|
SCREW LOCKING SLF TAP 3.5x10MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637258
|
|
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 3.5x12MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
SCREW LOCKING SLF TAP 3.5x12MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637259
|
|
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 3.5x14MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
SCREW LOCKING SLF TAP 3.5x14MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637260
|
|
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 3.5x16MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270634850
|
|
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 3.5x16MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270634850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
SCREW LOCKING SLF TAP 3.5x18MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270636275
|
|
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 3.5x18MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270636275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
SCREW LOCKING SLF TAP 3.5x20MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270636276
|
|
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 3.5x20MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270636276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
SCREW LOCKING SLF TAP 3.5x22MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270641388
|
|
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 3.5x22MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270641388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
SCREW LOCKING SLF TAP 3.5x24MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
SCREW LOCKING SLF TAP 3.5x24MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633836
|
|
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 3.5x26MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633835
|
|
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 3.5x26MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
SCREW LOCKING SLF TAP 3.5x28MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
SCREW LOCKING SLF TAP 3.5x28MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633524
|
|
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 3.5x30MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633834
|
|
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 3.5x30MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
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 |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
SCREW LOCKING SLF TAP 3.5x32MM
|
Facility
|
IP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270638923
|
|
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 3.5x34MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270633833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
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
|
|