|
LIGASURE ADVANCE PISTOL 44CM
|
Facility
|
OP
|
$3,423.63
|
|
| Hospital Charge Code |
270663053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.23 |
| Max. Negotiated Rate |
$1,711.82 |
| Rate for Payer: Aetna Commercial |
$1,300.98
|
| Rate for Payer: Aetna Medicare Advantage |
$1,027.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$873.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$873.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$873.03
|
| Rate for Payer: Cigna Commercial |
$1,711.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$890.14
|
| Rate for Payer: Oxford Commercial |
$684.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$513.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$684.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$108.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$97.23
|
|
|
LIGASURE ADVANCE PISTOL 44CM
|
Facility
|
IP
|
$3,423.63
|
|
| Hospital Charge Code |
270663053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$513.54 |
| Max. Negotiated Rate |
$513.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$513.54
|
|
|
LIGASURE ATLAS 37CM HANDSWITCH
|
Facility
|
IP
|
$1,881.15
|
|
| Hospital Charge Code |
270684272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.17 |
| Max. Negotiated Rate |
$282.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$282.17
|
|
|
LIGASURE ATLAS 37CM HANDSWITCH
|
Facility
|
OP
|
$1,881.15
|
|
| Hospital Charge Code |
270684272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.42 |
| Max. Negotiated Rate |
$940.58 |
| Rate for Payer: Aetna Commercial |
$714.84
|
| Rate for Payer: Aetna Medicare Advantage |
$564.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$479.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$479.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$479.69
|
| Rate for Payer: Cigna Commercial |
$940.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$489.10
|
| Rate for Payer: Oxford Commercial |
$376.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$282.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$376.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.42
|
|
|
LIGASURE BLUNT TIP 23CM
|
Facility
|
OP
|
$2,496.00
|
|
| Hospital Charge Code |
270698020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.89 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$948.48
|
| Rate for Payer: Aetna Medicare Advantage |
$748.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$636.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$636.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$636.48
|
| Rate for Payer: Cigna Commercial |
$1,248.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$648.96
|
| Rate for Payer: Oxford Commercial |
$499.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$374.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$499.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.89
|
|
|
LIGASURE BLUNT TIP 23CM
|
Facility
|
IP
|
$2,496.00
|
|
| Hospital Charge Code |
270698020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.40 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$374.40
|
|
|
LIGASURE CUR SM JAW SEALER
|
Facility
|
OP
|
$2,314.89
|
|
| Hospital Charge Code |
270675533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$1,157.44 |
| Rate for Payer: Aetna Commercial |
$879.66
|
| Rate for Payer: Aetna Medicare Advantage |
$694.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$590.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$590.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$590.30
|
| Rate for Payer: Cigna Commercial |
$1,157.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$601.87
|
| Rate for Payer: Oxford Commercial |
$462.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$347.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$462.98
|
| Rate for Payer: UnitedHealthcare Community & State |
$73.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$65.74
|
|
|
LIGASURE CUR SM JAW SEALER
|
Facility
|
IP
|
$2,314.89
|
|
| Hospital Charge Code |
270675533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.23 |
| Max. Negotiated Rate |
$347.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$347.23
|
|
|
LIGASURE EXACT
|
Facility
|
OP
|
$3,025.00
|
|
| Hospital Charge Code |
270689841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.91 |
| Max. Negotiated Rate |
$1,512.50 |
| Rate for Payer: Aetna Commercial |
$1,149.50
|
| Rate for Payer: Aetna Medicare Advantage |
$907.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$771.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$771.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$771.38
|
| Rate for Payer: Cigna Commercial |
$1,512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$786.50
|
| Rate for Payer: Oxford Commercial |
$605.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$453.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$95.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$85.91
|
|
|
LIGASURE EXACT
|
Facility
|
IP
|
$3,025.00
|
|
| Hospital Charge Code |
270689841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.75 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$453.75
|
|
|
LIGASURE IMPACT OPEN DEVICE
|
Facility
|
OP
|
$2,467.50
|
|
| Hospital Charge Code |
270643235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$1,233.75 |
| Rate for Payer: Aetna Commercial |
$937.65
|
| Rate for Payer: Aetna Medicare Advantage |
$740.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$629.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$629.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$629.21
|
| Rate for Payer: Cigna Commercial |
$1,233.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$641.55
|
| Rate for Payer: Oxford Commercial |
$493.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$370.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$493.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$77.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.08
|
|
|
LIGASURE IMPACT OPEN DEVICE
|
Facility
|
IP
|
$2,467.50
|
|
| Hospital Charge Code |
270643235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$370.12 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$370.12
|
|
|
LIGASURE MARYLAND JAW 5MM
|
Facility
|
OP
|
$2,829.75
|
|
| Hospital Charge Code |
270685434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$1,414.88 |
| Rate for Payer: Aetna Commercial |
$1,075.31
|
| Rate for Payer: Aetna Medicare Advantage |
$848.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$721.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$721.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$721.59
|
| Rate for Payer: Cigna Commercial |
$1,414.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$735.74
|
| Rate for Payer: Oxford Commercial |
$565.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$424.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$565.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$89.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$80.36
|
|
|
LIGASURE MARYLAND JAW 5MM
|
Facility
|
IP
|
$2,829.75
|
|
| Hospital Charge Code |
270685434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.46 |
| Max. Negotiated Rate |
$424.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$424.46
|
|
|
LIGASURE MARYLAND SEALER/ DIVI
|
Facility
|
IP
|
$3,276.30
|
|
| Hospital Charge Code |
270667974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.44 |
| Max. Negotiated Rate |
$491.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$491.44
|
|
|
LIGASURE MARYLAND SEALER/ DIVI
|
Facility
|
OP
|
$3,276.30
|
|
| Hospital Charge Code |
270667974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.05 |
| Max. Negotiated Rate |
$1,638.15 |
| Rate for Payer: Aetna Commercial |
$1,244.99
|
| Rate for Payer: Aetna Medicare Advantage |
$982.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$835.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$835.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$835.46
|
| Rate for Payer: Cigna Commercial |
$1,638.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$851.84
|
| Rate for Payer: Oxford Commercial |
$655.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$491.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$655.26
|
| Rate for Payer: UnitedHealthcare Community & State |
$103.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$93.05
|
|
|
LIGASURE MAX VESSEL SEALNG ELC
|
Facility
|
IP
|
$550.00
|
|
| Hospital Charge Code |
270335488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
LIGASURE MAX VESSEL SEALNG ELC
|
Facility
|
OP
|
$550.00
|
|
| Hospital Charge Code |
270335488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.00
|
| Rate for Payer: Oxford Commercial |
$110.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
LIGASURE RETRACTOR L HOOK
|
Facility
|
IP
|
$3,355.13
|
|
| Hospital Charge Code |
270690924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$503.27 |
| Max. Negotiated Rate |
$503.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$503.27
|
|
|
LIGASURE RETRACTOR L HOOK
|
Facility
|
OP
|
$3,355.13
|
|
| Hospital Charge Code |
270690924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.29 |
| Max. Negotiated Rate |
$1,677.57 |
| Rate for Payer: Aetna Commercial |
$1,274.95
|
| Rate for Payer: Aetna Medicare Advantage |
$1,006.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$855.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$855.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$855.56
|
| Rate for Payer: Cigna Commercial |
$1,677.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$872.33
|
| Rate for Payer: Oxford Commercial |
$671.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$503.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$671.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$106.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$95.29
|
|
|
LIGASURE SEALER/DIVIDER 5MM
|
Facility
|
IP
|
$1,715.00
|
|
| Hospital Charge Code |
270660184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$257.25 |
| Max. Negotiated Rate |
$257.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$257.25
|
|
|
LIGASURE SEALER/DIVIDER 5MM
|
Facility
|
OP
|
$1,715.00
|
|
| Hospital Charge Code |
270660184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.71 |
| Max. Negotiated Rate |
$857.50 |
| Rate for Payer: Aetna Commercial |
$651.70
|
| Rate for Payer: Aetna Medicare Advantage |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$437.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$437.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$437.32
|
| Rate for Payer: Cigna Commercial |
$857.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$445.90
|
| Rate for Payer: Oxford Commercial |
$343.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$257.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$343.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.71
|
|
|
LIGASURE VESSEL SEALING INS DS
|
Facility
|
IP
|
$1,461.00
|
|
| Hospital Charge Code |
270335522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.15 |
| Max. Negotiated Rate |
$219.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$219.15
|
|
|
LIGASURE VESSEL SEALING INS DS
|
Facility
|
OP
|
$1,461.00
|
|
| Hospital Charge Code |
270335522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.49 |
| Max. Negotiated Rate |
$730.50 |
| Rate for Payer: Aetna Commercial |
$555.18
|
| Rate for Payer: Aetna Medicare Advantage |
$438.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$372.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$372.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$372.56
|
| Rate for Payer: Cigna Commercial |
$730.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$379.86
|
| Rate for Payer: Oxford Commercial |
$292.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$219.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$292.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.49
|
|
|
LIGATE/STP LONG LEG VEIN LT
|
Facility
|
OP
|
$25,406.80
|
|
|
Service Code
|
HCPCS 37722
|
| Hospital Charge Code |
16000738
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$721.55 |
| Max. Negotiated Rate |
$13,607.37 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,607.37
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$3,751.17
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,605.77
|
| Rate for Payer: Oxford Commercial |
$9,354.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,811.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,269.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$802.85
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$721.55
|
|