|
SUTURE MONOCRYL 4-0 V-20
|
Facility
|
OP
|
$10.73
|
|
| Hospital Charge Code |
270672368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.37 |
| Rate for Payer: Aetna Commercial |
$3.22
|
| Rate for Payer: Aetna Medicare Advantage |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.74
|
| Rate for Payer: Cigna Commercial |
$5.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.39
|
| Rate for Payer: Oxford Commercial |
$5.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.37
|
|
|
SUTURE MONOCRYL 5-0 P-3
|
Facility
|
OP
|
$24.20
|
|
| Hospital Charge Code |
270671524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$7.26
|
| Rate for Payer: Aetna Medicare Advantage |
$7.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.17
|
| Rate for Payer: Cigna Commercial |
$12.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.15
|
| Rate for Payer: Oxford Commercial |
$12.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.10
|
|
|
SUTURE MONOCRYL 5-0 P-3
|
Facility
|
IP
|
$24.20
|
|
| Hospital Charge Code |
270671524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.63
|
|
|
SUTURE MONOCRYL 5-0 P-3
|
Facility
|
IP
|
$32.80
|
|
| Hospital Charge Code |
270660427
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.92
|
|
|
SUTURE MONOCRYL 5-0 P-3
|
Facility
|
OP
|
$32.80
|
|
| Hospital Charge Code |
270660427
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: Aetna Commercial |
$9.84
|
| Rate for Payer: Aetna Medicare Advantage |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.36
|
| Rate for Payer: Cigna Commercial |
$16.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.26
|
| Rate for Payer: Oxford Commercial |
$16.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.40
|
|
|
SUTURE MONOCRYL 5-0 RB-1
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
270672616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare Advantage |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.06
|
| Rate for Payer: Cigna Commercial |
$6.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.56
|
| Rate for Payer: Oxford Commercial |
$6.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.00
|
|
|
SUTURE MONOCRYL 5-0 RB-1
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
270672616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
|
|
SUTURE MONOCRYL 5-0 V-10
|
Facility
|
OP
|
$26.18
|
|
| Hospital Charge Code |
270663587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$13.09 |
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna Medicare Advantage |
$7.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.68
|
| Rate for Payer: Cigna Commercial |
$13.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.40
|
| Rate for Payer: Oxford Commercial |
$13.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.09
|
|
|
SUTURE MONOCRYL 5-0 V-10
|
Facility
|
IP
|
$26.18
|
|
| Hospital Charge Code |
270663587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.93
|
|
|
SUTURE MONOCRYL 6-0 P-3
|
Facility
|
IP
|
$41.66
|
|
| Hospital Charge Code |
270660431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.25
|
|
|
SUTURE MONOCRYL 6-0 P-3
|
Facility
|
OP
|
$41.66
|
|
| Hospital Charge Code |
270660431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$12.50
|
| Rate for Payer: Aetna Medicare Advantage |
$12.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.62
|
| Rate for Payer: Cigna Commercial |
$20.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.42
|
| Rate for Payer: Oxford Commercial |
$20.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.83
|
|
|
SUTURE MONOCRYL 6-0 PS-6
|
Facility
|
OP
|
$24.98
|
|
| Hospital Charge Code |
270661076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Medicare Advantage |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.37
|
| Rate for Payer: Cigna Commercial |
$12.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.25
|
| Rate for Payer: Oxford Commercial |
$12.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.49
|
|
|
SUTURE MONOCRYL 6-0 PS-6
|
Facility
|
IP
|
$24.98
|
|
| Hospital Charge Code |
270661076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.75
|
|
|
SUTURE MONOCRYL CT-1 SIZE 0 X
|
Facility
|
IP
|
$112.65
|
|
| Hospital Charge Code |
270667541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.90
|
|
|
SUTURE MONOCRYL CT-1 SIZE 0 X
|
Facility
|
OP
|
$112.65
|
|
| Hospital Charge Code |
270667541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$56.33 |
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: Aetna Medicare Advantage |
$33.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.73
|
| Rate for Payer: Cigna Commercial |
$56.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.64
|
| Rate for Payer: Oxford Commercial |
$56.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$56.33
|
|
|
SUTURE MONOCRYL CT-1 SIZE 2-0
|
Facility
|
IP
|
$169.83
|
|
| Hospital Charge Code |
270667542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.47
|
|
|
SUTURE MONOCRYL CT-1 SIZE 2-0
|
Facility
|
OP
|
$169.83
|
|
| Hospital Charge Code |
270667542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$84.92 |
| Rate for Payer: Aetna Commercial |
$50.95
|
| Rate for Payer: Aetna Medicare Advantage |
$50.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.31
|
| Rate for Payer: Cigna Commercial |
$84.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.08
|
| Rate for Payer: Oxford Commercial |
$84.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$84.92
|
|
|
SUTURE MONOCRYL PLUS 3-0 UR6
|
Facility
|
OP
|
$17.31
|
|
| Hospital Charge Code |
270698084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$8.65 |
| Rate for Payer: Aetna Commercial |
$5.19
|
| Rate for Payer: Aetna Medicare Advantage |
$5.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.41
|
| Rate for Payer: Cigna Commercial |
$8.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.25
|
| Rate for Payer: Oxford Commercial |
$8.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.65
|
|
|
SUTURE MONOCRYL PLUS 3-0 UR6
|
Facility
|
IP
|
$17.31
|
|
| Hospital Charge Code |
270698084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.60
|
|
|
SUTURE MONOCRYL PLUS PS 2 3-0
|
Facility
|
IP
|
$114.73
|
|
| Hospital Charge Code |
270692959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.21
|
|
|
SUTURE MONOCRYL PLUS PS 2 3-0
|
Facility
|
OP
|
$175.30
|
|
| Hospital Charge Code |
270692958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$87.65 |
| Rate for Payer: Aetna Commercial |
$52.59
|
| Rate for Payer: Aetna Medicare Advantage |
$52.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44.70
|
| Rate for Payer: Cigna Commercial |
$87.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.79
|
| Rate for Payer: Oxford Commercial |
$87.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$87.65
|
|
|
SUTURE MONOCRYL PLUS PS 2 3-0
|
Facility
|
OP
|
$114.73
|
|
| Hospital Charge Code |
270692959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$57.37 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare Advantage |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.26
|
| Rate for Payer: Cigna Commercial |
$57.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.91
|
| Rate for Payer: Oxford Commercial |
$57.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$57.37
|
|
|
SUTURE MONOCRYL PLUS PS 2 3-0
|
Facility
|
IP
|
$175.30
|
|
| Hospital Charge Code |
270692958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.30 |
| Max. Negotiated Rate |
$26.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.30
|
|
|
SUTURE MONOCRYL SH SIZE 0 X 27
|
Facility
|
IP
|
$30.95
|
|
| Hospital Charge Code |
270667543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.64
|
|
|
SUTURE MONOCRYL SH SIZE 0 X 27
|
Facility
|
OP
|
$30.95
|
|
| Hospital Charge Code |
270667543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$15.47 |
| Rate for Payer: Aetna Commercial |
$9.29
|
| Rate for Payer: Aetna Medicare Advantage |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.89
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.02
|
| Rate for Payer: Oxford Commercial |
$15.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.47
|
|