|
SUTURE BIOSYN 4/0 30 U/D P12
|
Facility
|
OP
|
$17.14
|
|
| Hospital Charge Code |
270656158S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: Aetna Medicare Advantage |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.37
|
| Rate for Payer: Cigna Commercial |
$8.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.46
|
| Rate for Payer: Oxford Commercial |
$3.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.49
|
|
|
SUTURE BIOSYN 4/0 30 U/D P12
|
Facility
|
OP
|
$17.14
|
|
| Hospital Charge Code |
270656158N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: Aetna Medicare Advantage |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.37
|
| Rate for Payer: Cigna Commercial |
$8.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.46
|
| Rate for Payer: Oxford Commercial |
$3.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.49
|
|
|
SUTURE BIOSYN 4/0 30 U/D P12
|
Facility
|
IP
|
$17.14
|
|
| Hospital Charge Code |
270656158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
|
|
SUTURE BIOSYN 4/0 30 U/D P12
|
Facility
|
IP
|
$17.14
|
|
| Hospital Charge Code |
270656158N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
|
|
SUTURE BIOSYN 4/0 30 U/D P12
|
Facility
|
OP
|
$17.14
|
|
| Hospital Charge Code |
270656158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: Aetna Medicare Advantage |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.37
|
| Rate for Payer: Cigna Commercial |
$8.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.46
|
| Rate for Payer: Oxford Commercial |
$3.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.49
|
|
|
SUTURE BIOSYN 4/0 30 U/D V20
|
Facility
|
OP
|
$6.83
|
|
| Hospital Charge Code |
270604710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| 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 |
$1.78
|
| Rate for Payer: Oxford Commercial |
$1.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.19
|
|
|
SUTURE BIOSYN 4/0 30 U/D V20
|
Facility
|
IP
|
$6.83
|
|
| Hospital Charge Code |
270604710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
|
|
SUTURE BIOSYN 4-0 P-12 SM5637
|
Facility
|
OP
|
$15.20
|
|
| Hospital Charge Code |
270641077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna Commercial |
$5.78
|
| Rate for Payer: Aetna Medicare Advantage |
$4.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.88
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.95
|
| Rate for Payer: Oxford Commercial |
$3.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.04
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.43
|
|
|
SUTURE BIOSYN 4-0 P-12 SM5637
|
Facility
|
IP
|
$15.20
|
|
| Hospital Charge Code |
270641077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.28
|
|
|
SUTURE BIOSYN 5/0 18 U/D P12
|
Facility
|
IP
|
$17.14
|
|
| Hospital Charge Code |
270675604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
|
|
SUTURE BIOSYN 5/0 18 U/D P12
|
Facility
|
OP
|
$17.14
|
|
| Hospital Charge Code |
270675604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: Aetna Medicare Advantage |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.37
|
| Rate for Payer: Cigna Commercial |
$8.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.46
|
| Rate for Payer: Oxford Commercial |
$3.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.49
|
|
|
SUTURE BIOSYN 5/0 18 UNDYED
|
Facility
|
IP
|
$17.14
|
|
| Hospital Charge Code |
270604713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
|
|
SUTURE BIOSYN 5/0 18 UNDYED
|
Facility
|
OP
|
$17.14
|
|
| Hospital Charge Code |
270604713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$6.51
|
| Rate for Payer: Aetna Medicare Advantage |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.37
|
| Rate for Payer: Cigna Commercial |
$8.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.46
|
| Rate for Payer: Oxford Commercial |
$3.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.49
|
|
|
SUTURE BIOSYN C14 2-0
|
Facility
|
OP
|
$16.85
|
|
| Hospital Charge Code |
270600575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Aetna Commercial |
$6.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.30
|
| Rate for Payer: Cigna Commercial |
$8.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.38
|
| Rate for Payer: Oxford Commercial |
$3.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.48
|
|
|
SUTURE BIOSYN C14 2-0
|
Facility
|
IP
|
$16.85
|
|
| Hospital Charge Code |
270600575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.53
|
|
|
SUTURE BIOSYN CV-23 30
|
Facility
|
OP
|
$5.80
|
|
| Hospital Charge Code |
270666890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.48
|
| Rate for Payer: Cigna Commercial |
$2.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.51
|
| Rate for Payer: Oxford Commercial |
$1.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.16
|
|
|
SUTURE BIOSYN CV-23 30
|
Facility
|
IP
|
$5.80
|
|
| Hospital Charge Code |
270666890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.87
|
|
|
SUTURE BIOSYN FS3 C13 4/0 UD
|
Facility
|
IP
|
$7.24
|
|
| Hospital Charge Code |
270656159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
|
|
SUTURE BIOSYN FS3 C13 4/0 UD
|
Facility
|
OP
|
$7.24
|
|
| Hospital Charge Code |
270656159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare Advantage |
$2.17
|
| 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 |
$3.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.88
|
| Rate for Payer: Oxford Commercial |
$1.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.21
|
|
|
SUTURE BIOSYN GU-45 2-0
|
Facility
|
OP
|
$8.79
|
|
| Hospital Charge Code |
270613700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Medicare Advantage |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.24
|
| Rate for Payer: Cigna Commercial |
$4.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.29
|
| Rate for Payer: Oxford Commercial |
$1.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.76
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.25
|
|
|
SUTURE BIOSYN GU-45 2-0
|
Facility
|
IP
|
$8.79
|
|
| Hospital Charge Code |
270613700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.32
|
|
|
SUTURE BIOSYN GU-46 2/0 VIO 36
|
Facility
|
OP
|
$7.91
|
|
| Hospital Charge Code |
270656168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.01
|
| Rate for Payer: Aetna Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.02
|
| Rate for Payer: Cigna Commercial |
$3.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.06
|
| Rate for Payer: Oxford Commercial |
$1.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.58
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.22
|
|
|
SUTURE BIOSYN GU-46 2/0 VIO 36
|
Facility
|
IP
|
$7.91
|
|
| Hospital Charge Code |
270656168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.19
|
|
|
SUTURE BIO TAK 3.0 COMPOSITE
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
270646446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$422.50
|
| Rate for Payer: Oxford Commercial |
$325.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
SUTURE BIO TAK 3.0 COMPOSITE
|
Facility
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
270646446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|