|
BLADE PATELLA REAMER W/PILO
|
Facility
|
IP
|
$876.25
|
|
| Hospital Charge Code |
270661319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.44 |
| Max. Negotiated Rate |
$131.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.44
|
|
|
BLADE PATELLA REAMER W/PILO
|
Facility
|
OP
|
$876.25
|
|
| Hospital Charge Code |
270661319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$438.12 |
| Rate for Payer: Aetna Commercial |
$332.98
|
| Rate for Payer: Aetna Medicare Advantage |
$262.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.44
|
| Rate for Payer: Cigna Commercial |
$438.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$227.82
|
| Rate for Payer: Oxford Commercial |
$175.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.89
|
|
|
BLADE PRECISION 19.5X0.38X41MM
|
Facility
|
IP
|
$180.20
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270691103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.03
|
|
|
BLADE PRECISION 19.5X0.38X41MM
|
Facility
|
OP
|
$180.20
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270691103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Aetna Commercial |
$68.48
|
| Rate for Payer: Aetna Medicare Advantage |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.95
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.85
|
| Rate for Payer: Oxford Commercial |
$36.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.04
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.12
|
|
|
BLADE PRECISION 9X.51X18.5MM
|
Facility
|
OP
|
$180.20
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270691100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Aetna Commercial |
$68.48
|
| Rate for Payer: Aetna Medicare Advantage |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.95
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.85
|
| Rate for Payer: Oxford Commercial |
$36.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.04
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.12
|
|
|
BLADE PRECISION 9X.51X18.5MM
|
Facility
|
IP
|
$180.20
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270691100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.03
|
|
|
BLADE QUADCUT M4 4.3MM 13CM
|
Facility
|
OP
|
$1,960.00
|
|
| Hospital Charge Code |
270663277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna Commercial |
$744.80
|
| Rate for Payer: Aetna Medicare Advantage |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$499.80
|
| Rate for Payer: Cigna Commercial |
$980.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$509.60
|
| Rate for Payer: Oxford Commercial |
$392.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$294.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$392.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$61.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$55.66
|
|
|
BLADE QUADCUT M4 4.3MM 13CM
|
Facility
|
IP
|
$1,960.00
|
|
| Hospital Charge Code |
270663277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$294.00
|
|
|
BLADE RADENOID ADULT 4.5MM
|
Facility
|
IP
|
$4,310.00
|
|
| Hospital Charge Code |
270665449
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$646.50
|
|
|
BLADE RADENOID ADULT 4.5MM
|
Facility
|
OP
|
$4,310.00
|
|
| Hospital Charge Code |
270665449
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$2,155.00 |
| Rate for Payer: Aetna Commercial |
$1,637.80
|
| Rate for Payer: Aetna Medicare Advantage |
$1,293.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,099.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,099.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,099.05
|
| Rate for Payer: Cigna Commercial |
$2,155.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,120.60
|
| Rate for Payer: Oxford Commercial |
$862.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$646.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$862.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$136.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$122.40
|
|
|
BLADE RADENOID PEDIATRIC 4.0M
|
Facility
|
OP
|
$4,435.00
|
|
| Hospital Charge Code |
270665450
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$2,217.50 |
| Rate for Payer: Aetna Commercial |
$1,685.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,330.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,130.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,130.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,130.92
|
| Rate for Payer: Cigna Commercial |
$2,217.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,153.10
|
| Rate for Payer: Oxford Commercial |
$887.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$665.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$887.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$125.95
|
|
|
BLADE RADENOID PEDIATRIC 4.0M
|
Facility
|
IP
|
$4,435.00
|
|
| Hospital Charge Code |
270665450
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$665.25 |
| Max. Negotiated Rate |
$665.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$665.25
|
|
|
BLADE RASP LARGE TEAR 6.5MMV 1
|
Facility
|
IP
|
$249.20
|
|
| Hospital Charge Code |
270655957
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$37.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.38
|
|
|
BLADE RASP LARGE TEAR 6.5MMV 1
|
Facility
|
OP
|
$249.20
|
|
| Hospital Charge Code |
270655957
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$124.60 |
| Rate for Payer: Aetna Commercial |
$94.70
|
| Rate for Payer: Aetna Medicare Advantage |
$74.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.55
|
| Rate for Payer: Cigna Commercial |
$124.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.79
|
| Rate for Payer: Oxford Commercial |
$49.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$49.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.08
|
|
|
BLADE RASP SMALL TEAR STR CUT
|
Facility
|
IP
|
$249.20
|
|
| Hospital Charge Code |
270655953
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$37.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.38
|
|
|
BLADE RASP SMALL TEAR STR CUT
|
Facility
|
OP
|
$249.20
|
|
| Hospital Charge Code |
270655953
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$124.60 |
| Rate for Payer: Aetna Commercial |
$94.70
|
| Rate for Payer: Aetna Medicare Advantage |
$74.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.55
|
| Rate for Payer: Cigna Commercial |
$124.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$64.79
|
| Rate for Payer: Oxford Commercial |
$49.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$49.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.08
|
|
|
BLADE RECIP DBL SIDE 70X0.64MM
|
Facility
|
IP
|
$209.40
|
|
| Hospital Charge Code |
270693704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$31.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.41
|
|
|
BLADE RECIP DBL SIDE 70X0.64MM
|
Facility
|
OP
|
$209.40
|
|
| Hospital Charge Code |
270693704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$104.70 |
| Rate for Payer: Aetna Commercial |
$79.57
|
| Rate for Payer: Aetna Medicare Advantage |
$62.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.40
|
| Rate for Payer: Cigna Commercial |
$104.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.44
|
| Rate for Payer: Oxford Commercial |
$41.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.95
|
|
|
BLADE REMOVAL 58MM
|
Facility
|
IP
|
$3,750.00
|
|
| Hospital Charge Code |
270671834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
|
|
BLADE REMOVAL 58MM
|
Facility
|
OP
|
$3,750.00
|
|
| Hospital Charge Code |
270671834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,425.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$956.25
|
| Rate for Payer: Cigna Commercial |
$1,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$975.00
|
| Rate for Payer: Oxford Commercial |
$750.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$750.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$118.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$106.50
|
|
|
BLADE RETRACTOR KOLBEL 36X68
|
Facility
|
IP
|
$858.80
|
|
| Hospital Charge Code |
270691430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.82 |
| Max. Negotiated Rate |
$128.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.82
|
|
|
BLADE RETRACTOR KOLBEL 36X68
|
Facility
|
OP
|
$858.80
|
|
| Hospital Charge Code |
270691430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.39 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Aetna Commercial |
$326.34
|
| Rate for Payer: Aetna Medicare Advantage |
$257.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.99
|
| Rate for Payer: Cigna Commercial |
$429.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.29
|
| Rate for Payer: Oxford Commercial |
$171.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$171.76
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.39
|
|
|
BLADE ROUND FLEX MED
|
Facility
|
IP
|
$3,375.00
|
|
| Hospital Charge Code |
270680026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.25 |
| Max. Negotiated Rate |
$506.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
|
|
BLADE ROUND FLEX MED
|
Facility
|
OP
|
$3,375.00
|
|
| Hospital Charge Code |
270680026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$1,687.50 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,012.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.62
|
| Rate for Payer: Cigna Commercial |
$1,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$877.50
|
| Rate for Payer: Oxford Commercial |
$675.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$675.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$106.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$95.85
|
|
|
BLADE ROUND SOLID BUR 1.5MM
|
Facility
|
IP
|
$115.35
|
|
| Hospital Charge Code |
270691108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.30
|
|