|
SUTURE PDS II 4-0 RB-1
|
Facility
|
IP
|
$12.14
|
|
| Hospital Charge Code |
270671533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.82
|
|
|
SUTURE PDS II 5-0 RB-1
|
Facility
|
OP
|
$20.46
|
|
| Hospital Charge Code |
270671532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$10.23 |
| Rate for Payer: Aetna Commercial |
$7.77
|
| Rate for Payer: Aetna Medicare Advantage |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.22
|
| Rate for Payer: Cigna Commercial |
$10.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.32
|
| Rate for Payer: Oxford Commercial |
$4.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
SUTURE PDS II 5-0 RB-1
|
Facility
|
IP
|
$20.46
|
|
| Hospital Charge Code |
270671532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.07
|
|
|
SUTURE PDS II 6-0 TF
|
Facility
|
IP
|
$15.49
|
|
| Hospital Charge Code |
270671537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.32
|
|
|
SUTURE PDS II 6-0 TF
|
Facility
|
OP
|
$15.49
|
|
| Hospital Charge Code |
270671537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna Commercial |
$5.89
|
| Rate for Payer: Aetna Medicare Advantage |
$4.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.95
|
| Rate for Payer: Cigna Commercial |
$7.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.03
|
| Rate for Payer: Oxford Commercial |
$3.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.44
|
|
|
SUTURE PDS II 7-0 BV-1
|
Facility
|
OP
|
$74.19
|
|
| Hospital Charge Code |
270671531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$37.09 |
| Rate for Payer: Aetna Commercial |
$28.19
|
| Rate for Payer: Aetna Medicare Advantage |
$22.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.92
|
| Rate for Payer: Cigna Commercial |
$37.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.29
|
| Rate for Payer: Oxford Commercial |
$14.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.11
|
|
|
SUTURE PDS II 7-0 BV-1
|
Facility
|
IP
|
$74.19
|
|
| Hospital Charge Code |
270671531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$11.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.13
|
|
|
SUTURE PDS PLUS 1 CTX
|
Facility
|
IP
|
$14.73
|
|
| Hospital Charge Code |
270672369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
|
|
SUTURE PDS PLUS 1 CTX
|
Facility
|
OP
|
$14.73
|
|
| Hospital Charge Code |
270672369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Aetna Commercial |
$5.60
|
| Rate for Payer: Aetna Medicare Advantage |
$4.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.76
|
| Rate for Payer: Cigna Commercial |
$7.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.83
|
| Rate for Payer: Oxford Commercial |
$2.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.42
|
|
|
SUTURE PDS PLUS 2-0 CT-2
|
Facility
|
OP
|
$14.03
|
|
| Hospital Charge Code |
270683593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Aetna Commercial |
$5.33
|
| Rate for Payer: Aetna Medicare Advantage |
$4.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.58
|
| Rate for Payer: Cigna Commercial |
$7.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.65
|
| Rate for Payer: Oxford Commercial |
$2.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.81
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.40
|
|
|
SUTURE PDS PLUS 2-0 CT-2
|
Facility
|
IP
|
$14.03
|
|
| Hospital Charge Code |
270683593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.10
|
|
|
SUTURE PDS PLUS 3/0 27 IN SH
|
Facility
|
OP
|
$13.48
|
|
| Hospital Charge Code |
270683604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$6.74 |
| Rate for Payer: Aetna Commercial |
$5.12
|
| Rate for Payer: Aetna Medicare Advantage |
$4.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.44
|
| Rate for Payer: Cigna Commercial |
$6.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.50
|
| Rate for Payer: Oxford Commercial |
$2.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.38
|
|
|
SUTURE PDS PLUS 3/0 27 IN SH
|
Facility
|
IP
|
$13.48
|
|
| Hospital Charge Code |
270683604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.02
|
|
|
SUTURE PDS PLUS 6-0 RB-2
|
Facility
|
OP
|
$33.89
|
|
| Hospital Charge Code |
270672372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$16.95 |
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Medicare Advantage |
$10.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.64
|
| Rate for Payer: Cigna Commercial |
$16.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.81
|
| Rate for Payer: Oxford Commercial |
$6.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.78
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.96
|
|
|
SUTURE PDS PLUS 6-0 RB-2
|
Facility
|
IP
|
$33.89
|
|
| Hospital Charge Code |
270672372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.08
|
|
|
SUTURE PDS PLUS CT-1
|
Facility
|
OP
|
$13.03
|
|
| Hospital Charge Code |
270663649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: Aetna Medicare Advantage |
$3.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.32
|
| Rate for Payer: Cigna Commercial |
$6.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.39
|
| Rate for Payer: Oxford Commercial |
$2.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.61
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.37
|
|
|
SUTURE PDS PLUS CT-1
|
Facility
|
IP
|
$13.03
|
|
| Hospital Charge Code |
270663649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
SUTURE PDS PLUS CTX 0
|
Facility
|
IP
|
$21.68
|
|
| Hospital Charge Code |
270663650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.25
|
|
|
SUTURE PDS PLUS CTX 0
|
Facility
|
OP
|
$21.68
|
|
| Hospital Charge Code |
270663650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna Commercial |
$8.24
|
| Rate for Payer: Aetna Medicare Advantage |
$6.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.53
|
| Rate for Payer: Cigna Commercial |
$10.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.64
|
| Rate for Payer: Oxford Commercial |
$4.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.34
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.62
|
|
|
SUTURE PDS PLUS XLH 96 IN
|
Facility
|
IP
|
$29.02
|
|
| Hospital Charge Code |
270692378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
|
|
SUTURE PDS PLUS XLH 96 IN
|
Facility
|
OP
|
$29.02
|
|
| Hospital Charge Code |
270692378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$14.51 |
| Rate for Payer: Aetna Commercial |
$11.03
|
| Rate for Payer: Aetna Medicare Advantage |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.40
|
| Rate for Payer: Cigna Commercial |
$14.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.55
|
| Rate for Payer: Oxford Commercial |
$5.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.82
|
|
|
SUTURE PDS SFX UNI 6IN S/A
|
Facility
|
OP
|
$185.85
|
|
| Hospital Charge Code |
270697557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$70.62
|
| Rate for Payer: Aetna Medicare Advantage |
$55.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.39
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.32
|
| Rate for Payer: Oxford Commercial |
$37.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$37.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.28
|
|
|
SUTURE PDS SFX UNI 6IN S/A
|
Facility
|
IP
|
$185.85
|
|
| Hospital Charge Code |
270697557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.88 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.88
|
|
|
SUTURE PDS STRATAFIX 0 30 CT-2
|
Facility
|
IP
|
$124.15
|
|
| Hospital Charge Code |
270681813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.62
|
|
|
SUTURE PDS STRATAFIX 0 30 CT-2
|
Facility
|
OP
|
$124.15
|
|
| Hospital Charge Code |
270681813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Aetna Medicare Advantage |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.66
|
| Rate for Payer: Cigna Commercial |
$62.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.28
|
| Rate for Payer: Oxford Commercial |
$24.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.83
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.53
|
|