|
TAPER ROUTER 2.3X 19MM
|
Facility
|
OP
|
$395.00
|
|
| Hospital Charge Code |
270691574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$150.10
|
| Rate for Payer: Aetna Medicare Advantage |
$118.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$100.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$100.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$100.72
|
| Rate for Payer: Cigna Commercial |
$197.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.50
|
| Rate for Payer: Oxford Commercial |
$79.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$79.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.47
|
|
|
TAPE SCOTCHCAST SYNTH 5X4 YD
|
Facility
|
IP
|
$20.55
|
|
| Hospital Charge Code |
270654217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.08
|
|
|
TAPE SCOTCHCAST SYNTH 5X4 YD
|
Facility
|
OP
|
$20.55
|
|
| Hospital Charge Code |
270654217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Aetna Commercial |
$7.81
|
| Rate for Payer: Aetna Medicare Advantage |
$6.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.24
|
| Rate for Payer: Cigna Commercial |
$10.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.17
|
| Rate for Payer: Oxford Commercial |
$4.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.11
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.54
|
|
|
TAPE SCOTCHCAST SYNTHETIC 4X4
|
Facility
|
OP
|
$16.67
|
|
| Hospital Charge Code |
270654215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: Aetna Commercial |
$6.33
|
| Rate for Payer: Aetna Medicare Advantage |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.25
|
| Rate for Payer: Cigna Commercial |
$8.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.00
|
| Rate for Payer: Oxford Commercial |
$3.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.44
|
|
|
TAPE SCOTCHCAST SYNTHETIC 4X4
|
Facility
|
IP
|
$16.67
|
|
| Hospital Charge Code |
270654215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.50
|
|
|
TAPESTRY BIOINTEG IMP 40X30MM
|
Facility
|
OP
|
$17,250.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
270698253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.73 |
| Max. Negotiated Rate |
$8,625.00 |
| Rate for Payer: Aetna Commercial |
$6,555.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,398.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,398.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,398.75
|
| Rate for Payer: Cigna Commercial |
$8,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,174.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,795.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,587.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$415.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$457.12
|
|
|
TAPESTRY BIOINTEG IMP 40X30MM
|
Facility
|
IP
|
$17,250.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
270698253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.50 |
| Max. Negotiated Rate |
$4,174.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,174.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,795.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,587.50
|
|
|
TAPESTRY BIOINT IMP 50X40X25MM
|
Facility
|
IP
|
$15,550.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
270699888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,332.50 |
| Max. Negotiated Rate |
$3,763.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,763.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,421.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,332.50
|
|
|
TAPESTRY BIOINT IMP 50X40X25MM
|
Facility
|
OP
|
$15,550.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
270699888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.75 |
| Max. Negotiated Rate |
$7,775.00 |
| Rate for Payer: Aetna Commercial |
$5,909.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,665.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,965.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,965.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,965.25
|
| Rate for Payer: Cigna Commercial |
$7,775.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,763.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,421.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,332.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$374.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$412.07
|
|
|
TAPE SURGICAL 3X5-1/2YD
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
270331213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
TAPE SURGICAL 3X5-1/2YD
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
270331213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.00
|
| Rate for Payer: Oxford Commercial |
$10.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.32
|
|
|
TAPE SURGICAL DURAPORE 3X10YD
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
270331214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$9.12
|
| Rate for Payer: Aetna Medicare Advantage |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.12
|
| Rate for Payer: Cigna Commercial |
$12.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.20
|
| Rate for Payer: Oxford Commercial |
$4.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.64
|
|
|
TAPE SURGICAL DURAPORE 3X10YD
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
270331214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.60
|
|
|
TAPE TIGER
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
270665746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
TAPE TIGER
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
270665746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.00
|
| Rate for Payer: Oxford Commercial |
$50.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.62
|
|
|
TAPE TONSIL 1/4 X 36 YDS
|
Facility
|
OP
|
$37.65
|
|
| Hospital Charge Code |
270302165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna Medicare Advantage |
$11.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.60
|
| Rate for Payer: Cigna Commercial |
$18.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.29
|
| Rate for Payer: Oxford Commercial |
$7.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.00
|
|
|
TAPE TONSIL 1/4 X 36 YDS
|
Facility
|
IP
|
$37.65
|
|
| Hospital Charge Code |
270302165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.65
|
|
|
TAPE TRANSPORE 1 ROLL
|
Facility
|
OP
|
$9.65
|
|
| Hospital Charge Code |
270350250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare Advantage |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.90
|
| Rate for Payer: Oxford Commercial |
$1.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.26
|
|
|
TAPE TRANSPORE 1 ROLL
|
Facility
|
IP
|
$9.65
|
|
| Hospital Charge Code |
270350250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
|
|
TAPE TRANSPORE 1 ROLL ******
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
8001794
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$7.98
|
| Rate for Payer: Aetna Medicare Advantage |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.36
|
| Rate for Payer: Cigna Commercial |
$10.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.30
|
| Rate for Payer: Oxford Commercial |
$4.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.56
|
|
|
TAPE TRANSPORE 1 ROLL ******
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
8001794
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.15
|
|
|
TAPE TRANSPORE 1X54
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
270605770
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
TAPE TRANSPORE 1X54
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
270605770
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.20
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
TAPE UMBILICAL
|
Facility
|
IP
|
$5.74
|
|
| Hospital Charge Code |
270658538
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.86
|
|
|
TAPE UMBILICAL
|
Facility
|
OP
|
$5.74
|
|
| Hospital Charge Code |
270658538
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare Advantage |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.46
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.72
|
| Rate for Payer: Oxford Commercial |
$1.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.15
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.15
|
|