|
TIGHTROPE SS XP
|
Facility
|
OP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$3,737.50 |
| Rate for Payer: Aetna Commercial |
$2,242.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,906.12
|
| Rate for Payer: Cigna Commercial |
$3,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
TIGHTROPE SS XP
|
Facility
|
IP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$1,808.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
TIGHT ROPE SYNDEMOSIS REPAIR
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270652942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
TIGHT ROPE SYNDEMOSIS REPAIR
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270652942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.25
|
| Rate for Payer: Oxford Commercial |
$212.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$212.50
|
|
|
TIGHTROPE SYSTEM
|
Facility
|
OP
|
$9,759.25
|
|
| Hospital Charge Code |
270702326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,463.89 |
| Max. Negotiated Rate |
$4,879.62 |
| Rate for Payer: Aetna Commercial |
$2,927.78
|
| Rate for Payer: Aetna Medicare Advantage |
$2,927.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,488.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,488.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,951.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,488.61
|
| Rate for Payer: Cigna Commercial |
$4,879.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,361.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,463.89
|
|
|
TIGHTROPE SYSTEM
|
Facility
|
IP
|
$9,759.25
|
|
| Hospital Charge Code |
270702326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,463.89 |
| Max. Negotiated Rate |
$2,361.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,951.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,361.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,463.89
|
|
|
TIGHT ROPE TITANIUM
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,320.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,320.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,122.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,122.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$880.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$2,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,064.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$660.00
|
|
|
TIGHT ROPE TITANIUM
|
Facility
|
IP
|
$4,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$1,064.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$880.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,064.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$660.00
|
|
|
TIGHTROPE TITANIUM XP
|
Facility
|
OP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$3,737.50 |
| Rate for Payer: Aetna Commercial |
$2,242.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,906.12
|
| Rate for Payer: Cigna Commercial |
$3,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
TIGHTROPE TITANIUM XP
|
Facility
|
IP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270682061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$1,808.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
TIGHTROPE WITH FIBER TAG
|
Facility
|
IP
|
$1,675.00
|
|
| Hospital Charge Code |
270690999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.25 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.25
|
|
|
TIGHTROPE WITH FIBER TAG
|
Facility
|
OP
|
$1,675.00
|
|
| Hospital Charge Code |
270690999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$837.50 |
| Rate for Payer: Aetna Commercial |
$502.50
|
| Rate for Payer: Aetna Medicare Advantage |
$502.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$427.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$427.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$427.12
|
| Rate for Payer: Cigna Commercial |
$837.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.75
|
| Rate for Payer: Oxford Commercial |
$837.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$837.50
|
|
|
TIGHTROPE XP STAINLESS
|
Facility
|
IP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270655935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$1,808.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
TIGHTROPE XP STAINLESS
|
Facility
|
OP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270655935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$3,737.50 |
| Rate for Payer: Aetna Commercial |
$2,242.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,906.12
|
| Rate for Payer: Cigna Commercial |
$3,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
TIGHTTOPE WTH FIBER TAG
|
Facility
|
IP
|
$2,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$635.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$525.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$635.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.75
|
|
|
TIGHTTOPE WTH FIBER TAG
|
Facility
|
OP
|
$2,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Aetna Medicare Advantage |
$787.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$669.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$669.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$669.38
|
| Rate for Payer: Cigna Commercial |
$1,312.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$635.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.75
|
|
|
TIGRIS VASCULAR STENT
|
Facility
|
OP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270680396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$3,737.50 |
| Rate for Payer: Aetna Commercial |
$2,242.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,906.12
|
| Rate for Payer: Cigna Commercial |
$3,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
TIGRIS VASCULAR STENT
|
Facility
|
IP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270680396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$1,808.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
TILADE INHALER
|
Facility
|
IP
|
$172.00
|
|
| Hospital Charge Code |
60634910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.80
|
|
|
TILADE INHALER
|
Facility
|
OP
|
$172.00
|
|
| Hospital Charge Code |
60634910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: Aetna Medicare Advantage |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.86
|
| Rate for Payer: Cigna Commercial |
$86.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.36
|
| Rate for Payer: Oxford Commercial |
$86.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.00
|
|
|
TILDA LEAD 45CM
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270663606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$1,062.50 |
| Rate for Payer: Aetna Commercial |
$637.50
|
| Rate for Payer: Aetna Medicare Advantage |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$541.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$541.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$541.88
|
| Rate for Payer: Cigna Commercial |
$1,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$514.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.75
|
|
|
TILDA LEAD 45CM
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270663606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$514.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.75
|
|
|
TILDA LEAD 53CM
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270675292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$514.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.75
|
|
|
TILDA LEAD 53CM
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270675292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$1,062.50 |
| Rate for Payer: Aetna Commercial |
$637.50
|
| Rate for Payer: Aetna Medicare Advantage |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$541.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$541.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$541.88
|
| Rate for Payer: Cigna Commercial |
$1,062.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$514.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.75
|
|
|
TILDA LEAD R53
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
270662058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$514.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.75
|
|