|
STAPLER UNIVERSAL ENDO GIA XL
|
Facility
|
IP
|
$2,189.48
|
|
| Hospital Charge Code |
270691810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$328.42 |
| Max. Negotiated Rate |
$328.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.42
|
|
|
STAPLER UNIVERSAL ENDO GIA XL
|
Facility
|
OP
|
$2,189.48
|
|
| Hospital Charge Code |
270691810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$1,094.74 |
| Rate for Payer: Aetna Commercial |
$832.00
|
| Rate for Payer: Aetna Medicare Advantage |
$656.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$558.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$558.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$558.32
|
| Rate for Payer: Cigna Commercial |
$1,094.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$569.26
|
| Rate for Payer: Oxford Commercial |
$437.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$328.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$437.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$69.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$62.18
|
|
|
STAPLER UNIVERS GIA SHORT 12MM
|
Facility
|
OP
|
$1,880.13
|
|
| Hospital Charge Code |
270687314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$940.07 |
| Rate for Payer: Aetna Commercial |
$714.45
|
| Rate for Payer: Aetna Medicare Advantage |
$564.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$479.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$479.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$479.43
|
| Rate for Payer: Cigna Commercial |
$940.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$488.83
|
| Rate for Payer: Oxford Commercial |
$376.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$282.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$376.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$59.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$53.40
|
|
|
STAPLER UNIVERS GIA SHORT 12MM
|
Facility
|
IP
|
$1,880.13
|
|
| Hospital Charge Code |
270687314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.02 |
| Max. Negotiated Rate |
$282.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$282.02
|
|
|
STAPLER UNT RELOAD 60MM PROXIM
|
Facility
|
IP
|
$226.15
|
|
| Hospital Charge Code |
270671552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$33.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.92
|
|
|
STAPLER UNT RELOAD 60MM PROXIM
|
Facility
|
OP
|
$226.15
|
|
| Hospital Charge Code |
270671552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$113.08 |
| Rate for Payer: Aetna Commercial |
$85.94
|
| Rate for Payer: Aetna Medicare Advantage |
$67.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.67
|
| Rate for Payer: Cigna Commercial |
$113.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.80
|
| Rate for Payer: Oxford Commercial |
$45.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.42
|
|
|
STAPLER VERSATACK MF 4.8MM
|
Facility
|
IP
|
$394.45
|
|
| Hospital Charge Code |
270658742
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.17 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.17
|
|
|
STAPLER VERSATACK MF 4.8MM
|
Facility
|
OP
|
$394.45
|
|
| Hospital Charge Code |
270658742
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$197.22 |
| Rate for Payer: Aetna Commercial |
$149.89
|
| Rate for Payer: Aetna Medicare Advantage |
$118.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$100.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$100.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$100.58
|
| Rate for Payer: Cigna Commercial |
$197.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.56
|
| Rate for Payer: Oxford Commercial |
$78.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$78.89
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.20
|
|
|
STAPLER WHITE RELOAD ECHE 60
|
Facility
|
OP
|
$696.95
|
|
| Hospital Charge Code |
270661392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$348.48 |
| Rate for Payer: Aetna Commercial |
$264.84
|
| Rate for Payer: Aetna Medicare Advantage |
$209.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$177.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$177.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$177.72
|
| Rate for Payer: Cigna Commercial |
$348.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.21
|
| Rate for Payer: Oxford Commercial |
$139.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.79
|
|
|
STAPLER WHITE RELOAD ECHE 60
|
Facility
|
IP
|
$696.95
|
|
| Hospital Charge Code |
270661392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$104.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.54
|
|
|
STAPLER Z 8MM
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
STAPLER Z 8MM
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.20 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,090.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$173.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$156.20
|
|
|
STAPLES 8X8 ARCUS
|
Facility
|
IP
|
$4,840.00
|
|
| Hospital Charge Code |
270691322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$726.00 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$726.00
|
|
|
STAPLES 8X8 ARCUS
|
Facility
|
OP
|
$4,840.00
|
|
| Hospital Charge Code |
270691322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.46 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna Commercial |
$1,839.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1,452.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,234.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,234.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,234.20
|
| Rate for Payer: Cigna Commercial |
$2,420.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.40
|
| Rate for Payer: Oxford Commercial |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$726.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$968.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$152.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$137.46
|
|
|
STAPLES FX
|
Facility
|
OP
|
$171.00
|
|
| Hospital Charge Code |
270335162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$64.98
|
| Rate for Payer: Aetna Medicare Advantage |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.60
|
| Rate for Payer: Cigna Commercial |
$85.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.46
|
| Rate for Payer: Oxford Commercial |
$34.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.86
|
|
|
STAPLES FX
|
Facility
|
IP
|
$171.00
|
|
| Hospital Charge Code |
270335162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.65
|
|
|
STAPLE SKIN EXTRACTOR
|
Facility
|
IP
|
$8.66
|
|
| Hospital Charge Code |
270649984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.30
|
|
|
STAPLE SKIN EXTRACTOR
|
Facility
|
OP
|
$8.66
|
|
| Hospital Charge Code |
270649984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna Medicare Advantage |
$2.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.21
|
| Rate for Payer: Cigna Commercial |
$4.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.25
|
| Rate for Payer: Oxford Commercial |
$1.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.25
|
|
|
STAPLES SINGLE N
|
Facility
|
IP
|
$1,647.85
|
|
| Hospital Charge Code |
270670928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.18 |
| Max. Negotiated Rate |
$247.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$247.18
|
|
|
STAPLES SINGLE N
|
Facility
|
OP
|
$1,647.85
|
|
| Hospital Charge Code |
270670928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$823.92 |
| Rate for Payer: Aetna Commercial |
$626.18
|
| Rate for Payer: Aetna Medicare Advantage |
$494.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$420.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$420.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$420.20
|
| Rate for Payer: Cigna Commercial |
$823.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$428.44
|
| Rate for Payer: Oxford Commercial |
$329.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$247.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$329.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.80
|
|
|
STAPLE STR NITINOL 8X8MM
|
Facility
|
OP
|
$6,036.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.43 |
| Max. Negotiated Rate |
$3,018.12 |
| Rate for Payer: Aetna Commercial |
$2,293.78
|
| Rate for Payer: Aetna Medicare Advantage |
$1,810.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,539.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,539.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,207.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,539.24
|
| Rate for Payer: Cigna Commercial |
$3,018.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,460.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$905.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$190.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$171.43
|
|
|
STAPLE STR NITINOL 8X8MM
|
Facility
|
IP
|
$6,036.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$905.44 |
| Max. Negotiated Rate |
$1,460.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,207.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,460.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$905.44
|
|
|
STAPLE SUPER MX NITI 20WX15L
|
Facility
|
OP
|
$17,825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.23 |
| Max. Negotiated Rate |
$8,912.50 |
| Rate for Payer: Aetna Commercial |
$6,773.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,347.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,545.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,545.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,565.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,545.38
|
| Rate for Payer: Cigna Commercial |
$8,912.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,313.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,673.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$563.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$506.23
|
|
|
STAPLE SUPER MX NITI 20WX15L
|
Facility
|
IP
|
$17,825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.75 |
| Max. Negotiated Rate |
$4,313.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,565.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,313.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,673.75
|
|
|
STAPLE SYSTEM 10X10X10MM
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.07 |
| Max. Negotiated Rate |
$3,135.00 |
| Rate for Payer: Aetna Commercial |
$2,382.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,881.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,598.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,598.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,254.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,598.85
|
| Rate for Payer: Cigna Commercial |
$3,135.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,517.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$940.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$198.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$178.07
|
|