|
FIBERTAK STRAIGHT KIT DISP
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270689681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.85 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$227.50
|
| Rate for Payer: Oxford Commercial |
$175.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.85
|
|
|
FIBER TAPE 2MM
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
270662177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
FIBER TAPE 2MM
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
270662177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$163.80
|
| Rate for Payer: Oxford Commercial |
$126.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$126.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.89
|
|
|
FIBER TAPE 2MM 7 BLUE
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
270664798
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| 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 |
$65.00
|
| Rate for Payer: Oxford Commercial |
$50.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.10
|
|
|
FIBER TAPE 2MM 7 BLUE
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
270664798
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
FIBER TAPE 54,2mm BLUE
|
Facility
|
OP
|
$475.00
|
|
| Hospital Charge Code |
270655833
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna Commercial |
$180.50
|
| Rate for Payer: Aetna Medicare Advantage |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$121.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$121.12
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$123.50
|
| Rate for Payer: Oxford Commercial |
$95.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$95.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.49
|
|
|
FIBER TAPE 54,2mm BLUE
|
Facility
|
IP
|
$475.00
|
|
| Hospital Charge Code |
270655833
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.25
|
|
|
FIBER TAPE BLUE ST NEEDLE 2mm
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
270678377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
FIBER TAPE BLUE ST NEEDLE 2mm
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
270678377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| 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 |
$65.00
|
| Rate for Payer: Oxford Commercial |
$50.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.10
|
|
|
FIBERTAPE CERLAGE SUTURE
|
Facility
|
OP
|
$2,250.00
|
|
| Hospital Charge Code |
270686292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$855.00
|
| 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 |
$585.00
|
| Rate for Payer: Oxford Commercial |
$450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$450.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
FIBERTAPE CERLAGE SUTURE
|
Facility
|
IP
|
$2,250.00
|
|
| Hospital Charge Code |
270686292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
FIBERTAPE CUTTER
|
Facility
|
IP
|
$5,250.00
|
|
| Hospital Charge Code |
270675962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
FIBERTAPE CUTTER
|
Facility
|
OP
|
$5,250.00
|
|
| Hospital Charge Code |
270675962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,995.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,365.00
|
| Rate for Payer: Oxford Commercial |
$1,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$165.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$149.10
|
|
|
FIBERTAPE TENDON COMPRESSION
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
270686294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
|
|
FIBERTAPE TENDON COMPRESSION
|
Facility
|
OP
|
$3,000.00
|
|
| Hospital Charge Code |
270686294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,140.00
|
| Rate for Payer: Aetna Medicare Advantage |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$780.00
|
| Rate for Payer: Oxford Commercial |
$600.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$450.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$94.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$85.20
|
|
|
FIBERWIRE
|
Facility
|
IP
|
$110.00
|
|
| Hospital Charge Code |
270656515
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|
|
FIBERWIRE
|
Facility
|
OP
|
$110.00
|
|
| Hospital Charge Code |
270656515
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Medicare Advantage |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.05
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.60
|
| Rate for Payer: Oxford Commercial |
$22.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.12
|
|
|
FIBER WIRE 0 38
|
Facility
|
IP
|
$110.00
|
|
| Hospital Charge Code |
270681225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|
|
FIBER WIRE 0 38
|
Facility
|
OP
|
$110.00
|
|
| Hospital Charge Code |
270681225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Medicare Advantage |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.05
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.60
|
| Rate for Payer: Oxford Commercial |
$22.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.12
|
|
|
FIBERWIRE 2-0
|
Facility
|
IP
|
$110.00
|
|
| Hospital Charge Code |
270659179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|
|
FIBERWIRE 2-0
|
Facility
|
OP
|
$110.00
|
|
| Hospital Charge Code |
270659179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Medicare Advantage |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.05
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.60
|
| Rate for Payer: Oxford Commercial |
$22.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.12
|
|
|
FIBERWIRE #2 2.4x12MM
|
Facility
|
OP
|
$2,180.00
|
|
| Hospital Charge Code |
270672002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.91 |
| Max. Negotiated Rate |
$1,090.00 |
| Rate for Payer: Aetna Commercial |
$828.40
|
| Rate for Payer: Aetna Medicare Advantage |
$654.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$555.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$555.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,090.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$566.80
|
| Rate for Payer: Oxford Commercial |
$436.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$327.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$436.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$61.91
|
|
|
FIBERWIRE #2 2.4x12MM
|
Facility
|
IP
|
$2,180.00
|
|
| Hospital Charge Code |
270672002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$327.00
|
|
|
FIBER WIRE 2/5 METRIC
|
Facility
|
OP
|
$110.00
|
|
| Hospital Charge Code |
270668477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Medicare Advantage |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.05
|
| Rate for Payer: Cigna Commercial |
$55.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.60
|
| Rate for Payer: Oxford Commercial |
$22.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.12
|
|
|
FIBER WIRE 2/5 METRIC
|
Facility
|
IP
|
$110.00
|
|
| Hospital Charge Code |
270668477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.50
|
|