|
SUTURE ETHILON 2-0 C-15
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
270675342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.35
|
|
|
SUTURE ETHILON 2-0 C-15
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
270675342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Medicare Advantage |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.29
|
| Rate for Payer: Cigna Commercial |
$4.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.17
|
| Rate for Payer: Oxford Commercial |
$4.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.50
|
|
|
SUTURE ETHILON 2-0 FS C-15
|
Facility
|
OP
|
$317.10
|
|
| Hospital Charge Code |
270673637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$158.55 |
| Rate for Payer: Aetna Commercial |
$95.13
|
| Rate for Payer: Aetna Medicare Advantage |
$95.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$80.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$80.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$80.86
|
| Rate for Payer: Cigna Commercial |
$158.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.22
|
| Rate for Payer: Oxford Commercial |
$158.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$158.55
|
|
|
SUTURE ETHILON 2-0 FS C-15
|
Facility
|
IP
|
$317.10
|
|
| Hospital Charge Code |
270673637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.56 |
| Max. Negotiated Rate |
$47.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.56
|
|
|
SUTURE ETHILON 2-0 KS
|
Facility
|
IP
|
$12.99
|
|
| Hospital Charge Code |
270655804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
SUTURE ETHILON 2-0 KS
|
Facility
|
OP
|
$12.99
|
|
| Hospital Charge Code |
270655804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.69
|
| Rate for Payer: Oxford Commercial |
$6.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
|
|
SUTURE ETHILON 2-0 PS
|
Facility
|
IP
|
$29.01
|
|
| Hospital Charge Code |
270667333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SUTURE ETHILON 2-0 PS
|
Facility
|
OP
|
$29.01
|
|
| Hospital Charge Code |
270667333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$14.51 |
| Rate for Payer: Aetna Commercial |
$8.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.40
|
| Rate for Payer: Cigna Commercial |
$14.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.77
|
| Rate for Payer: Oxford Commercial |
$14.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.51
|
|
|
SUTURE ETHILON 2-0 PS-2
|
Facility
|
OP
|
$17.99
|
|
| Hospital Charge Code |
270671388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.59
|
| Rate for Payer: Cigna Commercial |
$8.99
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.34
|
| Rate for Payer: Oxford Commercial |
$8.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.99
|
|
|
SUTURE ETHILON 2-0 PS-2
|
Facility
|
IP
|
$17.99
|
|
| Hospital Charge Code |
270671388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.70
|
|
|
SUTURE ETHILON 2 GS-18
|
Facility
|
OP
|
$13.45
|
|
| Hospital Charge Code |
270604723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare Advantage |
$4.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.43
|
| Rate for Payer: Cigna Commercial |
$6.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.75
|
| Rate for Payer: Oxford Commercial |
$6.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.72
|
|
|
SUTURE ETHILON 2 GS-18
|
Facility
|
OP
|
$35.33
|
|
| Hospital Charge Code |
270672227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$17.66 |
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna Medicare Advantage |
$10.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.01
|
| Rate for Payer: Cigna Commercial |
$17.66
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.59
|
| Rate for Payer: Oxford Commercial |
$17.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.66
|
|
|
SUTURE ETHILON 2 GS-18
|
Facility
|
IP
|
$35.33
|
|
| Hospital Charge Code |
270672227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.30
|
|
|
SUTURE ETHILON 2 GS-18
|
Facility
|
IP
|
$13.45
|
|
| Hospital Charge Code |
270604723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.02
|
|
|
SUTURE ETHILON 3/0 4IN BLACK B
|
Facility
|
IP
|
$71.61
|
|
| Hospital Charge Code |
270683447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.74
|
|
|
SUTURE ETHILON 3/0 4IN BLACK B
|
Facility
|
OP
|
$71.61
|
|
| Hospital Charge Code |
270683447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$21.48
|
| Rate for Payer: Aetna Medicare Advantage |
$21.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.26
|
| Rate for Payer: Cigna Commercial |
$35.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.31
|
| Rate for Payer: Oxford Commercial |
$35.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.80
|
|
|
SUTURE ETHILON 3-0 BLK PS-2
|
Facility
|
OP
|
$18.06
|
|
| Hospital Charge Code |
270664322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Aetna Commercial |
$5.42
|
| Rate for Payer: Aetna Medicare Advantage |
$5.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.61
|
| Rate for Payer: Cigna Commercial |
$9.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.35
|
| Rate for Payer: Oxford Commercial |
$9.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.03
|
|
|
SUTURE ETHILON 3-0 BLK PS-2
|
Facility
|
IP
|
$18.06
|
|
| Hospital Charge Code |
270664322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.71
|
|
|
SUTURE ETHILON 3-0 FS-1
|
Facility
|
IP
|
$9.18
|
|
| Hospital Charge Code |
270663643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.38
|
|
|
SUTURE ETHILON 3-0 FS-1
|
Facility
|
OP
|
$9.18
|
|
| Hospital Charge Code |
270663643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare Advantage |
$2.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.34
|
| Rate for Payer: Cigna Commercial |
$4.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.19
|
| Rate for Payer: Oxford Commercial |
$4.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.59
|
|
|
SUTURE ETHILON 3-0 KS CUTTING
|
Facility
|
IP
|
$9.51
|
|
| Hospital Charge Code |
270672358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.43
|
|
|
SUTURE ETHILON 3-0 KS CUTTING
|
Facility
|
OP
|
$9.51
|
|
| Hospital Charge Code |
270672358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: UnitedHealthcare Commercial |
$4.75
|
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Medicare Advantage |
$2.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.24
|
| Rate for Payer: Oxford Commercial |
$4.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.43
|
|
|
SUTURE ETHILON 4-0 FS-2
|
Facility
|
IP
|
$8.30
|
|
| Hospital Charge Code |
270677492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
|
|
SUTURE ETHILON 4-0 FS-2
|
Facility
|
OP
|
$8.30
|
|
| Hospital Charge Code |
270677492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$2.49
|
| Rate for Payer: Aetna Medicare Advantage |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.12
|
| Rate for Payer: Cigna Commercial |
$4.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.08
|
| Rate for Payer: Oxford Commercial |
$4.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.15
|
|
|
SUTURE ETHILON 4-0 P-3
|
Facility
|
OP
|
$27.92
|
|
| Hospital Charge Code |
270671397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Aetna Medicare Advantage |
$8.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.12
|
| Rate for Payer: Cigna Commercial |
$13.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.63
|
| Rate for Payer: Oxford Commercial |
$13.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.96
|
|