|
SUTURE 0 THX26 CV-2 GORE 2U05A
|
Facility
|
IP
|
$107.50
|
|
| Hospital Charge Code |
270641568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$16.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.12
|
|
|
SUTURE 0 VICRYL PLUS
|
Facility
|
IP
|
$77.98
|
|
| Hospital Charge Code |
270670523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
|
|
SUTURE 0 VICRYL PLUS
|
Facility
|
OP
|
$77.98
|
|
| Hospital Charge Code |
270670523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$38.99 |
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: Aetna Medicare Advantage |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.88
|
| Rate for Payer: Cigna Commercial |
$38.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.39
|
| Rate for Payer: Oxford Commercial |
$15.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.07
|
|
|
SUTURE 1 CHROMIC GS-25 36 105P
|
Facility
|
IP
|
$7.63
|
|
| Hospital Charge Code |
270655755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.14
|
|
|
SUTURE 1 CHROMIC GS-25 36 105P
|
Facility
|
OP
|
$7.63
|
|
| Hospital Charge Code |
270655755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare Advantage |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.95
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.29
|
| Rate for Payer: Oxford Commercial |
$1.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.20
|
|
|
SUTURE 2-0 27 PDS PLUS CT-1
|
Facility
|
OP
|
$11.50
|
|
| Hospital Charge Code |
270664321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna Commercial |
$4.37
|
| Rate for Payer: Aetna Medicare Advantage |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.93
|
| Rate for Payer: Cigna Commercial |
$5.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.45
|
| Rate for Payer: Oxford Commercial |
$2.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.30
|
|
|
SUTURE 2-0 27 PDS PLUS CT-1
|
Facility
|
IP
|
$11.50
|
|
| Hospital Charge Code |
270664321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.73
|
|
|
SUTURE 2-0 CHROMIC GS-21 30
|
Facility
|
IP
|
$6.40
|
|
| Hospital Charge Code |
270655768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.96
|
|
|
SUTURE 2-0 CHROMIC GS-21 30
|
Facility
|
OP
|
$6.40
|
|
| Hospital Charge Code |
270655768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare Advantage |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.63
|
| Rate for Payer: Cigna Commercial |
$3.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.92
|
| Rate for Payer: Oxford Commercial |
$1.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.28
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.17
|
|
|
SUTURE 2-0 POLYSORB GS-21 36U
|
Facility
|
OP
|
$6.40
|
|
| Hospital Charge Code |
270655789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare Advantage |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.63
|
| Rate for Payer: Cigna Commercial |
$3.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.92
|
| Rate for Payer: Oxford Commercial |
$1.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.28
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.17
|
|
|
SUTURE 2-0 POLYSORB GS-21 36U
|
Facility
|
IP
|
$6.40
|
|
| Hospital Charge Code |
270655789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.96
|
|
|
SUTURE 2-0 SILK SH POP OFF MUL
|
Facility
|
IP
|
$65.15
|
|
| Hospital Charge Code |
270685433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.77
|
|
|
SUTURE 2-0 SILK SH POP OFF MUL
|
Facility
|
OP
|
$65.15
|
|
| Hospital Charge Code |
270685433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$32.58 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna Medicare Advantage |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.61
|
| Rate for Payer: Cigna Commercial |
$32.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.55
|
| Rate for Payer: Oxford Commercial |
$13.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.73
|
|
|
SUTURE 2 CO-BRAID UL TRABRAID
|
Facility
|
OP
|
$645.00
|
|
| Hospital Charge Code |
270681121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$322.50 |
| Rate for Payer: Aetna Commercial |
$245.10
|
| Rate for Payer: Aetna Medicare Advantage |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$164.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$164.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$164.47
|
| Rate for Payer: Cigna Commercial |
$322.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.50
|
| Rate for Payer: Oxford Commercial |
$129.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$129.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.09
|
|
|
SUTURE 2 CO-BRAID UL TRABRAID
|
Facility
|
IP
|
$645.00
|
|
| Hospital Charge Code |
270681121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.75 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.75
|
|
|
SUTURE 2 LR 20 IN
|
Facility
|
IP
|
$50.83
|
|
| Hospital Charge Code |
270690998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$7.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.62
|
|
|
SUTURE 2 LR 20 IN
|
Facility
|
OP
|
$50.83
|
|
| Hospital Charge Code |
270690998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$25.41 |
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: Aetna Medicare Advantage |
$15.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.96
|
| Rate for Payer: Cigna Commercial |
$25.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.25
|
| Rate for Payer: Oxford Commercial |
$10.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.35
|
|
|
SUTURE #2 TW BRAID POLYBLEND
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
270677966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.77 |
| 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 |
$34.50
|
| 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 |
$2.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.05
|
|
|
SUTURE #2 TW BRAID POLYBLEND
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
270677966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
|
|
SUTURE #2 W/BLACK
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
270672174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Medicare Advantage |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.65
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$69.00
|
| Rate for Payer: Oxford Commercial |
$46.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$46.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.09
|
|
|
SUTURE #2 W/BLACK
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
270672174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
|
|
SUTURE #2 W/BLUE
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
270672175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
|
|
SUTURE #2 W/BLUE
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
270672175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Medicare Advantage |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.65
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$69.00
|
| Rate for Payer: Oxford Commercial |
$46.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$46.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.09
|
|
|
SUTURE 3-0 27 PDS PLUS SH
|
Facility
|
IP
|
$11.80
|
|
| Hospital Charge Code |
270664319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.77
|
|
|
SUTURE 3-0 27 PDS PLUS SH
|
Facility
|
OP
|
$11.80
|
|
| Hospital Charge Code |
270664319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$5.90 |
| Rate for Payer: Aetna Commercial |
$4.48
|
| Rate for Payer: Aetna Medicare Advantage |
$3.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.01
|
| Rate for Payer: Cigna Commercial |
$5.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.54
|
| Rate for Payer: Oxford Commercial |
$2.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.31
|
|