|
SUTURE POLYSORB 2/0 3x27 VIO
|
Facility
|
OP
|
$7.24
|
|
| Hospital Charge Code |
270604526
|
|
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 POLYSORB 2/0 60 U/D
|
Facility
|
OP
|
$7.40
|
|
| Hospital Charge Code |
270651156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Medicare Advantage |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.89
|
| Rate for Payer: Cigna Commercial |
$3.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.22
|
| Rate for Payer: Oxford Commercial |
$1.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.20
|
|
|
SUTURE POLYSORB 2/0 60 U/D
|
Facility
|
IP
|
$7.40
|
|
| Hospital Charge Code |
270651156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.11
|
|
|
SUTURE POLYSORB 2/0 60 UNDYED
|
Facility
|
IP
|
$5.97
|
|
| Hospital Charge Code |
270656138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
|
|
SUTURE POLYSORB 2/0 60 UNDYED
|
Facility
|
OP
|
$5.97
|
|
| Hospital Charge Code |
270656138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna Commercial |
$2.27
|
| Rate for Payer: Aetna Medicare Advantage |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.52
|
| Rate for Payer: Cigna Commercial |
$2.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.79
|
| Rate for Payer: Oxford Commercial |
$1.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.19
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.16
|
|
|
SUTURE POLYSORB 2/0 60 VIO
|
Facility
|
IP
|
$7.40
|
|
| Hospital Charge Code |
270604522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.11
|
|
|
SUTURE POLYSORB 2/0 60 VIO
|
Facility
|
OP
|
$7.40
|
|
| Hospital Charge Code |
270604522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Medicare Advantage |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.89
|
| Rate for Payer: Cigna Commercial |
$3.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.22
|
| Rate for Payer: Oxford Commercial |
$1.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.20
|
|
|
SUTURE POLYSORB 2 0 GS21
|
Facility
|
OP
|
$6.81
|
|
| Hospital Charge Code |
270662049N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare Advantage |
$2.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.74
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.04
|
| Rate for Payer: Oxford Commercial |
$1.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.18
|
|
|
SUTURE POLYSORB 2 0 GS21
|
Facility
|
OP
|
$6.81
|
|
| Hospital Charge Code |
270662049S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare Advantage |
$2.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.74
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.04
|
| Rate for Payer: Oxford Commercial |
$1.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.18
|
|
|
SUTURE POLYSORB 2 0 GS21
|
Facility
|
IP
|
$6.81
|
|
| Hospital Charge Code |
270662049S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
|
|
SUTURE POLYSORB 2 0 GS21
|
Facility
|
OP
|
$6.81
|
|
| Hospital Charge Code |
270662049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare Advantage |
$2.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.74
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.04
|
| Rate for Payer: Oxford Commercial |
$1.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.18
|
|
|
SUTURE POLYSORB 2 0 GS21
|
Facility
|
IP
|
$6.81
|
|
| Hospital Charge Code |
270662049N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
|
|
SUTURE POLYSORB 2 0 GS21
|
Facility
|
IP
|
$6.81
|
|
| Hospital Charge Code |
270662049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
|
|
SUTURE POLYSORB 2-0 VL 60 PCT
|
Facility
|
OP
|
$5.80
|
|
| Hospital Charge Code |
270656143
|
|
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 POLYSORB 2-0 VL 60 PCT
|
Facility
|
IP
|
$5.80
|
|
| Hospital Charge Code |
270656143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.87
|
|
|
SUTURE POLYSORB 2 5x30 VIOLET
|
Facility
|
IP
|
$59.26
|
|
| Hospital Charge Code |
270663266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.89
|
|
|
SUTURE POLYSORB 2 5x30 VIOLET
|
Facility
|
OP
|
$59.26
|
|
| Hospital Charge Code |
270663266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$29.63 |
| Rate for Payer: Aetna Commercial |
$22.52
|
| Rate for Payer: Aetna Medicare Advantage |
$17.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.11
|
| Rate for Payer: Cigna Commercial |
$29.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.78
|
| Rate for Payer: Oxford Commercial |
$11.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.57
|
|
|
SUTURE POLYSORB 3/0 12x18 U/D
|
Facility
|
IP
|
$28.66
|
|
| Hospital Charge Code |
270655783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.30
|
|
|
SUTURE POLYSORB 3/0 12x18 U/D
|
Facility
|
OP
|
$28.66
|
|
| Hospital Charge Code |
270655783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: Aetna Medicare Advantage |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.31
|
| Rate for Payer: Cigna Commercial |
$14.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.60
|
| Rate for Payer: Oxford Commercial |
$5.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.76
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
IP
|
$13.13
|
|
| Hospital Charge Code |
270661668S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.97
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
IP
|
$13.33
|
|
| Hospital Charge Code |
270661668N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.00
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
OP
|
$12.83
|
|
| Hospital Charge Code |
2709007228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Aetna Commercial |
$4.88
|
| Rate for Payer: Aetna Medicare Advantage |
$3.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.27
|
| Rate for Payer: Cigna Commercial |
$6.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.85
|
| Rate for Payer: Oxford Commercial |
$2.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
OP
|
$13.33
|
|
| Hospital Charge Code |
270661668N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: Aetna Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.40
|
| Rate for Payer: Cigna Commercial |
$6.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.00
|
| Rate for Payer: Oxford Commercial |
$2.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.35
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
IP
|
$13.13
|
|
| Hospital Charge Code |
270661668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.97
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
OP
|
$13.13
|
|
| Hospital Charge Code |
270661668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna Commercial |
$4.99
|
| Rate for Payer: Aetna Medicare Advantage |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.35
|
| Rate for Payer: Cigna Commercial |
$6.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.94
|
| Rate for Payer: Oxford Commercial |
$2.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.63
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.35
|
|
