|
SUTURE ORTH W/NEED VIOL 223104
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
270636647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.75
|
|
|
SUTURE PALIN GUT GS-21 3-0 30
|
Facility
|
OP
|
$6.73
|
|
| Hospital Charge Code |
270651124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna Medicare Advantage |
$2.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.72
|
| Rate for Payer: Cigna Commercial |
$3.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.75
|
| Rate for Payer: Oxford Commercial |
$1.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.35
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.19
|
|
|
SUTURE PALIN GUT GS-21 3-0 30
|
Facility
|
IP
|
$6.73
|
|
| Hospital Charge Code |
270651124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.01
|
|
|
SUTUREPASSERFIRSTPASSMINIRT
|
Facility
|
IP
|
$2,475.00
|
|
| Hospital Charge Code |
270686254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$371.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
SUTUREPASSERFIRSTPASSMINIRT
|
Facility
|
OP
|
$2,475.00
|
|
| Hospital Charge Code |
270686254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$940.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$643.50
|
| Rate for Payer: Oxford Commercial |
$495.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$495.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.29
|
|
|
SUTURE PASSER HIP SWITSTITCH
|
Facility
|
IP
|
$1,200.00
|
|
| Hospital Charge Code |
270687986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$180.00
|
|
|
SUTURE PASSER HIP SWITSTITCH
|
Facility
|
OP
|
$1,200.00
|
|
| Hospital Charge Code |
270687986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$456.00
|
| Rate for Payer: Aetna Medicare Advantage |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$306.00
|
| Rate for Payer: Cigna Commercial |
$600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$312.00
|
| Rate for Payer: Oxford Commercial |
$240.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$180.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$240.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$37.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.08
|
|
|
SUTURE PASSING WIRE
|
Facility
|
OP
|
$540.00
|
|
| Hospital Charge Code |
270667981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Medicare Advantage |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$137.70
|
| Rate for Payer: Cigna Commercial |
$270.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$140.40
|
| Rate for Payer: Oxford Commercial |
$108.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$108.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.34
|
|
|
SUTURE PASSING WIRE
|
Facility
|
IP
|
$540.00
|
|
| Hospital Charge Code |
270667981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.00
|
|
|
SUTURE PASSING WIRE
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
270335618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.50
|
| Rate for Payer: Oxford Commercial |
$45.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.39
|
|
|
SUTURE PASSING WIRE
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
270335618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
SUTURE PDO 30CM VIOLET 1/2 C
|
Facility
|
IP
|
$59.06
|
|
| Hospital Charge Code |
270686782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.86
|
|
|
SUTURE PDO 30CM VIOLET 1/2 C
|
Facility
|
OP
|
$59.06
|
|
| Hospital Charge Code |
270686782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$29.53 |
| Rate for Payer: Aetna Commercial |
$22.44
|
| Rate for Payer: Aetna Medicare Advantage |
$17.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.06
|
| Rate for Payer: Cigna Commercial |
$29.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.36
|
| Rate for Payer: Oxford Commercial |
$11.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.81
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.68
|
|
|
SUTURE PDO SZ0 36MM 1/2 CIRCLE
|
Facility
|
IP
|
$103.44
|
|
| Hospital Charge Code |
270675899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.52
|
|
|
SUTURE PDO SZ0 36MM 1/2 CIRCLE
|
Facility
|
OP
|
$103.44
|
|
| Hospital Charge Code |
270675899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$51.72 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Medicare Advantage |
$31.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.38
|
| Rate for Payer: Cigna Commercial |
$51.72
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.89
|
| Rate for Payer: Oxford Commercial |
$20.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.94
|
|
|
SUTURE PDS 2-0 CT1 27 IN
|
Facility
|
IP
|
$12.02
|
|
| Hospital Charge Code |
270681804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
|
|
SUTURE PDS 2-0 CT1 27 IN
|
Facility
|
OP
|
$12.02
|
|
| Hospital Charge Code |
270681804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial |
$4.57
|
| Rate for Payer: Aetna Medicare Advantage |
$3.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.07
|
| Rate for Payer: Cigna Commercial |
$6.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.13
|
| Rate for Payer: Oxford Commercial |
$2.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
|
SUTURE PDS 5-0 RB1 DOUBLE ARM
|
Facility
|
IP
|
$49.70
|
|
| Hospital Charge Code |
270685432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$7.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.46
|
|
|
SUTURE PDS 5-0 RB1 DOUBLE ARM
|
Facility
|
OP
|
$49.70
|
|
| Hospital Charge Code |
270685432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: Aetna Commercial |
$18.89
|
| Rate for Payer: Aetna Medicare Advantage |
$14.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.67
|
| Rate for Payer: Cigna Commercial |
$24.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.92
|
| Rate for Payer: Oxford Commercial |
$9.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.41
|
|
|
SUTURE PDS CT 0
|
Facility
|
OP
|
$12.73
|
|
| Hospital Charge Code |
270600574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare Advantage |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.25
|
| Rate for Payer: Cigna Commercial |
$6.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.31
|
| Rate for Payer: Oxford Commercial |
$2.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.36
|
|
|
SUTURE PDS CT 0
|
Facility
|
IP
|
$12.73
|
|
| Hospital Charge Code |
270600574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.91
|
|
|
SUTURE PDS II 0 CP-1
|
Facility
|
IP
|
$12.75
|
|
| Hospital Charge Code |
270673259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.91
|
|
|
SUTURE PDS II 0 CP-1
|
Facility
|
OP
|
$12.75
|
|
| Hospital Charge Code |
270673259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare Advantage |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.25
|
| Rate for Payer: Cigna Commercial |
$6.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.31
|
| Rate for Payer: Oxford Commercial |
$2.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.36
|
|
|
SUTURE PDS II 0 CT-1
|
Facility
|
IP
|
$12.06
|
|
| Hospital Charge Code |
270671536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.81
|
|
|
SUTURE PDS II 0 CT-1
|
Facility
|
OP
|
$20.26
|
|
| Hospital Charge Code |
270604719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Aetna Medicare Advantage |
$6.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.17
|
| Rate for Payer: Cigna Commercial |
$10.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.27
|
| Rate for Payer: Oxford Commercial |
$4.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|