|
KNIFE W/BD XSTAR BLADE
|
Facility
|
OP
|
$71.96
|
|
| Hospital Charge Code |
270652260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$35.98 |
| Rate for Payer: Aetna Commercial |
$27.34
|
| Rate for Payer: Aetna Medicare Advantage |
$21.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.35
|
| Rate for Payer: Cigna Commercial |
$35.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.71
|
| Rate for Payer: Oxford Commercial |
$14.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.04
|
|
|
KNIFE W/BD XSTAR BLADE
|
Facility
|
IP
|
$71.96
|
|
| Hospital Charge Code |
270652260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$10.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.79
|
|
|
KNIFE W/XSTAR BLADE
|
Facility
|
IP
|
$97.40
|
|
| Hospital Charge Code |
270652263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$14.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.61
|
|
|
KNIFE W/XSTAR BLADE
|
Facility
|
OP
|
$97.40
|
|
| Hospital Charge Code |
270652263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$48.70 |
| Rate for Payer: Aetna Commercial |
$37.01
|
| Rate for Payer: Aetna Medicare Advantage |
$29.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.84
|
| Rate for Payer: Cigna Commercial |
$48.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.32
|
| Rate for Payer: Oxford Commercial |
$19.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.77
|
|
|
KNIVES
|
Facility
|
IP
|
$1,011.00
|
|
| Hospital Charge Code |
270668391
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.65 |
| Max. Negotiated Rate |
$151.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$151.65
|
|
|
KNIVES
|
Facility
|
OP
|
$1,011.00
|
|
| Hospital Charge Code |
270668391
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$505.50 |
| Rate for Payer: Aetna Commercial |
$384.18
|
| Rate for Payer: Aetna Medicare Advantage |
$303.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$257.81
|
| Rate for Payer: Cigna Commercial |
$505.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$262.86
|
| Rate for Payer: Oxford Commercial |
$202.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$151.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$202.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.71
|
|
|
KNOTLESS ANCHOR 4.5 PEEK AND B
|
Facility
|
IP
|
$4,936.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.44 |
| Max. Negotiated Rate |
$1,194.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$987.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,194.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$740.44
|
|
|
KNOTLESS ANCHOR 4.5 PEEK AND B
|
Facility
|
OP
|
$4,936.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.19 |
| Max. Negotiated Rate |
$2,468.12 |
| Rate for Payer: Aetna Commercial |
$1,875.78
|
| Rate for Payer: Aetna Medicare Advantage |
$1,480.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,258.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,258.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$987.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,258.74
|
| Rate for Payer: Cigna Commercial |
$2,468.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,194.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$740.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$155.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$140.19
|
|
|
KNOTLESS FIBERTAK 2.6MM
|
Facility
|
IP
|
$2,549.25
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270705065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$382.39 |
| Max. Negotiated Rate |
$616.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$509.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$616.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$382.39
|
|
|
KNOTLESS FIBERTAK 2.6MM
|
Facility
|
OP
|
$2,549.25
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270705065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$1,274.62 |
| Rate for Payer: Aetna Commercial |
$968.72
|
| Rate for Payer: Aetna Medicare Advantage |
$764.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$650.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$650.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$509.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$650.06
|
| Rate for Payer: Cigna Commercial |
$1,274.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$616.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$382.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$80.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$72.40
|
|
|
KNOTLESS FIBERTAK BICEPS IMPL
|
Facility
|
OP
|
$5,098.50
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270705651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$2,549.25 |
| Rate for Payer: Aetna Commercial |
$1,937.43
|
| Rate for Payer: Aetna Medicare Advantage |
$1,529.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,300.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,300.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,019.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,300.12
|
| Rate for Payer: Cigna Commercial |
$2,549.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,233.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$764.77
|
| Rate for Payer: UnitedHealthcare Community & State |
$161.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$144.80
|
|
|
KNOTLESS FIBERTAK BICEPS IMPL
|
Facility
|
IP
|
$5,098.50
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270705651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$764.77 |
| Max. Negotiated Rate |
$1,233.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,019.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,233.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$764.77
|
|
|
KNOTLESS FIBERTAK DISP KIT
|
Facility
|
OP
|
$1,375.00
|
|
| Hospital Charge Code |
270695227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Aetna Commercial |
$522.50
|
| Rate for Payer: Aetna Medicare Advantage |
$412.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$350.62
|
| Rate for Payer: Cigna Commercial |
$687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$357.50
|
| Rate for Payer: Oxford Commercial |
$275.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$275.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.05
|
|
|
KNOTLESS FIBERTAK DISP KIT
|
Facility
|
IP
|
$1,375.00
|
|
| Hospital Charge Code |
270695227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$206.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
|
|
KNOTLESS SUTURETAK 3.0MM
|
Facility
|
OP
|
$2,703.00
|
|
| Hospital Charge Code |
270702503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.77 |
| Max. Negotiated Rate |
$1,351.50 |
| Rate for Payer: Aetna Commercial |
$1,027.14
|
| Rate for Payer: Aetna Medicare Advantage |
$810.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$689.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$689.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$689.26
|
| Rate for Payer: Cigna Commercial |
$1,351.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$654.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$405.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$85.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$76.77
|
|
|
KNOTLESS SUTURETAK 3.0MM
|
Facility
|
IP
|
$2,703.00
|
|
| Hospital Charge Code |
270702503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.45 |
| Max. Negotiated Rate |
$654.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$540.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$654.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$405.45
|
|
|
KNOT OUSHER/CUTTER
|
Facility
|
OP
|
$281.00
|
|
| Hospital Charge Code |
270335941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$140.50 |
| Rate for Payer: Aetna Commercial |
$106.78
|
| Rate for Payer: Aetna Medicare Advantage |
$84.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$71.66
|
| Rate for Payer: Cigna Commercial |
$140.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.06
|
| Rate for Payer: Oxford Commercial |
$56.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$56.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.98
|
|
|
KNOT OUSHER/CUTTER
|
Facility
|
IP
|
$281.00
|
|
| Hospital Charge Code |
270335941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$42.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.15
|
|
|
KNOT PUSHER CUTTER
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270694780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
|
|
KNOT PUSHER CUTTER
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270694780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$418.00
|
| Rate for Payer: Aetna Medicare Advantage |
$330.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$280.50
|
| Rate for Payer: Cigna Commercial |
$550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$286.00
|
| Rate for Payer: Oxford Commercial |
$220.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.24
|
|
|
KNOT PUSHER ENDO SLIDE 38CM
|
Facility
|
OP
|
$54.57
|
|
| Hospital Charge Code |
270665013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$27.29 |
| Rate for Payer: Aetna Commercial |
$20.74
|
| Rate for Payer: Aetna Medicare Advantage |
$16.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.92
|
| Rate for Payer: Cigna Commercial |
$27.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.19
|
| Rate for Payer: Oxford Commercial |
$10.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.55
|
|
|
KNOT PUSHER ENDO SLIDE 38CM
|
Facility
|
IP
|
$54.57
|
|
| Hospital Charge Code |
270665013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.19
|
|
|
KNOT PUSHER REDSAY LG 5.0 29CM
|
Facility
|
OP
|
$2,650.80
|
|
| Hospital Charge Code |
270698341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.28 |
| Max. Negotiated Rate |
$1,325.40 |
| Rate for Payer: Aetna Commercial |
$1,007.30
|
| Rate for Payer: Aetna Medicare Advantage |
$795.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$675.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$675.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$675.95
|
| Rate for Payer: Cigna Commercial |
$1,325.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$689.21
|
| Rate for Payer: Oxford Commercial |
$530.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$397.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$530.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$83.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$75.28
|
|
|
KNOT PUSHER REDSAY LG 5.0 29CM
|
Facility
|
IP
|
$2,650.80
|
|
| Hospital Charge Code |
270698341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$397.62 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$397.62
|
|
|
KNOT PUSHER/SUTURE CUTTER
|
Facility
|
IP
|
$625.00
|
|
| Hospital Charge Code |
270675822
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.75
|
|