|
SUTURE VICRYL 0 UR-5
|
Facility
|
OP
|
$15.58
|
|
| Hospital Charge Code |
270671463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$7.79 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna Medicare Advantage |
$4.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.97
|
| Rate for Payer: Cigna Commercial |
$7.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.03
|
| Rate for Payer: Oxford Commercial |
$7.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.79
|
|
|
SUTURE VICRYL 0 UR-5
|
Facility
|
IP
|
$15.58
|
|
| Hospital Charge Code |
270671463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.34
|
|
|
SUTURE VICRYL 0 V-20
|
Facility
|
IP
|
$7.17
|
|
| Hospital Charge Code |
270673242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
|
|
SUTURE VICRYL 0 V-20
|
Facility
|
OP
|
$7.17
|
|
| Hospital Charge Code |
270673242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Aetna Commercial |
$2.15
|
| Rate for Payer: Aetna Medicare Advantage |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.83
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.93
|
| Rate for Payer: Oxford Commercial |
$3.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.58
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
OP
|
$9.23
|
|
| Hospital Charge Code |
270672380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna Medicare Advantage |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.35
|
| Rate for Payer: Cigna Commercial |
$4.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.20
|
| Rate for Payer: Oxford Commercial |
$4.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.62
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
IP
|
$7.20
|
|
| Hospital Charge Code |
270671454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
IP
|
$7.57
|
|
| Hospital Charge Code |
270671461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.14
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
OP
|
$7.72
|
|
| Hospital Charge Code |
270671489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare Advantage |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.97
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.00
|
| Rate for Payer: Oxford Commercial |
$3.86
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.86
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
IP
|
$9.23
|
|
| Hospital Charge Code |
270672380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.38
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
OP
|
$7.57
|
|
| Hospital Charge Code |
270671461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$2.27
|
| Rate for Payer: Aetna Medicare Advantage |
$2.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.93
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.98
|
| Rate for Payer: Oxford Commercial |
$3.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.79
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
OP
|
$7.20
|
|
| Hospital Charge Code |
270671454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare Advantage |
$2.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.84
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.94
|
| Rate for Payer: Oxford Commercial |
$3.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.60
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
IP
|
$7.72
|
|
| Hospital Charge Code |
270671489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.16
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
OP
|
$59.10
|
|
| Hospital Charge Code |
270672381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$29.55 |
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Aetna Medicare Advantage |
$17.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.07
|
| Rate for Payer: Cigna Commercial |
$29.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.68
|
| Rate for Payer: Oxford Commercial |
$29.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.55
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
IP
|
$59.10
|
|
| Hospital Charge Code |
270672381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.87
|
|
|
SUTURE VICRYL 1CT-1 8X18 UNDYE
|
Facility
|
OP
|
$53.45
|
|
| Hospital Charge Code |
270694728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$26.73 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: Aetna Medicare Advantage |
$16.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.63
|
| Rate for Payer: Cigna Commercial |
$26.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.95
|
| Rate for Payer: Oxford Commercial |
$26.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.73
|
|
|
SUTURE VICRYL 1CT-1 8X18 UNDYE
|
Facility
|
IP
|
$53.45
|
|
| Hospital Charge Code |
270694728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.02
|
|
|
SUTURE VICRYL 1CT1 CR 8X18
|
Facility
|
OP
|
$77.30
|
|
| Hospital Charge Code |
270698430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$38.65 |
| Rate for Payer: Aetna Commercial |
$23.19
|
| Rate for Payer: Aetna Medicare Advantage |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.71
|
| Rate for Payer: Cigna Commercial |
$38.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.05
|
| Rate for Payer: Oxford Commercial |
$38.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.65
|
|
|
SUTURE VICRYL 1CT1 CR 8X18
|
Facility
|
IP
|
$77.30
|
|
| Hospital Charge Code |
270698430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.60
|
|
|
SUTURE VICRYL 1 CT-1/GS-21
|
Facility
|
IP
|
$54.17
|
|
| Hospital Charge Code |
270655802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.13
|
|
|
SUTURE VICRYL 1 CT-1/GS-21
|
Facility
|
OP
|
$54.17
|
|
| Hospital Charge Code |
270655802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna Commercial |
$16.25
|
| Rate for Payer: Aetna Medicare Advantage |
$16.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.81
|
| Rate for Payer: Cigna Commercial |
$27.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.04
|
| Rate for Payer: Oxford Commercial |
$27.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.09
|
|
|
SUTURE VICRYL 1 GS-24
|
Facility
|
IP
|
$7.20
|
|
| Hospital Charge Code |
270675772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
|
|
SUTURE VICRYL 1 GS-24
|
Facility
|
OP
|
$7.20
|
|
| Hospital Charge Code |
270675772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare Advantage |
$2.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.84
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.94
|
| Rate for Payer: Oxford Commercial |
$3.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.60
|
|
|
SUTURE VICRYL 1 GS-24
|
Facility
|
IP
|
$7.65
|
|
| Hospital Charge Code |
270655701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.15
|
|
|
SUTURE VICRYL 1 GS-24
|
Facility
|
OP
|
$7.65
|
|
| Hospital Charge Code |
270655701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare Advantage |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.95
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.99
|
| Rate for Payer: Oxford Commercial |
$3.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.83
|
|
|
SUTURE VICRYL 1 MO-4
|
Facility
|
OP
|
$11.02
|
|
| Hospital Charge Code |
270671471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna Medicare Advantage |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.81
|
| Rate for Payer: Cigna Commercial |
$5.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.43
|
| Rate for Payer: Oxford Commercial |
$5.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.51
|
|