|
FLIPCUTTER II 12MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270685170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
FLIPCUTTER II 12MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270685170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER II 6MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270671284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER II 6MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270671284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
FLIPCUTTER II 7MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270670866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
FLIPCUTTER II 7MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270670866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER II SHORT 9MM
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270681911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
FLIPCUTTER II SHORT 9MM
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270681911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
FLIPCUTTER SHORT 11 MM
|
Facility
|
IP
|
$3,475.00
|
|
| Hospital Charge Code |
270679793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$521.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
|
|
FLIPCUTTER SHORT 11 MM
|
Facility
|
OP
|
$3,475.00
|
|
| Hospital Charge Code |
270679793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.69 |
| Max. Negotiated Rate |
$1,737.50 |
| Rate for Payer: Aetna Commercial |
$1,320.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,042.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$886.12
|
| Rate for Payer: Cigna Commercial |
$1,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$903.50
|
| Rate for Payer: Oxford Commercial |
$695.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$695.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$109.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$98.69
|
|
|
FLIPCUTTER SHORT 8 MM
|
Facility
|
OP
|
$3,475.00
|
|
| Hospital Charge Code |
270681859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.69 |
| Max. Negotiated Rate |
$1,737.50 |
| Rate for Payer: Aetna Commercial |
$1,320.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,042.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$886.12
|
| Rate for Payer: Cigna Commercial |
$1,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$903.50
|
| Rate for Payer: Oxford Commercial |
$695.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$695.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$109.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$98.69
|
|
|
FLIPCUTTER SHORT 8 MM
|
Facility
|
IP
|
$3,475.00
|
|
| Hospital Charge Code |
270681859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$521.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
|
|
FLIPCUTTER SHORT 9.5 MM
|
Facility
|
IP
|
$3,475.00
|
|
| Hospital Charge Code |
270679790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$521.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
|
|
FLIPCUTTER SHORT 9.5 MM
|
Facility
|
OP
|
$3,475.00
|
|
| Hospital Charge Code |
270679790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.69 |
| Max. Negotiated Rate |
$1,737.50 |
| Rate for Payer: Aetna Commercial |
$1,320.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,042.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$886.12
|
| Rate for Payer: Cigna Commercial |
$1,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$903.50
|
| Rate for Payer: Oxford Commercial |
$695.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$695.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$109.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$98.69
|
|
|
FLIPCUTTER SHORT 9.MM
|
Facility
|
OP
|
$3,475.00
|
|
| Hospital Charge Code |
270679789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.69 |
| Max. Negotiated Rate |
$1,737.50 |
| Rate for Payer: Aetna Commercial |
$1,320.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,042.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$886.12
|
| Rate for Payer: Cigna Commercial |
$1,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$903.50
|
| Rate for Payer: Oxford Commercial |
$695.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$695.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$109.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$98.69
|
|
|
FLIPCUTTER SHORT 9.MM
|
Facility
|
IP
|
$3,475.00
|
|
| Hospital Charge Code |
270679789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$521.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
|
|
FLIPCUTTER TRAY LOANER
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270667129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$325.00
|
| Rate for Payer: Oxford Commercial |
$250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.50
|
|
|
FLIPCUTTER TRAY LOANER
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270667129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
FLONASE .05% SPRAY
|
Facility
|
OP
|
$564.94
|
|
|
Service Code
|
NDC 50383070016
|
| Hospital Charge Code |
60629341
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$282.47 |
| Rate for Payer: Aetna Commercial |
$214.68
|
| Rate for Payer: Aetna Medicare Advantage |
$169.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$144.06
|
| Rate for Payer: Cigna Commercial |
$282.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.88
|
| Rate for Payer: Oxford Commercial |
$112.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.99
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.04
|
|
|
FLONASE .05% SPRAY
|
Facility
|
IP
|
$564.94
|
|
|
Service Code
|
NDC 50383070016
|
| Hospital Charge Code |
60629341
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.74 |
| Max. Negotiated Rate |
$84.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.74
|
|
|
FLORASTOR 250MG CAP
|
Facility
|
IP
|
$6.63
|
|
|
Service Code
|
NDC 4142000007
|
| Hospital Charge Code |
60635700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.99
|
|
|
FLORASTOR 250MG CAP
|
Facility
|
OP
|
$6.63
|
|
|
Service Code
|
NDC 4142000007
|
| Hospital Charge Code |
60635700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.69
|
| Rate for Payer: Cigna Commercial |
$3.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.72
|
| Rate for Payer: Oxford Commercial |
$1.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.19
|
|
|
FLOSEAL HEMOSTATIC MATRIX 10 M
|
Facility
|
OP
|
$1,541.68
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
670680120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$770.84 |
| Rate for Payer: Aetna Commercial |
$585.84
|
| Rate for Payer: Aetna Medicare Advantage |
$462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$393.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$393.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$308.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$393.13
|
| Rate for Payer: Cigna Commercial |
$770.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.78
|
|
|
FLOSEAL HEMOSTATIC MATRIX 10 M
|
Facility
|
IP
|
$1,541.68
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
670680120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.25 |
| Max. Negotiated Rate |
$373.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$308.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.25
|
|
|
FLOSEAL HEMOSTATIC MATRIX 10ml
|
Facility
|
OP
|
$1,541.68
|
|
|
Service Code
|
HCPCS C2615
|
| Hospital Charge Code |
270680120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$770.84 |
| Rate for Payer: Aetna Commercial |
$585.84
|
| Rate for Payer: Aetna Medicare Advantage |
$462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$393.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$393.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$308.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$393.13
|
| Rate for Payer: Cigna Commercial |
$770.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.78
|
|