|
BEAR TIB 16x63/67 MAX11146736
|
Facility
|
OP
|
$7,628.50
|
|
| Hospital Charge Code |
270635584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.28 |
| Max. Negotiated Rate |
$3,814.25 |
| Rate for Payer: Aetna Commercial |
$2,288.55
|
| Rate for Payer: Aetna Medicare Advantage |
$2,288.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,945.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,945.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,525.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,945.27
|
| Rate for Payer: Cigna Commercial |
$3,814.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,846.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,144.28
|
|
|
BEAR TIB CR 10Mx79/83M 183560
|
Facility
|
IP
|
$5,260.00
|
|
| Hospital Charge Code |
270640762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$789.00 |
| Max. Negotiated Rate |
$1,272.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,052.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,272.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$789.00
|
|
|
BEAR TIB CR 10Mx79/83M 183560
|
Facility
|
OP
|
$5,260.00
|
|
| Hospital Charge Code |
270640762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$789.00 |
| Max. Negotiated Rate |
$2,630.00 |
| Rate for Payer: Aetna Commercial |
$1,578.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,578.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,341.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,341.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,052.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,341.30
|
| Rate for Payer: Cigna Commercial |
$2,630.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,272.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$789.00
|
|
|
BEAR TIBIA 10mm 79/83mm 183660
|
Facility
|
OP
|
$5,520.00
|
|
| Hospital Charge Code |
270639713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$828.00 |
| Max. Negotiated Rate |
$2,760.00 |
| Rate for Payer: Aetna Commercial |
$1,656.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,656.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,407.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,407.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,104.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,407.60
|
| Rate for Payer: Cigna Commercial |
$2,760.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,335.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$828.00
|
|
|
BEAR TIBIA 10mm 79/83mm 183660
|
Facility
|
IP
|
$5,520.00
|
|
| Hospital Charge Code |
270639713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$828.00 |
| Max. Negotiated Rate |
$1,335.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,104.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,335.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$828.00
|
|
|
BEAR TIB PS+14Mx79/83M 183764
|
Facility
|
IP
|
$5,875.00
|
|
| Hospital Charge Code |
270640787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$1,421.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,421.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$881.25
|
|
|
BEAR TIB PS+14Mx79/83M 183764
|
Facility
|
OP
|
$5,875.00
|
|
| Hospital Charge Code |
270640787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,937.50 |
| Rate for Payer: Aetna Commercial |
$1,762.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,762.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,498.12
|
| Rate for Payer: Cigna Commercial |
$2,937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,421.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$881.25
|
|
|
BEAR TIB PS+16MMx79/83M 183766
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270640903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$3,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,550.00
|
| Rate for Payer: Cigna Commercial |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
BEAR TIB PS+16MMx79/83M 183766
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270640903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
BEAVER BLADE #67
|
Facility
|
IP
|
$7.88
|
|
| Hospital Charge Code |
270650779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.18
|
|
|
BEAVER BLADE #67
|
Facility
|
OP
|
$7.88
|
|
| Hospital Charge Code |
270650779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna Medicare Advantage |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.01
|
| Rate for Payer: Cigna Commercial |
$3.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.02
|
| Rate for Payer: Oxford Commercial |
$3.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.94
|
|
|
BEAVER OPTUMUM KNIFE 15 DEG
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
270656603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$75.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.50
|
| Rate for Payer: Oxford Commercial |
$125.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$125.00
|
|
|
BEAVER OPTUMUM KNIFE 15 DEG
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
270656603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3020M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3237M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3082M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3120M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3247M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3235M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3950M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: Cigna Commercial |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3248M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3042M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3033M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3048M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
BEBTELOVIMAB INJ AND MONITOR
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
3047M0222
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: Cigna Commercial |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|