|
TROCAR 10/12MM ML1012D
|
Facility
|
IP
|
$820.00
|
|
| Hospital Charge Code |
270600263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.00
|
|
|
TROCAR 10/12MM PURP 512SD
|
Facility
|
IP
|
$215.07
|
|
| Hospital Charge Code |
270608755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.26 |
| Max. Negotiated Rate |
$32.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.26
|
|
|
TROCAR 10/12MM PURP 512SD
|
Facility
|
OP
|
$215.07
|
|
| Hospital Charge Code |
270608755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$107.53 |
| Rate for Payer: Aetna Commercial |
$64.52
|
| Rate for Payer: Aetna Medicare Advantage |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.84
|
| Rate for Payer: Cigna Commercial |
$107.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.96
|
| Rate for Payer: Oxford Commercial |
$107.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$107.53
|
|
|
TROCAR 10MM
|
Facility
|
IP
|
$146.00
|
|
| Hospital Charge Code |
270338715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$21.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.90
|
|
|
TROCAR 10MM
|
Facility
|
OP
|
$146.00
|
|
| Hospital Charge Code |
270338715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$43.80
|
| Rate for Payer: Aetna Medicare Advantage |
$43.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.23
|
| Rate for Payer: Cigna Commercial |
$73.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.98
|
| Rate for Payer: Oxford Commercial |
$73.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$73.00
|
|
|
TROCAR 10MM BLUNT TIP SGL
|
Facility
|
OP
|
$967.07
|
|
| Hospital Charge Code |
270622305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.72 |
| Max. Negotiated Rate |
$483.54 |
| Rate for Payer: Aetna Commercial |
$290.12
|
| Rate for Payer: Aetna Medicare Advantage |
$290.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$246.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$246.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$246.60
|
| Rate for Payer: Cigna Commercial |
$483.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.72
|
| Rate for Payer: Oxford Commercial |
$483.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$483.54
|
|
|
TROCAR 10MM BLUNT TIP SGL
|
Facility
|
IP
|
$967.07
|
|
| Hospital Charge Code |
270622305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.06 |
| Max. Negotiated Rate |
$145.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$145.06
|
|
|
TROCAR 10MM SECONDARY *****
|
Facility
|
OP
|
$174.00
|
|
| Hospital Charge Code |
1605625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Aetna Medicare Advantage |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.37
|
| Rate for Payer: Cigna Commercial |
$87.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.62
|
| Rate for Payer: Oxford Commercial |
$87.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$87.00
|
|
|
TROCAR 10MM SECONDARY *****
|
Facility
|
IP
|
$174.00
|
|
| Hospital Charge Code |
1605625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.10
|
|
|
TROCAR 12MM
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
270338712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
|
|
TROCAR 12MM
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
270338712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$60.50 |
| Rate for Payer: Aetna Commercial |
$36.30
|
| Rate for Payer: Aetna Medicare Advantage |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$30.86
|
| Rate for Payer: Cigna Commercial |
$60.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.73
|
| Rate for Payer: Oxford Commercial |
$60.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$60.50
|
|
|
TROCAR 12MM LONG
|
Facility
|
IP
|
$203.00
|
|
| Hospital Charge Code |
270338719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$30.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.45
|
|
|
TROCAR 12MM LONG
|
Facility
|
OP
|
$203.00
|
|
| Hospital Charge Code |
270338719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.39 |
| Max. Negotiated Rate |
$101.50 |
| Rate for Payer: Aetna Commercial |
$60.90
|
| Rate for Payer: Aetna Medicare Advantage |
$60.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.77
|
| Rate for Payer: Cigna Commercial |
$101.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.39
|
| Rate for Payer: Oxford Commercial |
$101.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$101.50
|
|
|
TROCAR 12x100 BLADED FIX CFB73
|
Facility
|
OP
|
$132.50
|
|
| Hospital Charge Code |
270642088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$66.25 |
| Rate for Payer: Aetna Commercial |
$39.75
|
| Rate for Payer: Aetna Medicare Advantage |
$39.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$33.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$33.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$33.79
|
| Rate for Payer: Cigna Commercial |
$66.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.23
|
| Rate for Payer: Oxford Commercial |
$66.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$66.25
|
|
|
TROCAR 12x100 BLADED FIX CFB73
|
Facility
|
IP
|
$132.50
|
|
| Hospital Charge Code |
270642088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$19.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.88
|
|
|
TROCAR 12x100 FIOS FIXAT CFF73
|
Facility
|
IP
|
$1,105.50
|
|
| Hospital Charge Code |
270642089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.82 |
| Max. Negotiated Rate |
$165.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.82
|
|
|
TROCAR 12x100 FIOS FIXAT CFF73
|
Facility
|
OP
|
$1,105.50
|
|
| Hospital Charge Code |
270642089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.72 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Aetna Commercial |
$331.65
|
| Rate for Payer: Aetna Medicare Advantage |
$331.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$281.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$281.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$281.90
|
| Rate for Payer: Cigna Commercial |
$552.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.72
|
| Rate for Payer: Oxford Commercial |
$552.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$552.75
|
|
|
TROCAR 12x100mm FIOS 1ST CFI83
|
Facility
|
OP
|
$184.25
|
|
| Hospital Charge Code |
270642085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$92.12 |
| Rate for Payer: Aetna Commercial |
$55.27
|
| Rate for Payer: Aetna Medicare Advantage |
$55.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$46.98
|
| Rate for Payer: Cigna Commercial |
$92.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.95
|
| Rate for Payer: Oxford Commercial |
$92.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$92.12
|
|
|
TROCAR 12x100mm FIOS 1ST CFI83
|
Facility
|
IP
|
$184.25
|
|
| Hospital Charge Code |
270642085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.64 |
| Max. Negotiated Rate |
$27.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.64
|
|
|
TROCAR 12 X 150 MM
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270692071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.00
|
| Rate for Payer: Oxford Commercial |
$250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.00
|
|
|
TROCAR 12 X 150 MM
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270692071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
TROCAR 15x100mm OPTICAL THREA
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
270642090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
TROCAR 15x100mm OPTICAL THREA
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
270642090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$84.00
|
| Rate for Payer: Aetna Medicare Advantage |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.40
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.40
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$140.00
|
|
|
TROCAR 15 X 150 MM
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
270692072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Medicare Advantage |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$114.75
|
| Rate for Payer: Cigna Commercial |
$225.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.50
|
| Rate for Payer: Oxford Commercial |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$225.00
|
|
|
TROCAR 15 X 150 MM
|
Facility
|
IP
|
$450.00
|
|
| Hospital Charge Code |
270692072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$67.50
|
|