|
SCREW LOCKING SLF TAP 3.5x32MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270638923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$165.18
|
| Rate for Payer: Aetna Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.40
|
| Rate for Payer: Cigna Commercial |
$275.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x34MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$165.18
|
| Rate for Payer: Aetna Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.40
|
| Rate for Payer: Cigna Commercial |
$275.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x34MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x35MM
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270646517
|
|
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 LOCKING SLF TAP 3.5x35MM
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270646517
|
|
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 LOCKING SLF TAP 3.5x36MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$165.18
|
| Rate for Payer: Aetna Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.40
|
| Rate for Payer: Cigna Commercial |
$275.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x36MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x38MM
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270634387
|
|
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 LOCKING SLF TAP 3.5x38MM
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270634387
|
|
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 LOCKING SLF TAP 3.5x40MM
|
Facility
|
IP
|
$642.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665278
|
|
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: Qualcare PPO/HMO/WC |
$96.41
|
|
|
SCREW LOCKING SLF TAP 3.5x40MM
|
Facility
|
OP
|
$642.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.41 |
| Max. Negotiated Rate |
$321.35 |
| Rate for Payer: Aetna Commercial |
$192.81
|
| 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: Qualcare PPO/HMO/WC |
$96.41
|
|
|
SCREW LOCKING SLF TAP 3.5x40MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x40MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$165.18
|
| Rate for Payer: Aetna Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.40
|
| Rate for Payer: Cigna Commercial |
$275.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x42MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x42MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$165.18
|
| Rate for Payer: Aetna Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.40
|
| Rate for Payer: Cigna Commercial |
$275.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x44MM
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270647696
|
|
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 LOCKING SLF TAP 3.5x44MM
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270647696
|
|
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 LOCKING SLF TAP 3.5X44MM
|
Facility
|
OP
|
$1,370.00
|
|
| Hospital Charge Code |
270670989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.50 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Aetna Commercial |
$411.00
|
| Rate for Payer: Aetna Medicare Advantage |
$411.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$274.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$349.35
|
| Rate for Payer: Cigna Commercial |
$685.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$331.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.50
|
|
|
SCREW LOCKING SLF TAP 3.5X44MM
|
Facility
|
IP
|
$1,370.00
|
|
| Hospital Charge Code |
270670989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.50 |
| Max. Negotiated Rate |
$331.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$274.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$331.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.50
|
|
|
SCREW LOCKING SLF TAP 3.5x45MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x45MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$165.18
|
| Rate for Payer: Aetna Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.40
|
| Rate for Payer: Cigna Commercial |
$275.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
SCREW LOCKING SLF TAP 3.5x46MM
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648816
|
|
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 LOCKING SLF TAP 3.5x46MM
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648816
|
|
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 LOCKING SLF TAP 3.5x48MM
|
Facility
|
OP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637380
|
|
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 LOCKING SLF TAP 3.5x48MM
|
Facility
|
IP
|
$534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637380
|
|
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
|
|