|
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
|
|
|
BLADE TFNA HELICAL 75MM STER
|
Facility
|
OP
|
$3,290.85
|
|
| Hospital Charge Code |
270677488
|
|
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 75MM STER
|
Facility
|
IP
|
$3,290.85
|
|
| Hospital Charge Code |
270677488
|
|
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 80MM STER
|
Facility
|
IP
|
$3,290.85
|
|
| Hospital Charge Code |
270675801
|
|
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 80MM STER
|
Facility
|
OP
|
$3,290.85
|
|
| Hospital Charge Code |
270675801
|
|
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 85MM STERIL
|
Facility
|
OP
|
$3,290.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677571
|
|
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 85MM STERIL
|
Facility
|
IP
|
$3,290.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677571
|
|
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 90MM STER
|
Facility
|
OP
|
$3,389.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677009
|
|
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 90MM STER
|
Facility
|
IP
|
$3,389.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677009
|
|
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 95MM STER
|
Facility
|
IP
|
$3,389.60
|
|
| Hospital Charge Code |
270675943
|
|
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 95MM STER
|
Facility
|
OP
|
$3,389.60
|
|
| Hospital Charge Code |
270675943
|
|
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 THIN OSTEOTOME 10MM
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
270664298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
BLADE THIN OSTEOTOME 10MM
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
270664298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.25
|
| Rate for Payer: Oxford Commercial |
$412.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$412.50
|
|
|
BLADE Ti SPIRAL 44 HUM 462644S
|
Facility
|
OP
|
$2,545.00
|
|
| Hospital Charge Code |
270637805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.75 |
| Max. Negotiated Rate |
$1,272.50 |
| Rate for Payer: Aetna Commercial |
$763.50
|
| Rate for Payer: Aetna Medicare Advantage |
$763.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$648.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$648.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$509.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$648.98
|
| Rate for Payer: Cigna Commercial |
$1,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$615.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$381.75
|
|
|
BLADE Ti SPIRAL 44 HUM 462644S
|
Facility
|
IP
|
$2,545.00
|
|
| Hospital Charge Code |
270637805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.75 |
| Max. Negotiated Rate |
$615.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$509.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$615.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$381.75
|
|
|
BLADE TITANIUM 11.0 HEL 456303
|
Facility
|
IP
|
$2,177.50
|
|
| Hospital Charge Code |
270633854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.62 |
| Max. Negotiated Rate |
$526.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$435.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$526.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$326.62
|
|
|
BLADE TITANIUM 11.0 HEL 456303
|
Facility
|
OP
|
$2,177.50
|
|
| Hospital Charge Code |
270633854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.62 |
| Max. Negotiated Rate |
$1,088.75 |
| Rate for Payer: Aetna Commercial |
$653.25
|
| Rate for Payer: Aetna Medicare Advantage |
$653.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$555.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$555.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$435.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$555.26
|
| Rate for Payer: Cigna Commercial |
$1,088.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$526.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$326.62
|
|
|
BLADE TOMCAT SHAVER SM J 3.5mm
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
270640299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
BLADE TOMCAT SHAVER SM J 3.5mm
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
270640299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$60.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.00
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.00
|
| Rate for Payer: Oxford Commercial |
$100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.00
|
|
|
BLADE TREPHINE 10.0MM 9721
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|
|
BLADE TREPHINE 10.0MM 9721
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE 11.0MM 9725
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE 11.0MM 9725
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|
|
BLADE TREPHINE 5.0MM 9701
|
Facility
|
OP
|
$422.45
|
|
| Hospital Charge Code |
270600190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare Advantage |
$126.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.72
|
| Rate for Payer: Cigna Commercial |
$211.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.92
|
| Rate for Payer: Oxford Commercial |
$211.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.22
|
|
|
BLADE TREPHINE 5.0MM 9701
|
Facility
|
IP
|
$422.45
|
|
| Hospital Charge Code |
270600190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$63.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.37
|
|