|
SUTURE SURGIGUT P24 5-0
|
Facility
|
IP
|
$39.25
|
|
| Hospital Charge Code |
270604499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.89
|
|
|
SUTURE SURGIGUT P24 5-0
|
Facility
|
OP
|
$39.25
|
|
| Hospital Charge Code |
270604499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$19.62 |
| Rate for Payer: Aetna Commercial |
$11.78
|
| Rate for Payer: Aetna Medicare Advantage |
$11.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.01
|
| Rate for Payer: Cigna Commercial |
$19.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.10
|
| Rate for Payer: Oxford Commercial |
$19.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.62
|
|
|
SUTURE SURGIGUT PC12 4-0
|
Facility
|
IP
|
$39.25
|
|
| Hospital Charge Code |
270604494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.89
|
|
|
SUTURE SURGIGUT PC12 4-0
|
Facility
|
OP
|
$39.25
|
|
| Hospital Charge Code |
270604494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$19.62 |
| Rate for Payer: Aetna Commercial |
$11.78
|
| Rate for Payer: Aetna Medicare Advantage |
$11.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.01
|
| Rate for Payer: Cigna Commercial |
$19.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.10
|
| Rate for Payer: Oxford Commercial |
$19.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.62
|
|
|
SUTURE SURGIGUT PL 3/0 30 V20
|
Facility
|
OP
|
$6.83
|
|
| Hospital Charge Code |
270656133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna Medicare Advantage |
$2.05
|
| 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 |
$3.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.89
|
| Rate for Payer: Oxford Commercial |
$3.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.42
|
|
|
SUTURE SURGIGUT PL 3/0 30 V20
|
Facility
|
IP
|
$6.83
|
|
| Hospital Charge Code |
270656133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
|
|
SUTURE SURGIGUT REEL 3-0
|
Facility
|
IP
|
$7.26
|
|
| Hospital Charge Code |
270604482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
|
|
SUTURE SURGIGUT REEL 3-0
|
Facility
|
OP
|
$7.26
|
|
| Hospital Charge Code |
270604482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare Advantage |
$2.18
|
| 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 |
$3.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.94
|
| Rate for Payer: Oxford Commercial |
$3.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.63
|
|
|
SUTURE SURGIGUT REEL 4-0
|
Facility
|
IP
|
$7.08
|
|
| Hospital Charge Code |
270604483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.06
|
|
|
SUTURE SURGIGUT REEL 4-0
|
Facility
|
OP
|
$7.08
|
|
| Hospital Charge Code |
270604483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna Medicare Advantage |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.81
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.92
|
| Rate for Payer: Oxford Commercial |
$3.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.54
|
|
|
SUTURE SURGIGUT SC11 4-0
|
Facility
|
IP
|
$19.25
|
|
| Hospital Charge Code |
270604631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.89
|
|
|
SUTURE SURGIGUT SC11 4-0
|
Facility
|
OP
|
$19.25
|
|
| Hospital Charge Code |
270604631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Aetna Commercial |
$5.78
|
| Rate for Payer: Aetna Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.91
|
| Rate for Payer: Cigna Commercial |
$9.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.50
|
| Rate for Payer: Oxford Commercial |
$9.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.62
|
|
|
SUTURE SURGIGUT SHR 0 30 V20
|
Facility
|
IP
|
$7.14
|
|
| Hospital Charge Code |
270651147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.07
|
|
|
SUTURE SURGIGUT SHR 0 30 V20
|
Facility
|
OP
|
$7.14
|
|
| Hospital Charge Code |
270651147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna Medicare Advantage |
$2.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.82
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.93
|
| Rate for Payer: Oxford Commercial |
$3.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.57
|
|
|
SUTURE SURGIGUT TIE 2-0
|
Facility
|
IP
|
$5.61
|
|
| Hospital Charge Code |
270604480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.84
|
|
|
SUTURE SURGIGUT TIE 2-0
|
Facility
|
OP
|
$5.61
|
|
| Hospital Charge Code |
270604480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna Medicare Advantage |
$1.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.43
|
| Rate for Payer: Cigna Commercial |
$2.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.73
|
| Rate for Payer: Oxford Commercial |
$2.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.81
|
|
|
SUTURE SURGIGUT TIE 3-0
|
Facility
|
IP
|
$11.23
|
|
| Hospital Charge Code |
270604481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.68
|
|
|
SUTURE SURGIGUT TIE 3-0
|
Facility
|
OP
|
$11.23
|
|
| Hospital Charge Code |
270604481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare Advantage |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.86
|
| Rate for Payer: Cigna Commercial |
$5.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.46
|
| Rate for Payer: Oxford Commercial |
$5.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.62
|
|
|
SUTURE SURGIGUT V20 0
|
Facility
|
OP
|
$63.25
|
|
| Hospital Charge Code |
270600550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$18.98
|
| 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 |
$8.22
|
| Rate for Payer: Oxford Commercial |
$31.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.62
|
|
|
SUTURE SURGIGUT V20 0
|
Facility
|
IP
|
$63.25
|
|
| Hospital Charge Code |
270600550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
|
|
SUTURE SURGIGUT V-20 4-0 30
|
Facility
|
OP
|
$7.26
|
|
| Hospital Charge Code |
270651143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare Advantage |
$2.18
|
| 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 |
$3.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.94
|
| Rate for Payer: Oxford Commercial |
$3.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.63
|
|
|
SUTURE SURGIGUT V-20 4-0 30
|
Facility
|
IP
|
$7.26
|
|
| Hospital Charge Code |
270651143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
|
|
SUTURE SURGILENE 6-0 P-13
|
Facility
|
OP
|
$28.60
|
|
| Hospital Charge Code |
270655913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Commercial |
$8.58
|
| Rate for Payer: Aetna Medicare Advantage |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.29
|
| Rate for Payer: Cigna Commercial |
$14.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.72
|
| Rate for Payer: Oxford Commercial |
$14.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.30
|
|
|
SUTURE SURGILENE 6-0 P-13
|
Facility
|
IP
|
$28.60
|
|
| Hospital Charge Code |
270655913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.29
|
|
|
SUTURE SURGILON 3/0 30 BK C14
|
Facility
|
OP
|
$19.71
|
|
| Hospital Charge Code |
270618236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$9.86 |
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: Aetna Medicare Advantage |
$5.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.03
|
| Rate for Payer: Cigna Commercial |
$9.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.56
|
| Rate for Payer: Oxford Commercial |
$9.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.86
|
|