|
TROCAR XCEL BLADELESS 15MM
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
270641080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Medicare Advantage |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.10
|
| Rate for Payer: Cigna Commercial |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.20
|
| Rate for Payer: Oxford Commercial |
$44.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.25
|
|
|
TROCAR XCEL BLADELESS 15MM
|
Facility
|
OP
|
$67.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
270630134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Aetna Commercial |
$25.55
|
| Rate for Payer: Aetna Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.15
|
| Rate for Payer: Cigna Commercial |
$33.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.91
|
|
|
TROCAR XCEL BLADELESS 15MM
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
270641080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.00
|
|
|
TROCAR XCEL BLADELESS 15MM
|
Facility
|
IP
|
$67.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
270630134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.09
|
|
|
TROCAR XCEL BLADELESS 5-11mm
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
270635613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
|
|
TROCAR XCEL BLADELESS 5-11mm
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
270635613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare Advantage |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.32
|
| Rate for Payer: Cigna Commercial |
$57.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.90
|
| Rate for Payer: Oxford Commercial |
$23.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.27
|
|
|
TROCAR XCEL BLADELESS 5-12mm
|
Facility
|
OP
|
$145.00
|
|
| Hospital Charge Code |
270647919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$72.50 |
| Rate for Payer: Aetna Commercial |
$55.10
|
| Rate for Payer: Aetna Medicare Advantage |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.98
|
| Rate for Payer: Cigna Commercial |
$72.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.70
|
| Rate for Payer: Oxford Commercial |
$29.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.12
|
|
|
TROCAR XCEL BLADELESS 5-12mm
|
Facility
|
IP
|
$145.00
|
|
| Hospital Charge Code |
270647919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.75
|
|
|
TROCAR XCEL BLADELESS 5x150MM
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
270665377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
TROCAR XCEL BLADELESS 5x150MM
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
270665377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.50
|
| Rate for Payer: Oxford Commercial |
$25.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.55
|
|
|
TROCAR Z THREAD 12X100 CANNULA
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
270662257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.50
|
| Rate for Payer: Oxford Commercial |
$25.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.55
|
|
|
TROCAR Z THREAD 12X100 CANNULA
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
270662257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
TROCAR Z THREAD 12X100 NON
|
Facility
|
IP
|
$1,678.60
|
|
| Hospital Charge Code |
270662255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$251.79 |
| Max. Negotiated Rate |
$251.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.79
|
|
|
TROCAR Z THREAD 12X100 NON
|
Facility
|
OP
|
$1,678.60
|
|
| Hospital Charge Code |
270662255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.67 |
| Max. Negotiated Rate |
$839.30 |
| Rate for Payer: Aetna Commercial |
$637.87
|
| Rate for Payer: Aetna Medicare Advantage |
$503.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.04
|
| Rate for Payer: Cigna Commercial |
$839.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$436.44
|
| Rate for Payer: Oxford Commercial |
$335.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$335.72
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$47.67
|
|
|
TROCHANTER HOOK COCR MEDIUM
|
Facility
|
OP
|
$3,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270611650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.04 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Aetna Commercial |
$1,485.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,173.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$997.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$997.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$782.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$997.05
|
| Rate for Payer: Cigna Commercial |
$1,955.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$946.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$586.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$123.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$111.04
|
|
|
TROCHANTER HOOK COCR MEDIUM
|
Facility
|
IP
|
$3,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270611650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.50 |
| Max. Negotiated Rate |
$946.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$782.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$946.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$586.50
|
|
|
TROCHANTERIC GRIP LG 2MM CABLE
|
Facility
|
IP
|
$10,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.00 |
| Max. Negotiated Rate |
$2,424.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,004.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,424.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,503.00
|
|
|
TROCHANTERIC GRIP LG 2MM CABLE
|
Facility
|
OP
|
$10,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270675953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.57 |
| Max. Negotiated Rate |
$5,010.00 |
| Rate for Payer: Aetna Commercial |
$3,807.60
|
| Rate for Payer: Aetna Medicare Advantage |
$3,006.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,555.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,555.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,004.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,555.10
|
| Rate for Payer: Cigna Commercial |
$5,010.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,424.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,503.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$316.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$284.57
|
|
|
TROCHANTERIC MED GRIP W/2 CBL
|
Facility
|
OP
|
$16,038.00
|
|
| Hospital Charge Code |
270670722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.48 |
| Max. Negotiated Rate |
$8,019.00 |
| Rate for Payer: Aetna Commercial |
$6,094.44
|
| Rate for Payer: Aetna Medicare Advantage |
$4,811.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,089.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,089.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,089.69
|
| Rate for Payer: Cigna Commercial |
$8,019.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,169.88
|
| Rate for Payer: Oxford Commercial |
$3,207.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,405.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,207.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$506.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$455.48
|
|
|
TROCHANTERIC MED GRIP W/2 CBL
|
Facility
|
IP
|
$16,038.00
|
|
| Hospital Charge Code |
270670722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,405.70 |
| Max. Negotiated Rate |
$2,405.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,405.70
|
|
|
TROCHANTERIC NAIL 10X170MM 125
|
Facility
|
OP
|
$11,735.00
|
|
|
Service Code
|
HCPCS 11735
|
| Hospital Charge Code |
270705029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.27 |
| Max. Negotiated Rate |
$5,867.50 |
| Rate for Payer: Aetna Commercial |
$4,459.30
|
| Rate for Payer: Aetna Medicare Advantage |
$3,520.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,992.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,992.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,347.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,992.43
|
| Rate for Payer: Cigna Commercial |
$5,867.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,839.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,760.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$370.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$333.27
|
|
|
TROCHANTERIC NAIL 10X170MM 125
|
Facility
|
IP
|
$11,735.00
|
|
|
Service Code
|
HCPCS 11735
|
| Hospital Charge Code |
270705029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,760.25 |
| Max. Negotiated Rate |
$2,839.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,347.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,839.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,760.25
|
|
|
TROCHANTERIC REATTACH DEV LNG
|
Facility
|
IP
|
$11,893.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,784.01 |
| Max. Negotiated Rate |
$2,878.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,378.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,878.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,784.01
|
|
|
TROCHANTERIC REATTACH DEV LNG
|
Facility
|
OP
|
$11,893.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.77 |
| Max. Negotiated Rate |
$5,946.70 |
| Rate for Payer: Aetna Commercial |
$4,519.49
|
| Rate for Payer: Aetna Medicare Advantage |
$3,568.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,032.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,032.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,378.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,032.82
|
| Rate for Payer: Cigna Commercial |
$5,946.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,878.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,784.01
|
| Rate for Payer: UnitedHealthcare Community & State |
$375.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$337.77
|
|
|
TROCHANTERIC REATTACH DEV STD
|
Facility
|
IP
|
$8,253.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,238.01 |
| Max. Negotiated Rate |
$1,997.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,650.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,997.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,238.01
|
|