|
SUTURE MONODERM 0 14x14CM
|
Facility
|
OP
|
$71.20
|
|
| Hospital Charge Code |
270678169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare Advantage |
$21.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.16
|
| Rate for Payer: Cigna Commercial |
$35.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.51
|
| Rate for Payer: Oxford Commercial |
$14.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.02
|
|
|
SUTURE MONODERM 0 36CMX36CM
|
Facility
|
OP
|
$113.33
|
|
| Hospital Charge Code |
270668404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$56.66 |
| Rate for Payer: Aetna Commercial |
$43.07
|
| Rate for Payer: Aetna Medicare Advantage |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.90
|
| Rate for Payer: Cigna Commercial |
$56.66
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.47
|
| Rate for Payer: Oxford Commercial |
$22.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.22
|
|
|
SUTURE MONODERM 0 36CMX36CM
|
Facility
|
IP
|
$113.33
|
|
| Hospital Charge Code |
270668404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.00
|
|
|
SUTURE MONODERM 2-0 14CMX14CM
|
Facility
|
OP
|
$71.20
|
|
| Hospital Charge Code |
270668403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare Advantage |
$21.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.16
|
| Rate for Payer: Cigna Commercial |
$35.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.51
|
| Rate for Payer: Oxford Commercial |
$14.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.02
|
|
|
SUTURE MONODERM 2-0 14CMX14CM
|
Facility
|
IP
|
$71.20
|
|
| Hospital Charge Code |
270668403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$10.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.68
|
|
|
SUTURE MONODERM 2-0 30CMX30CM
|
Facility
|
OP
|
$97.14
|
|
| Hospital Charge Code |
270668402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$48.57 |
| Rate for Payer: Aetna Commercial |
$36.91
|
| Rate for Payer: Aetna Medicare Advantage |
$29.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.77
|
| Rate for Payer: Cigna Commercial |
$48.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.26
|
| Rate for Payer: Oxford Commercial |
$19.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.76
|
|
|
SUTURE MONODERM 2-0 30CMX30CM
|
Facility
|
IP
|
$97.14
|
|
| Hospital Charge Code |
270668402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$14.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.57
|
|
|
SUTURE MONOSOF 10/0 5 BLACK
|
Facility
|
IP
|
$74.92
|
|
| Hospital Charge Code |
270653854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$11.24 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.24
|
|
|
SUTURE MONOSOF 10/0 5 BLACK
|
Facility
|
OP
|
$74.92
|
|
| Hospital Charge Code |
270653854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$28.47
|
| Rate for Payer: Aetna Medicare Advantage |
$22.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.10
|
| Rate for Payer: Cigna Commercial |
$37.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.48
|
| Rate for Payer: Oxford Commercial |
$14.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.98
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.13
|
|
|
SUTURE MONOSOF 10-0 BLACK
|
Facility
|
OP
|
$110.42
|
|
| Hospital Charge Code |
270651166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Aetna Commercial |
$41.96
|
| Rate for Payer: Aetna Medicare Advantage |
$33.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.16
|
| Rate for Payer: Cigna Commercial |
$55.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$28.71
|
| Rate for Payer: Oxford Commercial |
$22.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.14
|
|
|
SUTURE MONOSOF 10-0 BLACK
|
Facility
|
IP
|
$110.42
|
|
| Hospital Charge Code |
270651166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.56
|
|
|
SUTURE MONOSOF 2/0 18 BLK
|
Facility
|
OP
|
$6.33
|
|
| Hospital Charge Code |
270656161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Medicare Advantage |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.61
|
| Rate for Payer: Cigna Commercial |
$3.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.65
|
| Rate for Payer: Oxford Commercial |
$1.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.18
|
|
|
SUTURE MONOSOF 2/0 18 BLK
|
Facility
|
IP
|
$6.33
|
|
| Hospital Charge Code |
270656161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.95
|
|
|
SUTURE MONOSOF 2/0 18 BLK PC5
|
Facility
|
OP
|
$12.60
|
|
| Hospital Charge Code |
270661184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna Medicare Advantage |
$3.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.21
|
| Rate for Payer: Cigna Commercial |
$6.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.28
|
| Rate for Payer: Oxford Commercial |
$2.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.36
|
|
|
SUTURE MONOSOF 2/0 18 BLK PC5
|
Facility
|
IP
|
$12.60
|
|
| Hospital Charge Code |
270661184N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.89
|
|
|
SUTURE MONOSOF 2/0 18 BLK PC5
|
Facility
|
OP
|
$12.60
|
|
| Hospital Charge Code |
270661184N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna Medicare Advantage |
$3.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.21
|
| Rate for Payer: Cigna Commercial |
$6.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.28
|
| Rate for Payer: Oxford Commercial |
$2.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.52
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.36
|
|
|
SUTURE MONOSOF 2/0 18 BLK PC5
|
Facility
|
IP
|
$12.60
|
|
| Hospital Charge Code |
270661184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.89
|
|
|
SUTURE MONOSOF 2 18 BLK GS18
|
Facility
|
IP
|
$12.65
|
|
| Hospital Charge Code |
270656029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.90
|
|
|
SUTURE MONOSOF 2 18 BLK GS18
|
Facility
|
OP
|
$12.65
|
|
| Hospital Charge Code |
270656029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Aetna Commercial |
$4.81
|
| Rate for Payer: Aetna Medicare Advantage |
$3.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.23
|
| Rate for Payer: Cigna Commercial |
$6.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.29
|
| Rate for Payer: Oxford Commercial |
$2.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.36
|
|
|
SUTURE MONOSOF 2 30 BLK GS18
|
Facility
|
IP
|
$13.62
|
|
| Hospital Charge Code |
270604508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.04
|
|
|
SUTURE MONOSOF 2 30 BLK GS18
|
Facility
|
OP
|
$13.62
|
|
| Hospital Charge Code |
270604508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: Aetna Commercial |
$5.18
|
| Rate for Payer: Aetna Medicare Advantage |
$4.09
|
| 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 |
$6.81
|
| 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 MONOSOF 3/0 18 BLK P14
|
Facility
|
OP
|
$13.21
|
|
| Hospital Charge Code |
270600781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$6.61 |
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna Medicare Advantage |
$3.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.37
|
| Rate for Payer: Cigna Commercial |
$6.61
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.43
|
| Rate for Payer: Oxford Commercial |
$2.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.38
|
|
|
SUTURE MONOSOF 3/0 18 BLK P14
|
Facility
|
IP
|
$13.21
|
|
| Hospital Charge Code |
270600781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.98
|
|
|
SUTURE MONOSOF 3/0 18 BLK PC5
|
Facility
|
IP
|
$16.58
|
|
| Hospital Charge Code |
270604510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.49
|
|
|
SUTURE MONOSOF 3/0 18 BLK PC5
|
Facility
|
OP
|
$16.58
|
|
| Hospital Charge Code |
270604510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$8.29 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Medicare Advantage |
$4.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.23
|
| Rate for Payer: Cigna Commercial |
$8.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.31
|
| 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 |
$0.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.47
|
|