|
STAPLE DOUBLE N
|
Facility
|
IP
|
$1,760.85
|
|
| Hospital Charge Code |
270670927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.13 |
| Max. Negotiated Rate |
$264.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$264.13
|
|
|
STAPLE DOUBLE N
|
Facility
|
OP
|
$1,760.85
|
|
| Hospital Charge Code |
270670927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.91 |
| Max. Negotiated Rate |
$880.42 |
| Rate for Payer: Aetna Commercial |
$528.25
|
| Rate for Payer: Aetna Medicare Advantage |
$528.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$449.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$449.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$449.02
|
| Rate for Payer: Cigna Commercial |
$880.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$228.91
|
| Rate for Payer: Oxford Commercial |
$880.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$264.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$880.42
|
|
|
STAPLE DYNANITE 11X10 W/INSTR
|
Facility
|
IP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$1,808.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
STAPLE DYNANITE 11X10 W/INSTR
|
Facility
|
OP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$3,737.50 |
| Rate for Payer: Aetna Commercial |
$2,242.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,906.12
|
| Rate for Payer: Cigna Commercial |
$3,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
STAPLE DYNANITE 9X10 W/INSTRU
|
Facility
|
IP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$1,808.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
STAPLE DYNANITE 9X10 W/INSTRU
|
Facility
|
OP
|
$7,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$3,737.50 |
| Rate for Payer: Aetna Commercial |
$2,242.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,906.12
|
| Rate for Payer: Cigna Commercial |
$3,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
STAPLE DYNANITE NITI W/INSTRS
|
Facility
|
IP
|
$7,475.00
|
|
| Hospital Charge Code |
270684944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$1,121.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
STAPLE DYNANITE NITI W/INSTRS
|
Facility
|
OP
|
$7,475.00
|
|
| Hospital Charge Code |
270684944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.75 |
| Max. Negotiated Rate |
$3,737.50 |
| Rate for Payer: Aetna Commercial |
$2,242.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,906.12
|
| Rate for Payer: Cigna Commercial |
$3,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$971.75
|
| Rate for Payer: Oxford Commercial |
$3,737.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,737.50
|
|
|
STAPLE EASYFUSE 18X15MM
|
Facility
|
OP
|
$7,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.25 |
| Max. Negotiated Rate |
$3,937.50 |
| Rate for Payer: Aetna Commercial |
$2,362.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,362.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,008.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,008.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,008.12
|
| Rate for Payer: Cigna Commercial |
$3,937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,905.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,181.25
|
|
|
STAPLE EASYFUSE 18X15MM
|
Facility
|
IP
|
$7,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.25 |
| Max. Negotiated Rate |
$1,905.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,905.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,181.25
|
|
|
STAPLE FUSEFORCE 15x15MM
|
Facility
|
OP
|
$6,425.00
|
|
| Hospital Charge Code |
270678361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$835.25 |
| Max. Negotiated Rate |
$3,212.50 |
| Rate for Payer: Aetna Commercial |
$1,927.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,927.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,638.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,638.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,638.38
|
| Rate for Payer: Cigna Commercial |
$3,212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$835.25
|
| Rate for Payer: Oxford Commercial |
$3,212.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,212.50
|
|
|
STAPLE FUSEFORCE 15x15MM
|
Facility
|
IP
|
$6,425.00
|
|
| Hospital Charge Code |
270678361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$963.75 |
| Max. Negotiated Rate |
$963.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.75
|
|
|
STAPLE FUSEFORCE 18x16MM
|
Facility
|
OP
|
$6,425.00
|
|
| Hospital Charge Code |
270669233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$835.25 |
| Max. Negotiated Rate |
$3,212.50 |
| Rate for Payer: Aetna Commercial |
$1,927.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,927.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,638.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,638.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,638.38
|
| Rate for Payer: Cigna Commercial |
$3,212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$835.25
|
| Rate for Payer: Oxford Commercial |
$3,212.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,212.50
|
|
|
STAPLE FUSEFORCE 18x16MM
|
Facility
|
IP
|
$6,425.00
|
|
| Hospital Charge Code |
270669233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$963.75 |
| Max. Negotiated Rate |
$963.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.75
|
|
|
STAPLE FUSEFORCE 18X16MM
|
Facility
|
IP
|
$9,115.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,367.25 |
| Max. Negotiated Rate |
$2,205.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,823.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,205.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,367.25
|
|
|
STAPLE FUSEFORCE 18X16MM
|
Facility
|
OP
|
$9,115.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,367.25 |
| Max. Negotiated Rate |
$4,557.50 |
| Rate for Payer: Aetna Commercial |
$2,734.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,734.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,823.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,324.32
|
| Rate for Payer: Cigna Commercial |
$4,557.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,205.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,367.25
|
|
|
STAPLE FUSEFORCE 25x22MM
|
Facility
|
OP
|
$6,425.00
|
|
| Hospital Charge Code |
270677126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$835.25 |
| Max. Negotiated Rate |
$3,212.50 |
| Rate for Payer: Aetna Commercial |
$1,927.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,927.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,638.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,638.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,638.38
|
| Rate for Payer: Cigna Commercial |
$3,212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$835.25
|
| Rate for Payer: Oxford Commercial |
$3,212.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,212.50
|
|
|
STAPLE FUSEFORCE 25x22MM
|
Facility
|
IP
|
$6,425.00
|
|
| Hospital Charge Code |
270677126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$963.75 |
| Max. Negotiated Rate |
$963.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.75
|
|
|
STAPLE FUSEFORCE 25x25MM
|
Facility
|
IP
|
$6,425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.75 |
| Max. Negotiated Rate |
$1,554.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,285.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,554.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.75
|
|
|
STAPLE FUSEFORCE 25x25MM
|
Facility
|
OP
|
$6,425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.75 |
| Max. Negotiated Rate |
$3,212.50 |
| Rate for Payer: Aetna Commercial |
$1,927.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,927.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,638.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,638.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,638.38
|
| Rate for Payer: Cigna Commercial |
$3,212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,554.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.75
|
|
|
STAPLE FUSEFORCE NITINOL 10X10
|
Facility
|
IP
|
$6,555.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.25 |
| Max. Negotiated Rate |
$1,586.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,311.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,586.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$983.25
|
|
|
STAPLE FUSEFORCE NITINOL 10X10
|
Facility
|
OP
|
$6,555.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.25 |
| Max. Negotiated Rate |
$3,277.50 |
| Rate for Payer: Aetna Commercial |
$1,966.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,966.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,671.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,671.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,311.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,671.53
|
| Rate for Payer: Cigna Commercial |
$3,277.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,586.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$983.25
|
|
|
STAPLE HAND FIX SYS 20x20MM
|
Facility
|
OP
|
$6,425.00
|
|
| Hospital Charge Code |
270675807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$835.25 |
| Max. Negotiated Rate |
$3,212.50 |
| Rate for Payer: Aetna Commercial |
$1,927.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,927.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,638.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,638.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,638.38
|
| Rate for Payer: Cigna Commercial |
$3,212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$835.25
|
| Rate for Payer: Oxford Commercial |
$3,212.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,212.50
|
|
|
STAPLE HAND FIX SYS 20x20MM
|
Facility
|
IP
|
$6,425.00
|
|
| Hospital Charge Code |
270675807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$963.75 |
| Max. Negotiated Rate |
$963.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$963.75
|
|
|
STAPLE JAWS STR 10X10MM
|
Facility
|
IP
|
$6,585.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.75 |
| Max. Negotiated Rate |
$1,593.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,317.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,593.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$987.75
|
|