|
ENDOSTITCH 0 BLK 18CM SOFSILK
|
Facility
|
OP
|
$559.50
|
|
| Hospital Charge Code |
270692094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$279.75 |
| Rate for Payer: Aetna Commercial |
$167.85
|
| Rate for Payer: Aetna Medicare Advantage |
$167.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$142.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$142.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$142.67
|
| Rate for Payer: Cigna Commercial |
$279.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.73
|
| Rate for Payer: Oxford Commercial |
$279.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$279.75
|
|
|
ENDO STITCH 173016
|
Facility
|
IP
|
$2,009.42
|
|
| Hospital Charge Code |
270600144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.41 |
| Max. Negotiated Rate |
$301.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.41
|
|
|
ENDO STITCH 173016
|
Facility
|
OP
|
$2,009.42
|
|
| Hospital Charge Code |
270600144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.22 |
| Max. Negotiated Rate |
$1,004.71 |
| Rate for Payer: Aetna Commercial |
$602.83
|
| Rate for Payer: Aetna Medicare Advantage |
$602.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$512.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$512.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,004.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$261.22
|
| Rate for Payer: Oxford Commercial |
$1,004.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$301.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,004.71
|
|
|
ENDO STITCH 3-0 POLY 48 IN
|
Facility
|
OP
|
$296.50
|
|
| Hospital Charge Code |
270692034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$148.25 |
| Rate for Payer: Aetna Commercial |
$88.95
|
| Rate for Payer: Aetna Medicare Advantage |
$88.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.61
|
| Rate for Payer: Cigna Commercial |
$148.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.55
|
| Rate for Payer: Oxford Commercial |
$148.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$148.25
|
|
|
ENDO STITCH 3-0 POLY 48 IN
|
Facility
|
IP
|
$296.50
|
|
| Hospital Charge Code |
270692034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.48 |
| Max. Negotiated Rate |
$44.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.48
|
|
|
ENDO STITCH 3-0 POLY 7 IN
|
Facility
|
OP
|
$295.00
|
|
| Hospital Charge Code |
270692035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$147.50 |
| Rate for Payer: Aetna Commercial |
$88.50
|
| Rate for Payer: Aetna Medicare Advantage |
$88.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.22
|
| Rate for Payer: Cigna Commercial |
$147.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.35
|
| Rate for Payer: Oxford Commercial |
$147.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$147.50
|
|
|
ENDO STITCH 3-0 POLY 7 IN
|
Facility
|
IP
|
$295.00
|
|
| Hospital Charge Code |
270692035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.25 |
| Max. Negotiated Rate |
$44.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.25
|
|
|
ENDOSTITCH APPLIER
|
Facility
|
OP
|
$326.00
|
|
| Hospital Charge Code |
270338703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna Commercial |
$97.80
|
| Rate for Payer: Aetna Medicare Advantage |
$97.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$83.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$83.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$83.13
|
| Rate for Payer: Cigna Commercial |
$163.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.38
|
| Rate for Payer: Oxford Commercial |
$163.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$163.00
|
|
|
ENDOSTITCH APPLIER
|
Facility
|
IP
|
$326.00
|
|
| Hospital Charge Code |
270338703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.90
|
|
|
ENDO STITCH - DLU *******
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
1606573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Aetna Commercial |
$34.50
|
| Rate for Payer: Aetna Medicare Advantage |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.32
|
| Rate for Payer: Cigna Commercial |
$57.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
|
|
ENDO STITCH - DLU *******
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
1606573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$27.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
|
|
ENDO STITCH SUT DEVICE 10MM
|
Facility
|
OP
|
$1,800.53
|
|
| Hospital Charge Code |
270658698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.07 |
| Max. Negotiated Rate |
$900.26 |
| Rate for Payer: Aetna Commercial |
$540.16
|
| Rate for Payer: Aetna Medicare Advantage |
$540.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$459.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$459.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$459.14
|
| Rate for Payer: Cigna Commercial |
$900.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$234.07
|
| Rate for Payer: Oxford Commercial |
$900.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$900.26
|
|
|
ENDO STITCH SUT DEVICE 10MM
|
Facility
|
IP
|
$1,800.53
|
|
| Hospital Charge Code |
270658698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.08 |
| Max. Negotiated Rate |
$270.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.08
|
|
|
ENDOSTITCH SUTURE
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
270338704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
|
|
ENDOSTITCH SUTURE
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
270338704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Medicare Advantage |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.83
|
| Rate for Payer: Cigna Commercial |
$33.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.58
|
| Rate for Payer: Oxford Commercial |
$33.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.00
|
|
|
ENDO THORACIC STAPLER
|
Facility
|
OP
|
$395.00
|
|
| Hospital Charge Code |
270338730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$118.50
|
| 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 |
$51.35
|
| Rate for Payer: Oxford Commercial |
$197.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$197.50
|
|
|
ENDO THORACIC STAPLER
|
Facility
|
IP
|
$395.00
|
|
| Hospital Charge Code |
270338730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.25
|
|
|
ENDOTINE TRANSBLEPH 3.0
|
Facility
|
OP
|
$1,245.00
|
|
| Hospital Charge Code |
270647458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.85 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Aetna Commercial |
$373.50
|
| Rate for Payer: Aetna Medicare Advantage |
$373.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$317.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$317.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$317.48
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.85
|
| Rate for Payer: Oxford Commercial |
$622.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$622.50
|
|
|
ENDOTINE TRANSBLEPH 3.0
|
Facility
|
IP
|
$1,245.00
|
|
| Hospital Charge Code |
270647458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.75 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.75
|
|
|
ENDOTRACHEAL EXTUBATION
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
2500361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$640.73 |
| Rate for Payer: Aetna Better Health Medicaid |
$628.17
|
| Rate for Payer: Aetna Commercial |
$14.70
|
| Rate for Payer: Aetna Medicare Advantage |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.49
|
| Rate for Payer: Cigna Commercial |
$564.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.35
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$640.73
|
|
|
ENDOTRACHEAL EXTUBATION
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
2500361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$7.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.35
|
|
|
ENDOTRACH IN-LINE SUCTION CATH
|
Facility
|
OP
|
$85.65
|
|
| Hospital Charge Code |
270650303R
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$42.83 |
| Rate for Payer: Aetna Commercial |
$25.70
|
| Rate for Payer: Aetna Medicare Advantage |
$25.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.84
|
| Rate for Payer: Cigna Commercial |
$42.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.13
|
| Rate for Payer: Oxford Commercial |
$42.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.83
|
|
|
ENDOTRACH IN-LINE SUCTION CATH
|
Facility
|
IP
|
$85.65
|
|
| Hospital Charge Code |
270650303R
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.85
|
|
|
ENDOTREACHEAL SHER 1 BRONCH
|
Facility
|
IP
|
$268.33
|
|
| Hospital Charge Code |
270660426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.25
|
|
|
ENDOTREACHEAL SHER 1 BRONCH
|
Facility
|
OP
|
$268.33
|
|
| Hospital Charge Code |
270660426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.88 |
| Max. Negotiated Rate |
$134.16 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Medicare Advantage |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.42
|
| Rate for Payer: Cigna Commercial |
$134.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.88
|
| Rate for Payer: Oxford Commercial |
$134.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$134.16
|
|