|
SUTURE SOFSILK 0 30 BLACK
|
Facility
|
IP
|
$5.36
|
|
| Hospital Charge Code |
270604596S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.80
|
|
|
SUTURE SOFSILK 0 30 BLACK
|
Facility
|
OP
|
$5.36
|
|
| Hospital Charge Code |
270604596S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.04
|
| Rate for Payer: Aetna Medicare Advantage |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.37
|
| Rate for Payer: Cigna Commercial |
$2.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.39
|
| Rate for Payer: Oxford Commercial |
$1.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.15
|
|
|
SUTURE SOFSILK 0 30 BLACK
|
Facility
|
OP
|
$5.36
|
|
| Hospital Charge Code |
270604596N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.04
|
| Rate for Payer: Aetna Medicare Advantage |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.37
|
| Rate for Payer: Cigna Commercial |
$2.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.39
|
| Rate for Payer: Oxford Commercial |
$1.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.15
|
|
|
SUTURE SOFSILK 0 30 BLACK
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
270659736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.27
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.30
|
| Rate for Payer: Oxford Commercial |
$1.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.14
|
|
|
SUTURE SOFSILK 0 30 BLACK
|
Facility
|
IP
|
$5.36
|
|
| Hospital Charge Code |
270604596N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.80
|
|
|
SUTURE SOFSILK 0 30 BLACK CT1
|
Facility
|
IP
|
$5.10
|
|
| Hospital Charge Code |
270613699S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.77
|
|
|
SUTURE SOFSILK 0 30 BLACK CT1
|
Facility
|
OP
|
$5.10
|
|
| Hospital Charge Code |
270613699N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare Advantage |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.30
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.33
|
| Rate for Payer: Oxford Commercial |
$1.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.02
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.14
|
|
|
SUTURE SOFSILK 0 30 BLACK CT1
|
Facility
|
OP
|
$5.10
|
|
| Hospital Charge Code |
270613699S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare Advantage |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.30
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.33
|
| Rate for Payer: Oxford Commercial |
$1.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.02
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.14
|
|
|
SUTURE SOFSILK 0 30 BLACK CT1
|
Facility
|
OP
|
$5.10
|
|
| Hospital Charge Code |
270613699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare Advantage |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.30
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.33
|
| Rate for Payer: Oxford Commercial |
$1.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.02
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.14
|
|
|
SUTURE SOFSILK 0 30 BLACK CT1
|
Facility
|
IP
|
$5.10
|
|
| Hospital Charge Code |
270613699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.77
|
|
|
SUTURE SOFSILK 0 30 BLACK CT1
|
Facility
|
IP
|
$5.10
|
|
| Hospital Charge Code |
270613699N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.77
|
|
|
SUTURE SOFSILK 0 30 BLACK V20
|
Facility
|
IP
|
$5.92
|
|
| Hospital Charge Code |
270661183N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.89
|
|
|
SUTURE SOFSILK 0 30 BLACK V20
|
Facility
|
OP
|
$5.92
|
|
| Hospital Charge Code |
270661183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna Medicare Advantage |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.51
|
| Rate for Payer: Cigna Commercial |
$2.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.54
|
| Rate for Payer: Oxford Commercial |
$1.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.18
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.17
|
|
|
SUTURE SOFSILK 0 30 BLACK V20
|
Facility
|
IP
|
$5.92
|
|
| Hospital Charge Code |
270661183S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.89
|
|
|
SUTURE SOFSILK 0 30 BLACK V20
|
Facility
|
OP
|
$5.92
|
|
| Hospital Charge Code |
270661183N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna Medicare Advantage |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.51
|
| Rate for Payer: Cigna Commercial |
$2.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.54
|
| Rate for Payer: Oxford Commercial |
$1.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.18
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.17
|
|
|
SUTURE SOFSILK 0 30 BLACK V20
|
Facility
|
IP
|
$5.92
|
|
| Hospital Charge Code |
270661183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.89
|
|
|
SUTURE SOFSILK 0 30 BLACK V20
|
Facility
|
OP
|
$5.92
|
|
| Hospital Charge Code |
270661183S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna Medicare Advantage |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.51
|
| Rate for Payer: Cigna Commercial |
$2.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.54
|
| Rate for Payer: Oxford Commercial |
$1.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.18
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.17
|
|
|
SUTURE SOFSILK 0 BLK 48
|
Facility
|
IP
|
$213.65
|
|
| Hospital Charge Code |
270658699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$32.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.05
|
|
|
SUTURE SOFSILK 0 BLK 48
|
Facility
|
OP
|
$213.65
|
|
| Hospital Charge Code |
270658699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$106.83 |
| Rate for Payer: Aetna Commercial |
$81.19
|
| Rate for Payer: Aetna Medicare Advantage |
$64.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.48
|
| Rate for Payer: Cigna Commercial |
$106.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.55
|
| Rate for Payer: Oxford Commercial |
$42.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.07
|
|
|
SUTURE SOFSILK 1 12x30 BLK
|
Facility
|
OP
|
$2.86
|
|
| Hospital Charge Code |
270626184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna Commercial |
$1.09
|
| Rate for Payer: Aetna Medicare Advantage |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.73
|
| Rate for Payer: Cigna Commercial |
$1.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.74
|
| Rate for Payer: Oxford Commercial |
$0.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.57
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.08
|
|
|
SUTURE SOFSILK 1 12x30 BLK
|
Facility
|
IP
|
$2.86
|
|
| Hospital Charge Code |
270626184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.43
|
|
|
SUTURE SOFSILK 1 30 BLACK V20
|
Facility
|
OP
|
$5.25
|
|
| Hospital Charge Code |
270666266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.34
|
| Rate for Payer: Cigna Commercial |
$2.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.36
|
| Rate for Payer: Oxford Commercial |
$1.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.15
|
|
|
SUTURE SOFSILK 1 30 BLACK V20
|
Facility
|
IP
|
$5.25
|
|
| Hospital Charge Code |
270666266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.79
|
|
|
SUTURE SOFSILK 2/0 12x30 BLK
|
Facility
|
OP
|
$7.45
|
|
| Hospital Charge Code |
270604591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$2.83
|
| Rate for Payer: Aetna Medicare Advantage |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.90
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.94
|
| Rate for Payer: Oxford Commercial |
$1.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.49
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.21
|
|
|
SUTURE SOFSILK 2/0 12x30 BLK
|
Facility
|
IP
|
$7.45
|
|
| Hospital Charge Code |
270604591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.12
|
|