|
SUTURE SURGILON 3/0 30 BK C14
|
Facility
|
OP
|
$19.71
|
|
| Hospital Charge Code |
270618236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$9.86 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Medicare Advantage |
$5.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.03
|
| Rate for Payer: Cigna Commercial |
$9.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.12
|
| Rate for Payer: Oxford Commercial |
$3.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.56
|
|
|
SUTURE SURGILON 4-0 TF CVF-21
|
Facility
|
IP
|
$125.40
|
|
| Hospital Charge Code |
270658811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$18.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.81
|
|
|
SUTURE SURGILON 4-0 TF CVF-21
|
Facility
|
OP
|
$125.40
|
|
| Hospital Charge Code |
270658811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna Commercial |
$47.65
|
| Rate for Payer: Aetna Medicare Advantage |
$37.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.98
|
| Rate for Payer: Cigna Commercial |
$62.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.60
|
| Rate for Payer: Oxford Commercial |
$25.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.56
|
|
|
SUTURE SURGILON C-14 2/0 BLK
|
Facility
|
IP
|
$35.36
|
|
| Hospital Charge Code |
270618237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.30
|
|
|
SUTURE SURGILON C-14 2/0 BLK
|
Facility
|
OP
|
$35.36
|
|
| Hospital Charge Code |
270618237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna Commercial |
$13.44
|
| Rate for Payer: Aetna Medicare Advantage |
$10.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.02
|
| Rate for Payer: Cigna Commercial |
$17.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.19
|
| Rate for Payer: Oxford Commercial |
$7.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.00
|
|
|
SUTURE SURGIPRO 0 30 BLUE CT1
|
Facility
|
IP
|
$8.11
|
|
| Hospital Charge Code |
270604668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.22
|
|
|
SUTURE SURGIPRO 0 30 BLUE CT1
|
Facility
|
OP
|
$8.11
|
|
| Hospital Charge Code |
270604668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.07
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.11
|
| Rate for Payer: Oxford Commercial |
$1.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
SUTURE SURGIPRO 0 30 BLUE CT2
|
Facility
|
IP
|
$8.21
|
|
| Hospital Charge Code |
270641078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
|
|
SUTURE SURGIPRO 0 30 BLUE CT2
|
Facility
|
OP
|
$8.21
|
|
| Hospital Charge Code |
270641078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.09
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.13
|
| Rate for Payer: Oxford Commercial |
$1.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
SUTURE SURGIPRO 0 30 BLUE MO6
|
Facility
|
OP
|
$11.83
|
|
| Hospital Charge Code |
270604669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.02
|
| Rate for Payer: Cigna Commercial |
$5.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.08
|
| Rate for Payer: Oxford Commercial |
$2.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
|
SUTURE SURGIPRO 0 30 BLUE MO6
|
Facility
|
IP
|
$11.83
|
|
| Hospital Charge Code |
270604669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.77
|
|
|
SUTURE SURGIPRO 0 GS-22 30 BLU
|
Facility
|
OP
|
$8.33
|
|
| Hospital Charge Code |
270656030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna Medicare Advantage |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.12
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.17
|
| Rate for Payer: Oxford Commercial |
$1.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.24
|
|
|
SUTURE SURGIPRO 0 GS-22 30 BLU
|
Facility
|
IP
|
$8.33
|
|
| Hospital Charge Code |
270656030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
|
|
SUTURE SURGIPRO 11 6/0 CV-11 D
|
Facility
|
IP
|
$107.02
|
|
| Hospital Charge Code |
270657219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
|
|
SUTURE SURGIPRO 11 6/0 CV-11 D
|
Facility
|
OP
|
$107.02
|
|
| Hospital Charge Code |
270657219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$53.51 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare Advantage |
$32.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.29
|
| Rate for Payer: Cigna Commercial |
$53.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.83
|
| Rate for Payer: Oxford Commercial |
$21.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.04
|
|
|
SUTURE SURGIPRO 1 30 BLUE CTX
|
Facility
|
OP
|
$8.31
|
|
| Hospital Charge Code |
270604666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare Advantage |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.12
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.16
|
| Rate for Payer: Oxford Commercial |
$1.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.66
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.24
|
|
|
SUTURE SURGIPRO 1 30 BLUE CTX
|
Facility
|
IP
|
$8.31
|
|
| Hospital Charge Code |
270604666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
|
|
SUTURE SURGIPRO 2/0 2x18 BLUE
|
Facility
|
IP
|
$50.23
|
|
| Hospital Charge Code |
270651275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.53
|
|
|
SUTURE SURGIPRO 2/0 2x18 BLUE
|
Facility
|
OP
|
$50.23
|
|
| Hospital Charge Code |
270651275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$19.09
|
| Rate for Payer: Aetna Medicare Advantage |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.81
|
| Rate for Payer: Cigna Commercial |
$25.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.06
|
| Rate for Payer: Oxford Commercial |
$10.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.43
|
|
|
SUTURE SURGIPRO 2/0 30 BLUE
|
Facility
|
OP
|
$8.31
|
|
| Hospital Charge Code |
270604671N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare Advantage |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.12
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.16
|
| Rate for Payer: Oxford Commercial |
$1.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.66
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.24
|
|
|
SUTURE SURGIPRO 2/0 30 BLUE
|
Facility
|
IP
|
$8.31
|
|
| Hospital Charge Code |
270604671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
|
|
SUTURE SURGIPRO 2/0 30 BLUE
|
Facility
|
OP
|
$8.21
|
|
| Hospital Charge Code |
270651177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.09
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.13
|
| Rate for Payer: Oxford Commercial |
$1.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
SUTURE SURGIPRO 2/0 30 BLUE
|
Facility
|
OP
|
$8.21
|
|
| Hospital Charge Code |
270604672S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.09
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.13
|
| Rate for Payer: Oxford Commercial |
$1.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
SUTURE SURGIPRO 2/0 30 BLUE
|
Facility
|
IP
|
$8.21
|
|
| Hospital Charge Code |
270604673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
|
|
SUTURE SURGIPRO 2/0 30 BLUE
|
Facility
|
OP
|
$8.31
|
|
| Hospital Charge Code |
270604671S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare Advantage |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.12
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.16
|
| Rate for Payer: Oxford Commercial |
$1.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.66
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.24
|
|