|
BLADE SURGICAL #11
|
Facility
|
OP
|
$7.25
|
|
| Hospital Charge Code |
270300350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare Advantage |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.85
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.94
|
| Rate for Payer: Oxford Commercial |
$3.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.62
|
|
|
BLADE SURGICAL #11
|
Facility
|
IP
|
$7.25
|
|
| Hospital Charge Code |
270300350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
|
|
BLADE SURGICAL #12
|
Facility
|
OP
|
$9.65
|
|
| Hospital Charge Code |
270300355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare Advantage |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.25
|
| Rate for Payer: Oxford Commercial |
$4.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.83
|
|
|
BLADE SURGICAL #12
|
Facility
|
IP
|
$9.65
|
|
| Hospital Charge Code |
270300355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.45
|
|
|
BLADE SURGICAL #15
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
270300360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.27
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.65
|
| Rate for Payer: Oxford Commercial |
$2.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.50
|
|
|
BLADE SURGICAL #15
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
270300360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
|
|
BLADE SURGICAL #20
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
270300365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.27
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.65
|
| Rate for Payer: Oxford Commercial |
$2.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.50
|
|
|
BLADE SURGICAL #20
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
270300365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
|
|
BLADE SYN SPIRAL 95MM 456.955
|
Facility
|
IP
|
$2,547.25
|
|
| Hospital Charge Code |
270611967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.09 |
| Max. Negotiated Rate |
$382.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$382.09
|
|
|
BLADE SYN SPIRAL 95MM 456.955
|
Facility
|
OP
|
$2,547.25
|
|
| Hospital Charge Code |
270611967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.14 |
| Max. Negotiated Rate |
$1,273.62 |
| Rate for Payer: Aetna Commercial |
$764.17
|
| Rate for Payer: Aetna Medicare Advantage |
$764.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$649.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$649.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$649.55
|
| Rate for Payer: Cigna Commercial |
$1,273.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$331.14
|
| Rate for Payer: Oxford Commercial |
$1,273.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$382.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,273.62
|
|
|
BLADE TAPER 1.5 X 10MM
|
Facility
|
IP
|
$36.75
|
|
| Hospital Charge Code |
270664987
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.51
|
|
|
BLADE TAPER 1.5 X 10MM
|
Facility
|
OP
|
$36.75
|
|
| Hospital Charge Code |
270664987
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna Commercial |
$11.03
|
| Rate for Payer: Aetna Medicare Advantage |
$11.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.37
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.78
|
| Rate for Payer: Oxford Commercial |
$18.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.38
|
|
|
BLADE TFNA FENES HELICAL 115MM
|
Facility
|
OP
|
$3,746.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.91 |
| Max. Negotiated Rate |
$1,873.03 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$561.91
|
| Rate for Payer: Aetna Commercial |
$1,123.82
|
| Rate for Payer: Aetna Medicare Advantage |
$1,123.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$955.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$955.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$749.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$955.24
|
| Rate for Payer: Cigna Commercial |
$1,873.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$906.54
|
|
|
BLADE TFNA FENES HELICAL 115MM
|
Facility
|
IP
|
$3,746.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.91 |
| Max. Negotiated Rate |
$906.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$749.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$906.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$561.91
|
|
|
BLADE TFNA HELICAL 100MM STR
|
Facility
|
OP
|
$3,290.85
|
|
| Hospital Charge Code |
270674944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.81 |
| Max. Negotiated Rate |
$1,645.42 |
| Rate for Payer: Aetna Commercial |
$987.25
|
| Rate for Payer: Aetna Medicare Advantage |
$987.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$839.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$839.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$839.17
|
| Rate for Payer: Cigna Commercial |
$1,645.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$427.81
|
| Rate for Payer: Oxford Commercial |
$1,645.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$493.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,645.42
|
|
|
BLADE TFNA HELICAL 100MM STR
|
Facility
|
IP
|
$3,290.85
|
|
| Hospital Charge Code |
270674944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.63 |
| Max. Negotiated Rate |
$493.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$493.63
|
|
|
BLADE TFNA HELICAL 105MM STER
|
Facility
|
OP
|
$3,389.60
|
|
| Hospital Charge Code |
270676584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.65 |
| Max. Negotiated Rate |
$1,694.80 |
| Rate for Payer: Aetna Commercial |
$1,016.88
|
| Rate for Payer: Aetna Medicare Advantage |
$1,016.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$864.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$864.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$864.35
|
| Rate for Payer: Cigna Commercial |
$1,694.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$440.65
|
| Rate for Payer: Oxford Commercial |
$1,694.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,694.80
|
|
|
BLADE TFNA HELICAL 105MM STER
|
Facility
|
IP
|
$3,389.60
|
|
| Hospital Charge Code |
270676584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$508.44 |
| Max. Negotiated Rate |
$508.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.44
|
|
|
BLADE TFNA HELICAL 105M STER
|
Facility
|
OP
|
$3,389.60
|
|
| Hospital Charge Code |
270683631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.65 |
| Max. Negotiated Rate |
$1,694.80 |
| Rate for Payer: Aetna Commercial |
$1,016.88
|
| Rate for Payer: Aetna Medicare Advantage |
$1,016.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$864.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$864.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$864.35
|
| Rate for Payer: Cigna Commercial |
$1,694.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$440.65
|
| Rate for Payer: Oxford Commercial |
$1,694.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,694.80
|
|
|
BLADE TFNA HELICAL 105M STER
|
Facility
|
IP
|
$3,389.60
|
|
| Hospital Charge Code |
270683631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$508.44 |
| Max. Negotiated Rate |
$508.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$508.44
|
|
|
BLADE TFNA HELICAL 110MM
|
Facility
|
OP
|
$16,050.00
|
|
| Hospital Charge Code |
270693448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,086.50 |
| Max. Negotiated Rate |
$8,025.00 |
| Rate for Payer: Aetna Commercial |
$4,815.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,815.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,092.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,092.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,092.75
|
| Rate for Payer: Cigna Commercial |
$8,025.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,086.50
|
| Rate for Payer: Oxford Commercial |
$8,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,407.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,025.00
|
|
|
BLADE TFNA HELICAL 110MM
|
Facility
|
IP
|
$16,050.00
|
|
| Hospital Charge Code |
270693448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,407.50 |
| Max. Negotiated Rate |
$2,407.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,407.50
|
|
|
BLADE TFNA HELICAL 110MM STER
|
Facility
|
OP
|
$3,290.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.63 |
| Max. Negotiated Rate |
$1,645.42 |
| Rate for Payer: Aetna Commercial |
$987.25
|
| Rate for Payer: Aetna Medicare Advantage |
$987.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$839.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$839.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$658.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$839.17
|
| Rate for Payer: Cigna Commercial |
$1,645.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$796.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$493.63
|
|
|
BLADE TFNA HELICAL 110MM STER
|
Facility
|
IP
|
$3,290.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.63 |
| Max. Negotiated Rate |
$796.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$658.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$796.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$493.63
|
|
|
BLADE TFNA HELICAL 115MM STR
|
Facility
|
IP
|
$3,290.85
|
|
| Hospital Charge Code |
270675686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.63 |
| Max. Negotiated Rate |
$493.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$493.63
|
|