|
FLEX HD MESH GRAFTS 6CM X 12CM
|
Facility
|
OP
|
$13,105.00
|
|
| Hospital Charge Code |
270663194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,965.75 |
| Max. Negotiated Rate |
$6,552.50 |
| Rate for Payer: Aetna Commercial |
$3,931.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,931.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,341.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,341.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,621.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,341.78
|
| Rate for Payer: Cigna Commercial |
$6,552.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,171.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,965.75
|
|
|
FLEX HD MESH GRAFTS 6CM X 12CM
|
Facility
|
IP
|
$13,105.00
|
|
| Hospital Charge Code |
270663194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,965.75 |
| Max. Negotiated Rate |
$3,171.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,621.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,171.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,965.75
|
|
|
FLEX HD MESH GRAFTS 6CMX16CM
|
Facility
|
OP
|
$17,480.00
|
|
| Hospital Charge Code |
270663195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,622.00 |
| Max. Negotiated Rate |
$8,740.00 |
| Rate for Payer: Aetna Commercial |
$5,244.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,244.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,457.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,457.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,496.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,457.40
|
| Rate for Payer: Cigna Commercial |
$8,740.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,230.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,622.00
|
|
|
FLEX HD MESH GRAFTS 6CMX16CM
|
Facility
|
IP
|
$17,480.00
|
|
| Hospital Charge Code |
270663195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,622.00 |
| Max. Negotiated Rate |
$4,230.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,496.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,230.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,622.00
|
|
|
FLEXIBLE COLLODION
|
Facility
|
IP
|
$52.50
|
|
| Hospital Charge Code |
6012561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.88
|
|
|
FLEXIBLE COLLODION
|
Facility
|
OP
|
$52.50
|
|
| Hospital Charge Code |
6012561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Commercial |
$15.75
|
| Rate for Payer: Aetna Medicare Advantage |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.39
|
| Rate for Payer: Cigna Commercial |
$26.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.83
|
| Rate for Payer: Oxford Commercial |
$26.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.25
|
|
|
FLEXIBLE DRILL
|
Facility
|
OP
|
$3,901.95
|
|
| Hospital Charge Code |
270656680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.25 |
| Max. Negotiated Rate |
$1,950.97 |
| Rate for Payer: Aetna Commercial |
$1,170.59
|
| Rate for Payer: Aetna Medicare Advantage |
$1,170.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$995.00
|
| Rate for Payer: Cigna Commercial |
$1,950.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$507.25
|
| Rate for Payer: Oxford Commercial |
$1,950.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$585.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,950.97
|
|
|
FLEXIBLE DRILL
|
Facility
|
IP
|
$3,901.95
|
|
| Hospital Charge Code |
270656680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$585.29 |
| Max. Negotiated Rate |
$585.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$585.29
|
|
|
FLEXIBLE DRILL ASSEMBLE 8 MM
|
Facility
|
IP
|
$1,959.90
|
|
| Hospital Charge Code |
270690396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.99 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$293.99
|
|
|
FLEXIBLE DRILL ASSEMBLE 8 MM
|
Facility
|
OP
|
$1,959.90
|
|
| Hospital Charge Code |
270690396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.79 |
| Max. Negotiated Rate |
$979.95 |
| Rate for Payer: Aetna Commercial |
$587.97
|
| Rate for Payer: Aetna Medicare Advantage |
$587.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$499.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$499.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$499.77
|
| Rate for Payer: Cigna Commercial |
$979.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$254.79
|
| Rate for Payer: Oxford Commercial |
$979.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$293.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$979.95
|
|
|
FLEXIBLE ENDOSCOPIC EVAL
|
Facility
|
IP
|
$361.05
|
|
|
Service Code
|
HCPCS 92612GN
|
| Hospital Charge Code |
74204034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.16
|
|
|
FLEXIBLE ENDOSCOPIC EVAL
|
Facility
|
OP
|
$361.05
|
|
|
Service Code
|
HCPCS 92612GN
|
| Hospital Charge Code |
74204034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$686.00 |
| Rate for Payer: Aetna Commercial |
$108.31
|
| Rate for Payer: Aetna Medicare Advantage |
$108.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.07
|
| Rate for Payer: Cigna Commercial |
$180.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.94
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$686.00
|
|
|
FLEXIBLE IRIS RETRACTOR
|
Facility
|
OP
|
$569.25
|
|
| Hospital Charge Code |
270666843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$284.62 |
| Rate for Payer: Aetna Commercial |
$170.78
|
| Rate for Payer: Aetna Medicare Advantage |
$170.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$145.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$145.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$145.16
|
| Rate for Payer: Cigna Commercial |
$284.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$74.00
|
| Rate for Payer: Oxford Commercial |
$284.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$284.62
|
|
|
FLEXIBLE IRIS RETRACTOR
|
Facility
|
IP
|
$569.25
|
|
| Hospital Charge Code |
270666843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.39 |
| Max. Negotiated Rate |
$85.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.39
|
|
|
FLEXIBLE REAMER 11 MM
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
270688543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
FLEXIBLE REAMER 11 MM
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
270688543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$525.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$227.50
|
| Rate for Payer: Oxford Commercial |
$875.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$875.00
|
|
|
FLEXIGRAFT
|
Facility
|
OP
|
$15,277.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270664582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.62 |
| Max. Negotiated Rate |
$7,638.75 |
| Rate for Payer: Aetna Commercial |
$4,583.25
|
| Rate for Payer: Aetna Medicare Advantage |
$4,583.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,895.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,895.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,055.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,895.76
|
| Rate for Payer: Cigna Commercial |
$7,638.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,697.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,291.62
|
|
|
FLEXIGRAFT
|
Facility
|
IP
|
$15,277.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270664582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.62 |
| Max. Negotiated Rate |
$3,697.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,055.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,697.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,291.62
|
|
|
FLEXIGRAFT CONNECT PRE ZORC
|
Facility
|
IP
|
$6,111.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.73 |
| Max. Negotiated Rate |
$1,478.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,222.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,478.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$916.73
|
|
|
FLEXIGRAFT CONNECT PRE ZORC
|
Facility
|
OP
|
$6,111.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.73 |
| Max. Negotiated Rate |
$3,055.75 |
| Rate for Payer: Aetna Commercial |
$1,833.45
|
| Rate for Payer: Aetna Medicare Advantage |
$1,833.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,558.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,558.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,558.43
|
| Rate for Payer: Cigna Commercial |
$3,055.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,478.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$916.73
|
|
|
FLEXIGRAFT MENISCUS MEDIAL RT
|
Facility
|
OP
|
$23,523.75
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
270697618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.56 |
| Max. Negotiated Rate |
$11,761.88 |
| Rate for Payer: Aetna Commercial |
$7,057.12
|
| Rate for Payer: Aetna Medicare Advantage |
$7,057.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,998.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,998.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,704.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,998.56
|
| Rate for Payer: Cigna Commercial |
$11,761.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,692.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,528.56
|
|
|
FLEXIGRAFT MENISCUS MEDIAL RT
|
Facility
|
IP
|
$23,523.75
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
270697618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.56 |
| Max. Negotiated Rate |
$5,692.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,704.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,692.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,528.56
|
|
|
Flexima Biliary Catheter 8Fr
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270688760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.75 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.75
|
|
|
Flexima Biliary Catheter 8Fr
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
270688760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Aetna Medicare Advantage |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$103.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$103.28
|
| Rate for Payer: Cigna Commercial |
$202.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.65
|
| Rate for Payer: Oxford Commercial |
$202.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$202.50
|
|
|
FLEXI-SEAL COLLECTION BAG
|
Facility
|
OP
|
$30.60
|
|
| Hospital Charge Code |
270646932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Aetna Medicare Advantage |
$9.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.80
|
| Rate for Payer: Cigna Commercial |
$15.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.98
|
| Rate for Payer: Oxford Commercial |
$15.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.30
|
|