|
SUTURE MONCRYL 4-0 PC-3
|
Facility
|
OP
|
$26.40
|
|
| Hospital Charge Code |
270671529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Aetna Commercial |
$10.03
|
| Rate for Payer: Aetna Medicare Advantage |
$7.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.73
|
| Rate for Payer: Cigna Commercial |
$13.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.86
|
| Rate for Payer: Oxford Commercial |
$5.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.28
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.75
|
|
|
SUTURE MONOCRYL 0 CT
|
Facility
|
IP
|
$10.80
|
|
| Hospital Charge Code |
270675260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.62
|
|
|
SUTURE MONOCRYL 0 CT
|
Facility
|
OP
|
$10.80
|
|
| Hospital Charge Code |
270675260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna Commercial |
$4.10
|
| Rate for Payer: Aetna Medicare Advantage |
$3.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.75
|
| Rate for Payer: Cigna Commercial |
$5.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.81
|
| Rate for Payer: Oxford Commercial |
$2.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.31
|
|
|
SUTURE MONOCRYL 0 CT-1
|
Facility
|
IP
|
$17.20
|
|
| Hospital Charge Code |
270655744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.58
|
|
|
SUTURE MONOCRYL 0 CT-1
|
Facility
|
OP
|
$11.66
|
|
| Hospital Charge Code |
270672362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$4.43
|
| Rate for Payer: Aetna Medicare Advantage |
$3.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.97
|
| Rate for Payer: Cigna Commercial |
$5.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.03
|
| Rate for Payer: Oxford Commercial |
$2.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.33
|
|
|
SUTURE MONOCRYL 0 CT-1
|
Facility
|
IP
|
$11.66
|
|
| Hospital Charge Code |
270672362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.75
|
|
|
SUTURE MONOCRYL 0 CT-1
|
Facility
|
IP
|
$11.79
|
|
| Hospital Charge Code |
270671519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.77
|
|
|
SUTURE MONOCRYL 0 CT-1
|
Facility
|
OP
|
$17.20
|
|
| Hospital Charge Code |
270655744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna Commercial |
$6.54
|
| Rate for Payer: Aetna Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.39
|
| Rate for Payer: Cigna Commercial |
$8.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.47
|
| Rate for Payer: Oxford Commercial |
$3.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.49
|
|
|
SUTURE MONOCRYL 0 CT-1
|
Facility
|
OP
|
$11.79
|
|
| Hospital Charge Code |
270671519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: Aetna Commercial |
$4.48
|
| Rate for Payer: Aetna Medicare Advantage |
$3.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.01
|
| Rate for Payer: Cigna Commercial |
$5.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.07
|
| Rate for Payer: Oxford Commercial |
$2.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.33
|
|
|
SUTURE MONOCRYL 0 CTX
|
Facility
|
OP
|
$11.70
|
|
| Hospital Charge Code |
270675261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna Commercial |
$4.45
|
| Rate for Payer: Aetna Medicare Advantage |
$3.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.98
|
| Rate for Payer: Cigna Commercial |
$5.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.04
|
| Rate for Payer: Oxford Commercial |
$2.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.34
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.33
|
|
|
SUTURE MONOCRYL 0 CTX
|
Facility
|
IP
|
$11.70
|
|
| Hospital Charge Code |
270675261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.75
|
|
|
SUTURE MONOCRYL 0 CTXB
|
Facility
|
IP
|
$13.61
|
|
| Hospital Charge Code |
270670986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.04
|
|
|
SUTURE MONOCRYL 0 CTXB
|
Facility
|
OP
|
$13.61
|
|
| Hospital Charge Code |
270670986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna Medicare Advantage |
$4.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.47
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.54
|
| Rate for Payer: Oxford Commercial |
$2.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.72
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.39
|
|
|
SUTURE MONOCRYL 2-0 CT-1
|
Facility
|
IP
|
$56.88
|
|
| Hospital Charge Code |
270671352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.53
|
|
|
SUTURE MONOCRYL 2-0 CT-1
|
Facility
|
OP
|
$56.88
|
|
| Hospital Charge Code |
270671352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$28.44 |
| Rate for Payer: Aetna Commercial |
$21.61
|
| Rate for Payer: Aetna Medicare Advantage |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.50
|
| Rate for Payer: Cigna Commercial |
$28.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.79
|
| Rate for Payer: Oxford Commercial |
$11.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.62
|
|
|
SUTURE MONOCRYL 2-0 SH
|
Facility
|
OP
|
$9.83
|
|
| Hospital Charge Code |
270671522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare Advantage |
$2.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.51
|
| Rate for Payer: Cigna Commercial |
$4.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.56
|
| Rate for Payer: Oxford Commercial |
$1.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.97
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.28
|
|
|
SUTURE MONOCRYL 2-0 SH
|
Facility
|
IP
|
$9.83
|
|
| Hospital Charge Code |
270671522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.47
|
|
|
SUTURE MONOCRYL 2-0 UR-5
|
Facility
|
IP
|
$12.12
|
|
| Hospital Charge Code |
270618020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.82
|
|
|
SUTURE MONOCRYL 2-0 UR-5
|
Facility
|
OP
|
$12.12
|
|
| Hospital Charge Code |
270618020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Aetna Commercial |
$4.61
|
| Rate for Payer: Aetna Medicare Advantage |
$3.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.09
|
| Rate for Payer: Cigna Commercial |
$6.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.15
|
| Rate for Payer: Oxford Commercial |
$2.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
|
SUTURE MONOCRYL 2-0 UR-6
|
Facility
|
OP
|
$12.07
|
|
| Hospital Charge Code |
270671528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna Commercial |
$4.59
|
| Rate for Payer: Aetna Medicare Advantage |
$3.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.08
|
| Rate for Payer: Cigna Commercial |
$6.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.14
|
| Rate for Payer: Oxford Commercial |
$2.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.41
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
|
SUTURE MONOCRYL 2-0 UR-6
|
Facility
|
IP
|
$12.07
|
|
| Hospital Charge Code |
270671528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.81
|
|
|
SUTURE MONOCRYL 2-0 V-20
|
Facility
|
OP
|
$10.85
|
|
| Hospital Charge Code |
270672143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Medicare Advantage |
$3.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.77
|
| Rate for Payer: Cigna Commercial |
$5.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.82
|
| Rate for Payer: Oxford Commercial |
$2.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.31
|
|
|
SUTURE MONOCRYL 2-0 V-20
|
Facility
|
IP
|
$10.85
|
|
| Hospital Charge Code |
270672143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.63
|
|
|
SUTURE MONOCRYL 2-1 UR-6
|
Facility
|
IP
|
$12.79
|
|
| Hospital Charge Code |
270672364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.92
|
|
|
SUTURE MONOCRYL 2-1 UR-6
|
Facility
|
OP
|
$12.79
|
|
| Hospital Charge Code |
270672364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$6.39 |
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: Aetna Medicare Advantage |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.26
|
| Rate for Payer: Cigna Commercial |
$6.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.33
|
| Rate for Payer: Oxford Commercial |
$2.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.56
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.36
|
|