|
SUTURE MONOSOF 4/0 30 BLK SC2
|
Facility
|
OP
|
$5.81
|
|
| Hospital Charge Code |
270675607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| 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 |
$0.17
|
|
|
SUTURE MONOSOF 4-0 P-13 18
|
Facility
|
IP
|
$13.39
|
|
| Hospital Charge Code |
270651312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.01
|
|
|
SUTURE MONOSOF 4-0 P-13 18
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
270651312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: Aetna Medicare Advantage |
$4.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.41
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.48
|
| Rate for Payer: Oxford Commercial |
$2.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.38
|
|
|
SUTURE MONOSOF 5/0 18 BLK P13
|
Facility
|
OP
|
$13.26
|
|
| Hospital Charge Code |
270604513N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Aetna Commercial |
$5.04
|
| Rate for Payer: Aetna Medicare Advantage |
$3.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.38
|
| Rate for Payer: Cigna Commercial |
$6.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.45
|
| Rate for Payer: Oxford Commercial |
$2.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.65
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.38
|
|
|
SUTURE MONOSOF 5/0 18 BLK P13
|
Facility
|
OP
|
$34.72
|
|
| Hospital Charge Code |
270604513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna Medicare Advantage |
$10.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.85
|
| Rate for Payer: Cigna Commercial |
$17.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.03
|
| Rate for Payer: Oxford Commercial |
$6.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.99
|
|
|
SUTURE MONOSOF 5/0 18 BLK P13
|
Facility
|
OP
|
$34.72
|
|
| Hospital Charge Code |
270604513S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna Medicare Advantage |
$10.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.85
|
| Rate for Payer: Cigna Commercial |
$17.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.03
|
| Rate for Payer: Oxford Commercial |
$6.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.99
|
|
|
SUTURE MONOSOF 5/0 18 BLK P13
|
Facility
|
IP
|
$34.72
|
|
| Hospital Charge Code |
270604513S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.21
|
|
|
SUTURE MONOSOF 5/0 18 BLK P13
|
Facility
|
IP
|
$13.26
|
|
| Hospital Charge Code |
270604513N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.99
|
|
|
SUTURE MONOSOF 5/0 18 BLK P13
|
Facility
|
IP
|
$34.72
|
|
| Hospital Charge Code |
270604513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.21
|
|
|
SUTURE MONOSOF 5/0 18 BLK PC1
|
Facility
|
IP
|
$13.82
|
|
| Hospital Charge Code |
270600775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.07
|
|
|
SUTURE MONOSOF 5/0 18 BLK PC1
|
Facility
|
OP
|
$13.82
|
|
| Hospital Charge Code |
270600775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.91 |
| Rate for Payer: Aetna Commercial |
$5.25
|
| Rate for Payer: Aetna Medicare Advantage |
$4.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.52
|
| Rate for Payer: Cigna Commercial |
$6.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.59
|
| Rate for Payer: Oxford Commercial |
$2.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.76
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.39
|
|
|
SUTURE MONOSOF 5/0 18 BLK PC5
|
Facility
|
IP
|
$151.99
|
|
| Hospital Charge Code |
270604512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.80
|
|
|
SUTURE MONOSOF 5/0 18 BLK PC5
|
Facility
|
OP
|
$151.99
|
|
| Hospital Charge Code |
270604512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$57.76
|
| Rate for Payer: Aetna Medicare Advantage |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.76
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.52
|
| Rate for Payer: Oxford Commercial |
$30.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.32
|
|
|
SUTURE MONOSOF 5/0 18 CLEAR
|
Facility
|
IP
|
$13.72
|
|
| Hospital Charge Code |
270604517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.06
|
|
|
SUTURE MONOSOF 5/0 18 CLEAR
|
Facility
|
OP
|
$13.72
|
|
| Hospital Charge Code |
270604517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.86 |
| Rate for Payer: Aetna Commercial |
$5.21
|
| Rate for Payer: Aetna Medicare Advantage |
$4.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.50
|
| Rate for Payer: Cigna Commercial |
$6.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.57
|
| Rate for Payer: Oxford Commercial |
$2.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.74
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.39
|
|
|
SUTURE MONOSOF 5/0 P-11
|
Facility
|
OP
|
$4.35
|
|
| Hospital Charge Code |
270655358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Aetna Medicare Advantage |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.11
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.13
|
| Rate for Payer: Oxford Commercial |
$0.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.87
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.12
|
|
|
SUTURE MONOSOF 5/0 P-11
|
Facility
|
IP
|
$4.35
|
|
| Hospital Charge Code |
270655358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.65
|
|
|
SUTURE MONOSOF 6/0 18 BLK P10
|
Facility
|
IP
|
$13.21
|
|
| Hospital Charge Code |
270617478
|
|
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 6/0 18 BLK P10
|
Facility
|
OP
|
$13.21
|
|
| Hospital Charge Code |
270617478
|
|
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 6/0 18 BLK P13
|
Facility
|
OP
|
$47.20
|
|
| Hospital Charge Code |
270651310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$23.60 |
| Rate for Payer: Aetna Commercial |
$17.94
|
| Rate for Payer: Aetna Medicare Advantage |
$14.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.04
|
| Rate for Payer: Cigna Commercial |
$23.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.27
|
| Rate for Payer: Oxford Commercial |
$9.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.34
|
|
|
SUTURE MONOSOF 6/0 18 BLK P13
|
Facility
|
IP
|
$47.20
|
|
| Hospital Charge Code |
270651310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.08
|
|
|
SUTURE MONOSOF 6/0 18 BLK PC1
|
Facility
|
OP
|
$17.14
|
|
| Hospital Charge Code |
270600773
|
|
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 MONOSOF 6/0 18 BLK PC1
|
Facility
|
IP
|
$17.14
|
|
| Hospital Charge Code |
270600773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
|
|
SUTURE MONOSOF 6/0 18 BLK PC3
|
Facility
|
OP
|
$17.14
|
|
| Hospital Charge Code |
270600774
|
|
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 MONOSOF 6/0 18 BLK PC3
|
Facility
|
IP
|
$17.14
|
|
| Hospital Charge Code |
270600774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.57
|
|