|
SUTURE BIOSYN C14 2-0
|
Facility
|
IP
|
$16.85
|
|
| Hospital Charge Code |
270600575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
|
|
SUTURE BIOSYN CV-23 30
|
Facility
|
IP
|
$5.80
|
|
| Hospital Charge Code |
270666890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.87
|
|
|
SUTURE BIOSYN CV-23 30
|
Facility
|
OP
|
$5.80
|
|
| Hospital Charge Code |
270666890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.48
|
| Rate for Payer: Cigna Commercial |
$2.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.74
|
| Rate for Payer: Oxford Commercial |
$1.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.15
|
|
|
SUTURE BIOSYN CV23 5-0
|
Facility
|
IP
|
$65.65
|
|
| Hospital Charge Code |
270604714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
SUTURE BIOSYN CV23 5-0
|
Facility
|
OP
|
$65.65
|
|
| Hospital Charge Code |
270604714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: Aetna Medicare Advantage |
$19.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.74
|
| Rate for Payer: Cigna Commercial |
$32.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.70
|
| Rate for Payer: Oxford Commercial |
$13.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.13
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.74
|
|
|
SUTURE BIOSYN FS3 C13 4/0 UD
|
Facility
|
OP
|
$7.24
|
|
| Hospital Charge Code |
270656159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare Advantage |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.85
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.17
|
| Rate for Payer: Oxford Commercial |
$1.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.19
|
|
|
SUTURE BIOSYN FS3 C13 4/0 UD
|
Facility
|
IP
|
$7.24
|
|
| Hospital Charge Code |
270656159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
|
|
SUTURE BIOSYN GS-11 0
|
Facility
|
IP
|
$8.70
|
|
| Hospital Charge Code |
270613633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.30
|
|
|
SUTURE BIOSYN GS-11 0
|
Facility
|
OP
|
$8.70
|
|
| Hospital Charge Code |
270613633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna Medicare Advantage |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.22
|
| Rate for Payer: Cigna Commercial |
$4.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.61
|
| Rate for Payer: Oxford Commercial |
$1.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.74
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
SUTURE BIOSYN GU-45 2-0
|
Facility
|
IP
|
$8.79
|
|
| Hospital Charge Code |
270613700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.32
|
|
|
SUTURE BIOSYN GU-45 2-0
|
Facility
|
OP
|
$8.79
|
|
| Hospital Charge Code |
270613700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Medicare Advantage |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.24
|
| Rate for Payer: Cigna Commercial |
$4.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.64
|
| Rate for Payer: Oxford Commercial |
$1.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.76
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
SUTURE BIOSYN GU-46 2/0 VIO 36
|
Facility
|
IP
|
$7.91
|
|
| Hospital Charge Code |
270656168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.19
|
|
|
SUTURE BIOSYN GU-46 2/0 VIO 36
|
Facility
|
OP
|
$7.91
|
|
| Hospital Charge Code |
270656168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.01
|
| Rate for Payer: Aetna Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.02
|
| Rate for Payer: Cigna Commercial |
$3.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.37
|
| Rate for Payer: Oxford Commercial |
$1.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.21
|
|
|
SUTURE BIOSYN HOS11 2-0
|
Facility
|
IP
|
$100.85
|
|
| Hospital Charge Code |
270604705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.13
|
|
|
SUTURE BIOSYN HOS11 2-0
|
Facility
|
OP
|
$100.85
|
|
| Hospital Charge Code |
270604705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$50.42 |
| Rate for Payer: Aetna Commercial |
$38.32
|
| Rate for Payer: Aetna Medicare Advantage |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.72
|
| Rate for Payer: Cigna Commercial |
$50.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.25
|
| Rate for Payer: Oxford Commercial |
$20.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.67
|
|
|
SUTURE BIOSYN P-14 4-0 SM5679
|
Facility
|
IP
|
$26.30
|
|
| Hospital Charge Code |
270632941C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.94
|
|
|
SUTURE BIOSYN P-14 4-0 SM5679
|
Facility
|
OP
|
$26.30
|
|
| Hospital Charge Code |
270632941C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$13.15 |
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Medicare Advantage |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.71
|
| Rate for Payer: Cigna Commercial |
$13.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.89
|
| Rate for Payer: Oxford Commercial |
$5.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.26
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.70
|
|
|
SUTURE BIOSYN V20 3-0
|
Facility
|
IP
|
$63.25
|
|
| Hospital Charge Code |
2706604708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
|
|
SUTURE BIOSYN V20 3-0
|
Facility
|
OP
|
$63.25
|
|
| Hospital Charge Code |
2706604708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$24.04
|
| Rate for Payer: Aetna Medicare Advantage |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.13
|
| Rate for Payer: Cigna Commercial |
$31.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.98
|
| Rate for Payer: Oxford Commercial |
$12.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.68
|
|
|
SUTURE BIO TAK 11.8 DISPOSABLE
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
270646445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
SUTURE BIO TAK 11.8 DISPOSABLE
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
270646445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$304.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.00
|
| Rate for Payer: Oxford Commercial |
$160.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$160.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.20
|
|
|
SUTURE BIO TAK 3.0 COMPOSITE
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270646446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$487.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.06
|
|
|
SUTURE BIO TAK 3.0 COMPOSITE
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270646446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
SUTURE BLACK W/NEEDLE
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
270672216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
|
|
SUTURE BLACK W/NEEDLE
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
270672216
|
|
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
|
|