|
SUTURE POLYSORB 2 5x30 VIOLET
|
Facility
|
IP
|
$59.26
|
|
| Hospital Charge Code |
270663266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.89
|
|
|
SUTURE POLYSORB 2 5x30 VIOLET
|
Facility
|
OP
|
$59.26
|
|
| Hospital Charge Code |
270663266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$29.63 |
| Rate for Payer: Aetna Commercial |
$22.52
|
| Rate for Payer: Aetna Medicare Advantage |
$17.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.11
|
| Rate for Payer: Cigna Commercial |
$29.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.41
|
| Rate for Payer: Oxford Commercial |
$11.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.68
|
|
|
SUTURE POLYSORB 3/0 12x18 U/D
|
Facility
|
OP
|
$28.66
|
|
| Hospital Charge Code |
270655783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: Aetna Medicare Advantage |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.31
|
| Rate for Payer: Cigna Commercial |
$14.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.45
|
| Rate for Payer: Oxford Commercial |
$5.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.81
|
|
|
SUTURE POLYSORB 3/0 12x18 U/D
|
Facility
|
IP
|
$28.66
|
|
| Hospital Charge Code |
270655783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.30
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
OP
|
$13.13
|
|
| Hospital Charge Code |
270661668S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna Commercial |
$4.99
|
| Rate for Payer: Aetna Medicare Advantage |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.35
|
| Rate for Payer: Cigna Commercial |
$6.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.41
|
| Rate for Payer: Oxford Commercial |
$2.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.63
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.37
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
IP
|
$13.33
|
|
| Hospital Charge Code |
270661668N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.00
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
IP
|
$13.13
|
|
| Hospital Charge Code |
270661668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.97
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
OP
|
$13.13
|
|
| Hospital Charge Code |
270661668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna Commercial |
$4.99
|
| Rate for Payer: Aetna Medicare Advantage |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.35
|
| Rate for Payer: Cigna Commercial |
$6.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.41
|
| Rate for Payer: Oxford Commercial |
$2.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.63
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.37
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
IP
|
$13.13
|
|
| Hospital Charge Code |
270661668S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.97
|
|
|
SUTURE POLYSORB 3/0 18IN UNDYE
|
Facility
|
OP
|
$13.33
|
|
| Hospital Charge Code |
270661668N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: Aetna Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.40
|
| Rate for Payer: Cigna Commercial |
$6.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.47
|
| Rate for Payer: Oxford Commercial |
$2.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.38
|
|
|
SUTURE POLYSORB 3/0 18 U/D P12
|
Facility
|
OP
|
$14.08
|
|
| Hospital Charge Code |
270656154N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: Aetna Commercial |
$5.35
|
| Rate for Payer: Aetna Medicare Advantage |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.59
|
| Rate for Payer: Cigna Commercial |
$7.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.66
|
| Rate for Payer: Oxford Commercial |
$2.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.40
|
|
|
SUTURE POLYSORB 3/0 18 U/D P12
|
Facility
|
IP
|
$14.08
|
|
| Hospital Charge Code |
270656154N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.11
|
|
|
SUTURE POLYSORB 3/0 18 U/D P12
|
Facility
|
IP
|
$14.08
|
|
| Hospital Charge Code |
270656154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.11
|
|
|
SUTURE POLYSORB 3/0 18 U/D P12
|
Facility
|
OP
|
$14.08
|
|
| Hospital Charge Code |
270656154S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: Aetna Commercial |
$5.35
|
| Rate for Payer: Aetna Medicare Advantage |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.59
|
| Rate for Payer: Cigna Commercial |
$7.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.66
|
| Rate for Payer: Oxford Commercial |
$2.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.40
|
|
|
SUTURE POLYSORB 3/0 18 U/D P12
|
Facility
|
IP
|
$14.08
|
|
| Hospital Charge Code |
270656154S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.11
|
|
|
SUTURE POLYSORB 3/0 18 U/D P12
|
Facility
|
OP
|
$14.08
|
|
| Hospital Charge Code |
270656154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: Aetna Commercial |
$5.35
|
| Rate for Payer: Aetna Medicare Advantage |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.59
|
| Rate for Payer: Cigna Commercial |
$7.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.66
|
| Rate for Payer: Oxford Commercial |
$2.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.40
|
|
|
SUTURE POLYSORB 3/0 30 CT1
|
Facility
|
IP
|
$6.07
|
|
| Hospital Charge Code |
270604550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.91
|
|
|
SUTURE POLYSORB 3/0 30 CT1
|
Facility
|
OP
|
$6.07
|
|
| Hospital Charge Code |
270604550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare Advantage |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.55
|
| Rate for Payer: Cigna Commercial |
$3.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.58
|
| Rate for Payer: Oxford Commercial |
$1.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.17
|
|
|
SUTURE POLYSORB 3/0 30 GS10
|
Facility
|
OP
|
$6.78
|
|
| Hospital Charge Code |
270651130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare Advantage |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.73
|
| Rate for Payer: Cigna Commercial |
$3.39
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.76
|
| Rate for Payer: Oxford Commercial |
$1.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.19
|
|
|
SUTURE POLYSORB 3/0 30 GS10
|
Facility
|
IP
|
$6.78
|
|
| Hospital Charge Code |
270651130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.02
|
|
|
SUTURE POLYSORB 3/0 30 U/D P12
|
Facility
|
IP
|
$13.92
|
|
| Hospital Charge Code |
270604577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.09
|
|
|
SUTURE POLYSORB 3/0 30 U/D P12
|
Facility
|
OP
|
$13.92
|
|
| Hospital Charge Code |
270604577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna Commercial |
$5.29
|
| Rate for Payer: Aetna Medicare Advantage |
$4.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.55
|
| Rate for Payer: Cigna Commercial |
$6.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.62
|
| Rate for Payer: Oxford Commercial |
$2.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.78
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.40
|
|
|
SUTURE POLYSORB 3/0 30 UD V20
|
Facility
|
OP
|
$6.07
|
|
| Hospital Charge Code |
270651281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare Advantage |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.55
|
| Rate for Payer: Cigna Commercial |
$3.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.58
|
| Rate for Payer: Oxford Commercial |
$1.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.17
|
|
|
SUTURE POLYSORB 3/0 30 UD V20
|
Facility
|
IP
|
$6.07
|
|
| Hospital Charge Code |
270651281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.91
|
|
|
SUTURE POLYSORB 3/0 30 UD V20
|
Facility
|
OP
|
$6.07
|
|
| Hospital Charge Code |
270651281N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare Advantage |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.55
|
| Rate for Payer: Cigna Commercial |
$3.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.58
|
| Rate for Payer: Oxford Commercial |
$1.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.17
|
|
