|
SUTURE MONOSOF 9-0 BLACK
|
Facility
|
OP
|
$102.71
|
|
| Hospital Charge Code |
270651163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Commercial |
$39.03
|
| Rate for Payer: Aetna Medicare Advantage |
$30.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.19
|
| Rate for Payer: Cigna Commercial |
$51.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.81
|
| Rate for Payer: Oxford Commercial |
$20.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.54
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.72
|
|
|
SUTURE MONOSOF C-14 2-0 30
|
Facility
|
IP
|
$5.82
|
|
| Hospital Charge Code |
270651173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.87
|
|
|
SUTURE MONOSOF C-14 2-0 30
|
Facility
|
OP
|
$5.82
|
|
| Hospital Charge Code |
270651173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare Advantage |
$1.75
|
| 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 |
$2.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.75
|
| 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 MONOSOF C-15 2-0
|
Facility
|
IP
|
$14.43
|
|
| Hospital Charge Code |
270604509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.16
|
|
|
SUTURE MONOSOF C-15 2-0
|
Facility
|
OP
|
$14.43
|
|
| Hospital Charge Code |
270604509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$7.21 |
| Rate for Payer: Aetna Commercial |
$5.48
|
| Rate for Payer: Aetna Medicare Advantage |
$4.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.68
|
| Rate for Payer: Cigna Commercial |
$7.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.33
|
| Rate for Payer: Oxford Commercial |
$2.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.89
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.38
|
|
|
SUTURE MONOSOF C-17 2-0 30
|
Facility
|
OP
|
$6.03
|
|
| Hospital Charge Code |
270651174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare Advantage |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.54
|
| Rate for Payer: Cigna Commercial |
$3.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.81
|
| Rate for Payer: Oxford Commercial |
$1.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.16
|
|
|
SUTURE MONOSOF C-17 2-0 30
|
Facility
|
IP
|
$6.03
|
|
| Hospital Charge Code |
270651174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
|
|
SUTURE MONOSOF MV1355 8-0
|
Facility
|
IP
|
$49.12
|
|
| Hospital Charge Code |
270604515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.37
|
|
|
SUTURE MONOSOF MV1355 8-0
|
Facility
|
OP
|
$49.12
|
|
| Hospital Charge Code |
270604515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$24.56 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Aetna Medicare Advantage |
$14.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.53
|
| Rate for Payer: Cigna Commercial |
$24.56
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.74
|
| Rate for Payer: Oxford Commercial |
$9.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.30
|
|
|
SUTURE MONOSOF MVK1004 10-0
|
Facility
|
IP
|
$211.25
|
|
| Hospital Charge Code |
270604516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$31.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.69
|
|
|
SUTURE MONOSOF MVK1004 10-0
|
Facility
|
OP
|
$211.25
|
|
| Hospital Charge Code |
270604516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$105.62 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare Advantage |
$63.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$53.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$53.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$53.87
|
| Rate for Payer: Cigna Commercial |
$105.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$63.38
|
| Rate for Payer: Oxford Commercial |
$42.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.60
|
|
|
SUTURE MONOSOF P-10 7-0 BLK
|
Facility
|
IP
|
$13.57
|
|
| Hospital Charge Code |
270649088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.04
|
|
|
SUTURE MONOSOF P-10 7-0 BLK
|
Facility
|
OP
|
$13.57
|
|
| Hospital Charge Code |
270649088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Aetna Commercial |
$5.16
|
| Rate for Payer: Aetna Medicare Advantage |
$4.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.46
|
| Rate for Payer: Cigna Commercial |
$6.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.07
|
| Rate for Payer: Oxford Commercial |
$2.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.36
|
|
|
SUTURE MONOSOF P-12 5-0 18
|
Facility
|
OP
|
$12.90
|
|
| Hospital Charge Code |
270651305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna Commercial |
$4.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.29
|
| Rate for Payer: Cigna Commercial |
$6.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.87
|
| Rate for Payer: Oxford Commercial |
$2.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
|
SUTURE MONOSOF P-12 5-0 18
|
Facility
|
IP
|
$12.90
|
|
| Hospital Charge Code |
270651305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.94
|
|
|
SUTURE MONOSOF P13 4-0 SN5691
|
Facility
|
IP
|
$12.67
|
|
| Hospital Charge Code |
270633023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.90
|
|
|
SUTURE MONOSOF P13 4-0 SN5691
|
Facility
|
OP
|
$12.67
|
|
| Hospital Charge Code |
270633023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Aetna Commercial |
$4.81
|
| Rate for Payer: Aetna Medicare Advantage |
$3.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.23
|
| Rate for Payer: Cigna Commercial |
$6.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.80
|
| Rate for Payer: Oxford Commercial |
$2.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
|
SUTURE MONOSOF P13 6-0
|
Facility
|
IP
|
$12.51
|
|
| Hospital Charge Code |
270604514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.88
|
|
|
SUTURE MONOSOF P13 6-0
|
Facility
|
OP
|
$12.51
|
|
| Hospital Charge Code |
270604514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Aetna Medicare Advantage |
$3.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.19
|
| Rate for Payer: Cigna Commercial |
$6.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.75
|
| Rate for Payer: Oxford Commercial |
$2.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.33
|
|
|
SUTURE MONOSOF P16 7-0
|
Facility
|
IP
|
$29.65
|
|
| Hospital Charge Code |
270600772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.45
|
|
|
SUTURE MONOSOF P16 7-0
|
Facility
|
OP
|
$29.65
|
|
| Hospital Charge Code |
270600772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna Commercial |
$11.27
|
| Rate for Payer: Aetna Medicare Advantage |
$8.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.56
|
| Rate for Payer: Cigna Commercial |
$14.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.89
|
| Rate for Payer: Oxford Commercial |
$5.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.79
|
|
|
SUTURE MONOSOF PC-11 5-0
|
Facility
|
IP
|
$16.68
|
|
| Hospital Charge Code |
270600777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.50
|
|
|
SUTURE MONOSOF PC-11 5-0
|
Facility
|
OP
|
$16.68
|
|
| Hospital Charge Code |
270600777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: Aetna Commercial |
$6.34
|
| Rate for Payer: Aetna Medicare Advantage |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.25
|
| Rate for Payer: Cigna Commercial |
$8.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.00
|
| Rate for Payer: Oxford Commercial |
$3.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.34
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.44
|
|
|
SUTURE MONOSOF PC12 5-0
|
Facility
|
IP
|
$26.45
|
|
| Hospital Charge Code |
270600776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.97
|
|
|
SUTURE MONOSOF PC12 5-0
|
Facility
|
OP
|
$26.45
|
|
| Hospital Charge Code |
270600776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$13.22 |
| Rate for Payer: Aetna Commercial |
$10.05
|
| Rate for Payer: Aetna Medicare Advantage |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.74
|
| Rate for Payer: Cigna Commercial |
$13.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.93
|
| Rate for Payer: Oxford Commercial |
$5.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.29
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.70
|
|