|
SUTURE CHROMIC GUT 2-0 V-20
|
Facility
|
OP
|
$13.65
|
|
| Hospital Charge Code |
270655683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Aetna Commercial |
$5.19
|
| Rate for Payer: Aetna Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.48
|
| Rate for Payer: Cigna Commercial |
$6.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.55
|
| Rate for Payer: Oxford Commercial |
$2.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.39
|
|
|
SUTURE CHROMIC GUT 2-0 V-26
|
Facility
|
IP
|
$16.03
|
|
| Hospital Charge Code |
270655750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.40
|
|
|
SUTURE CHROMIC GUT 2-0 V-26
|
Facility
|
OP
|
$16.03
|
|
| Hospital Charge Code |
270655750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna Medicare Advantage |
$4.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.09
|
| Rate for Payer: Cigna Commercial |
$8.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.17
|
| Rate for Payer: Oxford Commercial |
$3.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.46
|
|
|
SUTURE CHROMIC GUT 2 CT-1
|
Facility
|
IP
|
$15.89
|
|
| Hospital Charge Code |
270659061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.38
|
|
|
SUTURE CHROMIC GUT 2 CT-1
|
Facility
|
OP
|
$15.89
|
|
| Hospital Charge Code |
270659061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$7.95 |
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna Medicare Advantage |
$4.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.05
|
| Rate for Payer: Cigna Commercial |
$7.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.13
|
| Rate for Payer: Oxford Commercial |
$3.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.18
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.45
|
|
|
SUTURE CHROMIC GUT 3/0 30 C13
|
Facility
|
IP
|
$7.75
|
|
| Hospital Charge Code |
270604722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.16
|
|
|
SUTURE CHROMIC GUT 3/0 30 C13
|
Facility
|
OP
|
$7.75
|
|
| Hospital Charge Code |
270604722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare Advantage |
$2.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.98
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.02
|
| Rate for Payer: Oxford Commercial |
$1.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.22
|
|
|
SUTURE CHROMIC GUT 3/0 30 CP2
|
Facility
|
IP
|
$6.99
|
|
| Hospital Charge Code |
270675605
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
|
|
SUTURE CHROMIC GUT 3/0 30 CP2
|
Facility
|
OP
|
$6.99
|
|
| Hospital Charge Code |
270675605
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna Medicare Advantage |
$2.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.78
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.82
|
| Rate for Payer: Oxford Commercial |
$1.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.20
|
|
|
SUTURE CHROMIC GUT 3/0 30 P12
|
Facility
|
OP
|
$14.94
|
|
| Hospital Charge Code |
270651287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: Aetna Medicare Advantage |
$4.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.81
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.88
|
| Rate for Payer: Oxford Commercial |
$2.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.99
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.42
|
|
|
SUTURE CHROMIC GUT 3/0 30 P12
|
Facility
|
IP
|
$14.94
|
|
| Hospital Charge Code |
270651287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.24
|
|
|
SUTURE CHROMIC GUT 3-0 CT-1
|
Facility
|
IP
|
$15.65
|
|
| Hospital Charge Code |
270655656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.35
|
|
|
SUTURE CHROMIC GUT 3-0 CT-1
|
Facility
|
OP
|
$15.65
|
|
| Hospital Charge Code |
270655656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna Commercial |
$5.95
|
| Rate for Payer: Aetna Medicare Advantage |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.99
|
| Rate for Payer: Cigna Commercial |
$7.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.07
|
| Rate for Payer: Oxford Commercial |
$3.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.13
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.44
|
|
|
SUTURE CHROMIC GUT 3-0 FS-2
|
Facility
|
OP
|
$15.01
|
|
| Hospital Charge Code |
270671391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna Medicare Advantage |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.83
|
| Rate for Payer: Cigna Commercial |
$7.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.90
|
| Rate for Payer: Oxford Commercial |
$3.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.43
|
|
|
SUTURE CHROMIC GUT 3-0 FS-2
|
Facility
|
IP
|
$15.01
|
|
| Hospital Charge Code |
270671391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
|
|
SUTURE CHROMIC GUT 3-0 PS-2
|
Facility
|
IP
|
$47.93
|
|
| Hospital Charge Code |
270655626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$7.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.19
|
|
|
SUTURE CHROMIC GUT 3-0 PS-2
|
Facility
|
OP
|
$47.93
|
|
| Hospital Charge Code |
270655626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$23.96 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: Aetna Medicare Advantage |
$14.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.22
|
| Rate for Payer: Cigna Commercial |
$23.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.46
|
| Rate for Payer: Oxford Commercial |
$9.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.36
|
|
|
SUTURE CHROMIC GUT 3-0 RB-1
|
Facility
|
OP
|
$16.62
|
|
| Hospital Charge Code |
270671514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$8.31 |
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: Aetna Medicare Advantage |
$4.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.24
|
| Rate for Payer: Cigna Commercial |
$8.31
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.32
|
| Rate for Payer: Oxford Commercial |
$3.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.47
|
|
|
SUTURE CHROMIC GUT 3-0 RB-1
|
Facility
|
IP
|
$16.62
|
|
| Hospital Charge Code |
270671514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.49
|
|
|
SUTURE CHROMIC GUT 3-0 TIES
|
Facility
|
IP
|
$15.74
|
|
| Hospital Charge Code |
270659079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.36
|
|
|
SUTURE CHROMIC GUT 3-0 TIES
|
Facility
|
OP
|
$15.74
|
|
| Hospital Charge Code |
270659079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$7.87 |
| Rate for Payer: Aetna Commercial |
$5.98
|
| Rate for Payer: Aetna Medicare Advantage |
$4.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.01
|
| Rate for Payer: Cigna Commercial |
$7.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.09
|
| Rate for Payer: Oxford Commercial |
$3.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.15
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.45
|
|
|
SUTURE CHROMIC GUT 3-0 V-20
|
Facility
|
IP
|
$13.86
|
|
| Hospital Charge Code |
270648403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.08
|
|
|
SUTURE CHROMIC GUT 3-0 V-20
|
Facility
|
OP
|
$13.86
|
|
| Hospital Charge Code |
270648403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.93 |
| Rate for Payer: Aetna Commercial |
$5.27
|
| Rate for Payer: Aetna Medicare Advantage |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.53
|
| Rate for Payer: Cigna Commercial |
$6.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.60
|
| Rate for Payer: Oxford Commercial |
$2.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.77
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.39
|
|
|
SUTURE CHROMIC GUT 3-0 V-26
|
Facility
|
OP
|
$16.21
|
|
| Hospital Charge Code |
270658813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Aetna Medicare Advantage |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.13
|
| Rate for Payer: Cigna Commercial |
$8.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.21
|
| Rate for Payer: Oxford Commercial |
$3.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.46
|
|
|
SUTURE CHROMIC GUT 3-0 V-26
|
Facility
|
IP
|
$16.21
|
|
| Hospital Charge Code |
270658813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.43
|
|