|
DISSECTING TOOL
|
Facility
|
OP
|
$764.75
|
|
| Hospital Charge Code |
270657887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$382.38 |
| Rate for Payer: Aetna Commercial |
$229.43
|
| Rate for Payer: Aetna Medicare Advantage |
$229.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$195.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$195.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$195.01
|
| Rate for Payer: Cigna Commercial |
$382.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.42
|
| Rate for Payer: Oxford Commercial |
$382.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$382.38
|
|
|
DISSECTING TOOL PURPLE
|
Facility
|
IP
|
$755.25
|
|
| Hospital Charge Code |
270657257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.29 |
| Max. Negotiated Rate |
$113.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.29
|
|
|
DISSECTING TOOL PURPLE
|
Facility
|
OP
|
$755.25
|
|
| Hospital Charge Code |
270657257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.18 |
| Max. Negotiated Rate |
$377.62 |
| Rate for Payer: Aetna Commercial |
$226.57
|
| Rate for Payer: Aetna Medicare Advantage |
$226.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$192.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$192.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$192.59
|
| Rate for Payer: Cigna Commercial |
$377.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.18
|
| Rate for Payer: Oxford Commercial |
$377.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$377.62
|
|
|
DISSECTOR 3.5MM x 7CM
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270702077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$84.15
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.90
|
| Rate for Payer: Oxford Commercial |
$165.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$165.00
|
|
|
DISSECTOR 3.5MM x 7CM
|
Facility
|
IP
|
$330.00
|
|
| Hospital Charge Code |
270702077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
|
|
DISSECTOR BALLN 240CC VBD-240T
|
Facility
|
IP
|
$1,572.85
|
|
| Hospital Charge Code |
270622271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.93 |
| Max. Negotiated Rate |
$235.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$235.93
|
|
|
DISSECTOR BALLN 240CC VBD-240T
|
Facility
|
OP
|
$1,572.85
|
|
| Hospital Charge Code |
270622271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.47 |
| Max. Negotiated Rate |
$786.42 |
| Rate for Payer: Aetna Commercial |
$471.86
|
| Rate for Payer: Aetna Medicare Advantage |
$471.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$401.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$401.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$401.08
|
| Rate for Payer: Cigna Commercial |
$786.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$204.47
|
| Rate for Payer: Oxford Commercial |
$786.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$235.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$786.42
|
|
|
DISSECTOR BALLOON OVAL
|
Facility
|
OP
|
$2,744.58
|
|
| Hospital Charge Code |
270655645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$356.80 |
| Max. Negotiated Rate |
$1,372.29 |
| Rate for Payer: Aetna Commercial |
$823.37
|
| Rate for Payer: Aetna Medicare Advantage |
$823.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$699.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$699.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$699.87
|
| Rate for Payer: Cigna Commercial |
$1,372.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.80
|
| Rate for Payer: Oxford Commercial |
$1,372.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$411.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,372.29
|
|
|
DISSECTOR BALLOON OVAL
|
Facility
|
IP
|
$2,744.58
|
|
| Hospital Charge Code |
270655645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.69 |
| Max. Negotiated Rate |
$411.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$411.69
|
|
|
DISSECTOR BALLOON ROUND
|
Facility
|
OP
|
$1,790.60
|
|
|
Service Code
|
HCPCS C1727
|
| Hospital Charge Code |
270665626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.59 |
| Max. Negotiated Rate |
$895.30 |
| Rate for Payer: Aetna Commercial |
$537.18
|
| Rate for Payer: Aetna Medicare Advantage |
$537.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$456.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$456.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$358.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$456.60
|
| Rate for Payer: Cigna Commercial |
$895.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$433.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$268.59
|
|
|
DISSECTOR BALLOON ROUND
|
Facility
|
IP
|
$1,790.60
|
|
|
Service Code
|
HCPCS C1727
|
| Hospital Charge Code |
270665626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.59 |
| Max. Negotiated Rate |
$433.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$358.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$433.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$268.59
|
|
|
DISSECTOR BALLOON SBT ROUND SM
|
Facility
|
IP
|
$6,836.00
|
|
| Hospital Charge Code |
270683704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,025.40 |
| Max. Negotiated Rate |
$1,025.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,025.40
|
|
|
DISSECTOR BALLOON SBT ROUND SM
|
Facility
|
OP
|
$6,836.00
|
|
| Hospital Charge Code |
270683704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$888.68 |
| Max. Negotiated Rate |
$3,418.00 |
| Rate for Payer: Aetna Commercial |
$2,050.80
|
| Rate for Payer: Aetna Medicare Advantage |
$2,050.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,743.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,743.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,743.18
|
| Rate for Payer: Cigna Commercial |
$3,418.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$888.68
|
| Rate for Payer: Oxford Commercial |
$3,418.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,025.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,418.00
|
|
|
DISSECTOR BLUNT TIP 5MM
|
Facility
|
OP
|
$2,249.25
|
|
| Hospital Charge Code |
270637402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,124.62 |
| Rate for Payer: Aetna Commercial |
$674.77
|
| Rate for Payer: Aetna Medicare Advantage |
$674.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.56
|
| Rate for Payer: Cigna Commercial |
$1,124.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.40
|
| Rate for Payer: Oxford Commercial |
$1,124.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,124.62
|
|
|
DISSECTOR BLUNT TIP 5MM
|
Facility
|
IP
|
$2,249.25
|
|
| Hospital Charge Code |
270637402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.39 |
| Max. Negotiated Rate |
$337.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.39
|
|
|
DISSECTOR CRVD ULTRASONIC 39MM
|
Facility
|
IP
|
$2,440.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270696236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$366.00
|
|
|
DISSECTOR CRVD ULTRASONIC 39MM
|
Facility
|
OP
|
$2,440.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270696236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.20 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna Commercial |
$732.00
|
| Rate for Payer: Aetna Medicare Advantage |
$732.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$622.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$622.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$622.20
|
| Rate for Payer: Cigna Commercial |
$1,220.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$317.20
|
| Rate for Payer: Oxford Commercial |
$1,220.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$366.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,220.00
|
|
|
DISSECTOR ENDO DISPOSAB RGBRS1
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
270641143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
|
|
DISSECTOR ENDO DISPOSAB RGBRS1
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
270641143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Aetna Commercial |
$277.50
|
| Rate for Payer: Aetna Medicare Advantage |
$277.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.88
|
| Rate for Payer: Cigna Commercial |
$462.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$120.25
|
| Rate for Payer: Oxford Commercial |
$462.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$462.50
|
|
|
DISSECTOR ENDO ULTRASONIC 39CM
|
Facility
|
IP
|
$2,040.00
|
|
| Hospital Charge Code |
270683165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$306.00
|
|
|
DISSECTOR ENDO ULTRASONIC 39CM
|
Facility
|
OP
|
$2,040.00
|
|
| Hospital Charge Code |
270683165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$612.00
|
| Rate for Payer: Aetna Medicare Advantage |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$520.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$520.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$520.20
|
| Rate for Payer: Cigna Commercial |
$1,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$265.20
|
| Rate for Payer: Oxford Commercial |
$1,020.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$306.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,020.00
|
|
|
DISSECTOR GSI BALLOON 174016
|
Facility
|
OP
|
$900.85
|
|
| Hospital Charge Code |
270618803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.11 |
| Max. Negotiated Rate |
$450.43 |
| Rate for Payer: Aetna Commercial |
$270.25
|
| Rate for Payer: Aetna Medicare Advantage |
$270.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.72
|
| Rate for Payer: Cigna Commercial |
$450.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.11
|
| Rate for Payer: Oxford Commercial |
$450.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$450.43
|
|
|
DISSECTOR GSI BALLOON 174016
|
Facility
|
IP
|
$900.85
|
|
| Hospital Charge Code |
270618803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.13 |
| Max. Negotiated Rate |
$135.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.13
|
|
|
DISSECTOR GSI VAS BALLOON
|
Facility
|
IP
|
$2,966.45
|
|
| Hospital Charge Code |
270605751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.97 |
| Max. Negotiated Rate |
$717.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$593.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$717.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.97
|
|
|
DISSECTOR GSI VAS BALLOON
|
Facility
|
OP
|
$2,966.45
|
|
| Hospital Charge Code |
270605751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.97 |
| Max. Negotiated Rate |
$1,483.22 |
| Rate for Payer: Aetna Commercial |
$889.93
|
| Rate for Payer: Aetna Medicare Advantage |
$889.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$756.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$756.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$593.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$756.44
|
| Rate for Payer: Cigna Commercial |
$1,483.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$717.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$444.97
|
|