|
SCREW CANN LCKG 5.0x80MM
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270634361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN LCKG 5.0x80MM
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270634361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$317.03
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.69
|
|
|
SCREW CANN LCKG 5.0x85MM
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270630779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$317.03
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.69
|
|
|
SCREW CANN LCKG 5.0x85MM
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270630779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN LNG THD 3x24MM
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: Aetna Medicare Advantage |
$245.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$208.84
|
| Rate for Payer: Cigna Commercial |
$409.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.26
|
|
|
SCREW CANN LNG THD 3x24MM
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$198.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$163.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.85
|
|
|
SCREW CANN LNG THD 3x34MM
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$198.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$163.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.85
|
|
|
SCREW CANN LNG THD 3x34MM
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: Aetna Medicare Advantage |
$245.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$208.84
|
| Rate for Payer: Cigna Commercial |
$409.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$122.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.26
|
|
|
SCREW CANN LNG THD 4.0X16MM
|
Facility
|
IP
|
$810.00
|
|
| Hospital Charge Code |
270670834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$196.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$196.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.50
|
|
|
SCREW CANN LNG THD 4.0X16MM
|
Facility
|
OP
|
$810.00
|
|
| Hospital Charge Code |
270670834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Medicare Advantage |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$206.55
|
| Rate for Payer: Cigna Commercial |
$405.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$196.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.00
|
|
|
SCREW CANN LNG THD 4.0x22MM
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$317.03
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.69
|
|
|
SCREW CANN LNG THD 4.0x22MM
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN LNG THD 4.0x24MM
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$317.03
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.69
|
|
|
SCREW CANN LNG THD 4.0x24MM
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN LNG THD 4.0X28MM
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Medicare Advantage |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$206.55
|
| Rate for Payer: Cigna Commercial |
$405.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$196.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.00
|
|
|
SCREW CANN LNG THD 4.0X28MM
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$196.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$196.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$121.50
|
|
|
SCREW CANN LNG THD 4.0x30MM
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$317.03
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.69
|
|
|
SCREW CANN LNG THD 4.0x30MM
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN LNG THD 4.0x32MM
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$317.03
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.69
|
|
|
SCREW CANN LNG THD 4.0x32MM
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN LNG THD 4.0x34MM
|
Facility
|
OP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: Aetna Commercial |
$326.55
|
| Rate for Payer: Aetna Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.13
|
| Rate for Payer: Cigna Commercial |
$429.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.41
|
|
|
SCREW CANN LNG THD 4.0x34MM
|
Facility
|
IP
|
$859.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.90 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.90
|
|
|
SCREW CANN LNG THD 4.0x36MM
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|
|
SCREW CANN LNG THD 4.0x36MM
|
Facility
|
OP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$417.15 |
| Rate for Payer: Aetna Commercial |
$317.03
|
| Rate for Payer: Aetna Medicare Advantage |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$212.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$212.75
|
| Rate for Payer: Cigna Commercial |
$417.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.69
|
|
|
SCREW CANN LNG THD 4.0x38MM
|
Facility
|
IP
|
$834.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$201.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$166.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$201.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$125.14
|
|