|
ANCHOR SUPQK W/#2PNCRYL 212135
|
Facility
|
OP
|
$1,383.90
|
|
| Hospital Charge Code |
270634401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.59 |
| Max. Negotiated Rate |
$691.95 |
| Rate for Payer: Aetna Commercial |
$415.17
|
| Rate for Payer: Aetna Medicare Advantage |
$415.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$352.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$352.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$352.89
|
| Rate for Payer: Cigna Commercial |
$691.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$334.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.59
|
|
|
ANCHOR SUPQK W/#2PNCRYL 212135
|
Facility
|
IP
|
$1,383.90
|
|
| Hospital Charge Code |
270634401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.59 |
| Max. Negotiated Rate |
$334.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$276.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$334.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.59
|
|
|
ANCHOR SUTURE BIOCOMPOSITE SW
|
Facility
|
IP
|
$2,860.00
|
|
| Hospital Charge Code |
270667330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$429.00
|
|
|
ANCHOR SUTURE BIOCOMPOSITE SW
|
Facility
|
OP
|
$2,860.00
|
|
| Hospital Charge Code |
270667330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.80 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$858.00
|
| Rate for Payer: Aetna Medicare Advantage |
$858.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$729.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$729.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$729.30
|
| Rate for Payer: Cigna Commercial |
$1,430.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$371.80
|
| Rate for Payer: Oxford Commercial |
$1,430.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$429.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,430.00
|
|
|
ANCHOR SUTURE BIOCORK AR1920BF
|
Facility
|
OP
|
$1,289.65
|
|
| Hospital Charge Code |
270629335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.45 |
| Max. Negotiated Rate |
$644.83 |
| Rate for Payer: Aetna Commercial |
$386.89
|
| Rate for Payer: Aetna Medicare Advantage |
$386.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$328.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$328.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$257.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$328.86
|
| Rate for Payer: Cigna Commercial |
$644.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$312.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$193.45
|
|
|
ANCHOR SUTURE BIOCORK AR1920BF
|
Facility
|
IP
|
$1,289.65
|
|
| Hospital Charge Code |
270629335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.45 |
| Max. Negotiated Rate |
$312.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$257.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$312.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$193.45
|
|
|
ANCHOR SUTURE BIO CORKSCREW
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270651515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$442.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
ANCHOR SUTURE BIO CORKSCREW
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270651515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$356.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
ANCHOR SUTURE CORKSCREW MICRO
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare Advantage |
$427.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$363.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$363.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$363.38
|
| Rate for Payer: Cigna Commercial |
$712.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.75
|
|
|
ANCHOR SUTURE CORKSCREW MICRO
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$285.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.75
|
|
|
ANCHOR SUTURE NANO TACK 1.4 MM
|
Facility
|
IP
|
$1,646.25
|
|
| Hospital Charge Code |
270680575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.94 |
| Max. Negotiated Rate |
$246.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$246.94
|
|
|
ANCHOR SUTURE NANO TACK 1.4 MM
|
Facility
|
OP
|
$1,646.25
|
|
| Hospital Charge Code |
270680575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.01 |
| Max. Negotiated Rate |
$823.12 |
| Rate for Payer: Aetna Commercial |
$493.88
|
| Rate for Payer: Aetna Medicare Advantage |
$493.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$419.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$419.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$419.79
|
| Rate for Payer: Cigna Commercial |
$823.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.01
|
| Rate for Payer: Oxford Commercial |
$823.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$246.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$823.12
|
|
|
ANCHOR SUTURE PEEK 4.5 X 15 MM
|
Facility
|
IP
|
$2,158.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$323.81 |
| Max. Negotiated Rate |
$522.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$431.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$522.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$323.81
|
|
|
ANCHOR SUTURE PEEK 4.5 X 15 MM
|
Facility
|
OP
|
$2,158.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$323.81 |
| Max. Negotiated Rate |
$1,079.38 |
| Rate for Payer: Aetna Commercial |
$647.62
|
| Rate for Payer: Aetna Medicare Advantage |
$647.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$550.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$550.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$431.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$550.48
|
| Rate for Payer: Cigna Commercial |
$1,079.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$522.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$323.81
|
|
|
ANCHOR SUTURE PEEK 5.5 X 15 MM
|
Facility
|
OP
|
$2,158.75
|
|
|
Service Code
|
HCPCS C1716
|
| Hospital Charge Code |
270701619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$323.81 |
| Max. Negotiated Rate |
$1,197.08 |
| Rate for Payer: Aetna Commercial |
$647.62
|
| Rate for Payer: Aetna Medicare Advantage |
$647.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$550.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$550.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$431.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$550.48
|
| Rate for Payer: Cigna Commercial |
$1,197.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$522.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$323.81
|
|
|
ANCHOR SUTURE PEEK 5.5 X 15 MM
|
Facility
|
IP
|
$2,158.75
|
|
|
Service Code
|
HCPCS C1716
|
| Hospital Charge Code |
270701619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$323.81 |
| Max. Negotiated Rate |
$522.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$431.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$522.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$323.81
|
|
|
ANCHOR SUTURE W/OS 2/38 902929
|
Facility
|
IP
|
$1,259.90
|
|
| Hospital Charge Code |
270633294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.99 |
| Max. Negotiated Rate |
$304.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.99
|
|
|
ANCHOR SUTURE W/OS 2/38 902929
|
Facility
|
OP
|
$1,259.90
|
|
| Hospital Charge Code |
270633294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.99 |
| Max. Negotiated Rate |
$629.95 |
| Rate for Payer: Aetna Commercial |
$377.97
|
| Rate for Payer: Aetna Medicare Advantage |
$377.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$321.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$321.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$321.27
|
| Rate for Payer: Cigna Commercial |
$629.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.99
|
|
|
ANCHOR SUTURE WSTP 2/38 902920
|
Facility
|
OP
|
$1,259.90
|
|
| Hospital Charge Code |
270633293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.99 |
| Max. Negotiated Rate |
$629.95 |
| Rate for Payer: Aetna Commercial |
$377.97
|
| Rate for Payer: Aetna Medicare Advantage |
$377.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$321.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$321.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$321.27
|
| Rate for Payer: Cigna Commercial |
$629.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.99
|
|
|
ANCHOR SUTURE WSTP 2/38 902920
|
Facility
|
IP
|
$1,259.90
|
|
| Hospital Charge Code |
270633293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.99 |
| Max. Negotiated Rate |
$304.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.99
|
|
|
ANCHOR SWIFTLOCK 1192
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270654460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
ANCHOR SWIFTLOCK 1192
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270654460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
ANCHOR SWIVELOCK 4.75MM
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
ANCHOR SWIVELOCK 4.75MM
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$235.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
ANCHOR SWIVELOCK 5.2MM
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$217.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.25
|
| Rate for Payer: Oxford Commercial |
$362.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$362.50
|
|