Hospital Charge Code |
270656224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Medicare Advantage |
$155.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.34
|
| Rate for Payer: Cigna Commercial |
$259.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
OP
|
$519.00
|
|
| Hospital Charge Code |
270656811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Medicare Advantage |
$155.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.34
|
| Rate for Payer: Cigna Commercial |
$259.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
IP
|
$519.00
|
|
| Hospital Charge Code |
270656224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$125.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$267.27 |
| Rate for Payer: Aetna Commercial |
$160.37
|
| Rate for Payer: Aetna Medicare Advantage |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.31
|
| Rate for Payer: Cigna Commercial |
$267.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$267.27 |
| Rate for Payer: Aetna Commercial |
$160.37
|
| Rate for Payer: Aetna Medicare Advantage |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.31
|
| Rate for Payer: Cigna Commercial |
$267.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
OP
|
$519.00
|
|
| Hospital Charge Code |
270656814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Medicare Advantage |
$155.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.34
|
| Rate for Payer: Cigna Commercial |
$259.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$129.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$129.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$267.27 |
| Rate for Payer: Aetna Commercial |
$160.37
|
| Rate for Payer: Aetna Medicare Advantage |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.31
|
| Rate for Payer: Cigna Commercial |
$267.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$267.27 |
| Rate for Payer: Aetna Commercial |
$160.37
|
| Rate for Payer: Aetna Medicare Advantage |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.31
|
| Rate for Payer: Cigna Commercial |
$267.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
IP
|
$519.00
|
|
| Hospital Charge Code |
270656223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$125.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
OP
|
$519.00
|
|
| Hospital Charge Code |
270656223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Medicare Advantage |
$155.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.34
|
| Rate for Payer: Cigna Commercial |
$259.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$129.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$267.27 |
| Rate for Payer: Aetna Commercial |
$160.37
|
| Rate for Payer: Aetna Medicare Advantage |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.31
|
| Rate for Payer: Cigna Commercial |
$267.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$129.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$129.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$129.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$267.27 |
| Rate for Payer: Aetna Commercial |
$160.37
|
| Rate for Payer: Aetna Medicare Advantage |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.31
|
| Rate for Payer: Cigna Commercial |
$267.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
SCREW 3.5MM LOCKING SELF TAP
|
Facility
|
IP
|
$519.00
|
|
| Hospital Charge Code |
270656811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$125.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.85
|
|