|
SUTURE SURGIPRO II 5/0 18 BLU
|
Facility
|
OP
|
$17.19
|
|
| Hospital Charge Code |
270651326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna Commercial |
$5.16
|
| Rate for Payer: Aetna Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.38
|
| Rate for Payer: Cigna Commercial |
$8.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.23
|
| Rate for Payer: Oxford Commercial |
$8.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.60
|
|
|
SUTURE SURGIPRO II 5/0 18 BLU
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
270660190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.47
|
|
|
SUTURE SURGIPRO II 5/0 30 BLU
|
Facility
|
IP
|
$28.46
|
|
| Hospital Charge Code |
270604678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.27
|
|
|
SUTURE SURGIPRO II 5/0 30 BLU
|
Facility
|
OP
|
$28.46
|
|
| Hospital Charge Code |
270604678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$14.23 |
| Rate for Payer: Aetna Commercial |
$8.54
|
| Rate for Payer: Aetna Medicare Advantage |
$8.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.26
|
| Rate for Payer: Cigna Commercial |
$14.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.70
|
| Rate for Payer: Oxford Commercial |
$14.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.23
|
|
|
SUTURE SURGIPRO II 5/0 30 BLU
|
Facility
|
OP
|
$16.93
|
|
| Hospital Charge Code |
270604680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Aetna Commercial |
$5.08
|
| Rate for Payer: Aetna Medicare Advantage |
$5.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.32
|
| Rate for Payer: Cigna Commercial |
$8.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.20
|
| Rate for Payer: Oxford Commercial |
$8.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.46
|
|
|
SUTURE SURGIPRO II 5/0 30 BLU
|
Facility
|
IP
|
$16.93
|
|
| Hospital Charge Code |
270604680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.54
|
|
|
SUTURE SURGIPRO II 5/0 36 BLU
|
Facility
|
IP
|
$41.68
|
|
| Hospital Charge Code |
270651334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.25
|
|
|
SUTURE SURGIPRO II 5/0 36 BLU
|
Facility
|
OP
|
$41.68
|
|
| Hospital Charge Code |
270651334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$20.84 |
| 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 |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.63
|
| Rate for Payer: Cigna Commercial |
$20.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.42
|
| Rate for Payer: Oxford Commercial |
$20.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.84
|
|
|
SUTURE SURGIPRO II 6/0 18 BLU
|
Facility
|
IP
|
$17.19
|
|
| Hospital Charge Code |
270610211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.58
|
|
|
SUTURE SURGIPRO II 6/0 18 BLU
|
Facility
|
OP
|
$17.19
|
|
| Hospital Charge Code |
270610211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna Commercial |
$5.16
|
| Rate for Payer: Aetna Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.38
|
| Rate for Payer: Cigna Commercial |
$8.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.23
|
| Rate for Payer: Oxford Commercial |
$8.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.60
|
|
|
SUTURE SURGIPRO II 6/0 18 BLU
|
Facility
|
IP
|
$17.19
|
|
| Hospital Charge Code |
270651323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.58
|
|
|
SUTURE SURGIPRO II 6/0 18 BLU
|
Facility
|
OP
|
$17.19
|
|
| Hospital Charge Code |
270651323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna Commercial |
$5.16
|
| Rate for Payer: Aetna Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.38
|
| Rate for Payer: Cigna Commercial |
$8.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.23
|
| Rate for Payer: Oxford Commercial |
$8.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.60
|
|
|
SUTURE SURGIPRO II 6/0 30 BLU
|
Facility
|
IP
|
$28.46
|
|
| Hospital Charge Code |
270604683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.27
|
|
|
SUTURE SURGIPRO II 6/0 30 BLU
|
Facility
|
IP
|
$27.69
|
|
| Hospital Charge Code |
270604685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.15
|
|
|
SUTURE SURGIPRO II 6/0 30 BLU
|
Facility
|
OP
|
$28.46
|
|
| Hospital Charge Code |
270604683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$14.23 |
| Rate for Payer: Aetna Commercial |
$8.54
|
| Rate for Payer: Aetna Medicare Advantage |
$8.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.26
|
| Rate for Payer: Cigna Commercial |
$14.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.70
|
| Rate for Payer: Oxford Commercial |
$14.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.23
|
|
|
SUTURE SURGIPRO II 6/0 30 BLU
|
Facility
|
OP
|
$27.69
|
|
| Hospital Charge Code |
270604685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$13.85 |
| Rate for Payer: Aetna Commercial |
$8.31
|
| Rate for Payer: Aetna Medicare Advantage |
$8.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.06
|
| Rate for Payer: Cigna Commercial |
$13.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.60
|
| Rate for Payer: Oxford Commercial |
$13.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.85
|
|
|
SUTURE SURGIPRO II 6/0 36 BLU
|
Facility
|
OP
|
$32.44
|
|
| Hospital Charge Code |
270604659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna Commercial |
$9.73
|
| Rate for Payer: Aetna Medicare Advantage |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.27
|
| Rate for Payer: Cigna Commercial |
$16.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.22
|
| Rate for Payer: Oxford Commercial |
$16.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.22
|
|
|
SUTURE SURGIPRO II 6/0 36 BLU
|
Facility
|
IP
|
$32.44
|
|
| Hospital Charge Code |
270604659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.87
|
|
|
SUTURE SURGIPRO II 7/0 24 BLU
|
Facility
|
IP
|
$42.43
|
|
| Hospital Charge Code |
270604686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.36
|
|
|
SUTURE SURGIPRO II 7/0 24 BLU
|
Facility
|
OP
|
$42.43
|
|
| Hospital Charge Code |
270604686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$21.21 |
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: Aetna Medicare Advantage |
$12.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.82
|
| Rate for Payer: Cigna Commercial |
$21.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.52
|
| Rate for Payer: Oxford Commercial |
$21.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.21
|
|
|
SUTURE SURGIPRO II 7/0 30 BLU
|
Facility
|
IP
|
$96.80
|
|
| Hospital Charge Code |
270656856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$14.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.52
|
|
|
SUTURE SURGIPRO II 7/0 30 BLU
|
Facility
|
OP
|
$96.80
|
|
| Hospital Charge Code |
270656856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Aetna Commercial |
$29.04
|
| Rate for Payer: Aetna Medicare Advantage |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.68
|
| Rate for Payer: Cigna Commercial |
$48.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.58
|
| Rate for Payer: Oxford Commercial |
$48.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$48.40
|
|
|
SUTURE SURGIPRO II CV-11 5-0
|
Facility
|
IP
|
$22.95
|
|
| Hospital Charge Code |
270656169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.44
|
|
|
SUTURE SURGIPRO II CV-11 5-0
|
Facility
|
OP
|
$22.95
|
|
| Hospital Charge Code |
270656169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Aetna Commercial |
$6.88
|
| Rate for Payer: Aetna Medicare Advantage |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.85
|
| Rate for Payer: Cigna Commercial |
$11.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.98
|
| Rate for Payer: Oxford Commercial |
$11.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.47
|
|
|
SUTURE SURGIPRO II CV-1 6-0 18
|
Facility
|
IP
|
$36.62
|
|
| Hospital Charge Code |
270651342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$5.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.49
|
|