|
HOOK NARROW BLADE 12
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
270659842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
HOOK NARROW BLADE 6.5
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
270669369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
HOOK NARROW BLADE 6.5
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
270669369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,040.00
|
| Rate for Payer: Oxford Commercial |
$800.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$800.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
HOOK NARROW BLADE 8
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
270669370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
HOOK NARROW BLADE 8
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
270669370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
HOOK PALATE BLUNT 8 IN
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
270688723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
|
|
HOOK PALATE BLUNT 8 IN
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
270688723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Medicare Advantage |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.27
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.04
|
| Rate for Payer: Oxford Commercial |
$30.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.37
|
|
|
HOOK RED DIST 10 MM
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270687554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
HOOK RED DIST 10 MM
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270687553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
HOOK RED DIST 10 MM
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270687553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
HOOK RED DIST 10 MM
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270687554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
HOOK RED DIST 12MM
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
270667964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
HOOK RED DIST 12MM
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
270667964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,040.00
|
| Rate for Payer: Oxford Commercial |
$800.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$800.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
HOOK RED DIST 8 MM
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270687555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
HOOK RED DIST 8 MM
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270687555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
HOOK SHAPED COLD KNIFE
|
Facility
|
OP
|
$1,140.00
|
|
| Hospital Charge Code |
270684367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$433.20
|
| Rate for Payer: Aetna Medicare Advantage |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$290.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$290.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$290.70
|
| Rate for Payer: Cigna Commercial |
$570.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$296.40
|
| Rate for Payer: Oxford Commercial |
$228.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$228.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.38
|
|
|
HOOK SHAPED COLD KNIFE
|
Facility
|
IP
|
$1,140.00
|
|
| Hospital Charge Code |
270684367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.00
|
|
|
HOOK SHARP
|
Facility
|
IP
|
$361.55
|
|
| Hospital Charge Code |
270614769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$54.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.23
|
|
|
HOOK SHARP
|
Facility
|
OP
|
$361.55
|
|
| Hospital Charge Code |
270614769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$180.78 |
| Rate for Payer: Aetna Commercial |
$137.39
|
| Rate for Payer: Aetna Medicare Advantage |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$92.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$92.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$92.20
|
| Rate for Payer: Cigna Commercial |
$180.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.00
|
| Rate for Payer: Oxford Commercial |
$72.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$72.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.27
|
|
|
HOOK SUTURE MINI
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
270691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$182.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$140.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
HOOK SUTURE MINI
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
270691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
HOOK WIDE BLADE 12
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
270659816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
HOOK WIDE BLADE 12
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
270659816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,040.00
|
| Rate for Payer: Oxford Commercial |
$800.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$800.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
HOOK WIDE BLADE 6.5
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
270675213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,040.00
|
| Rate for Payer: Oxford Commercial |
$800.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$800.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
HOOK WIDE BLADE 6.5
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
270675213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|