|
SUTURE VICRYL 1 CT-1
|
Facility
|
IP
|
$9.23
|
|
| Hospital Charge Code |
270672380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.38
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
OP
|
$9.23
|
|
| Hospital Charge Code |
270672380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna Medicare Advantage |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.35
|
| Rate for Payer: Cigna Commercial |
$4.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.40
|
| Rate for Payer: Oxford Commercial |
$1.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.26
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
OP
|
$7.57
|
|
| Hospital Charge Code |
270671461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare Advantage |
$2.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.93
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.97
|
| Rate for Payer: Oxford Commercial |
$1.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.51
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.21
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
IP
|
$7.20
|
|
| Hospital Charge Code |
270671454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
OP
|
$7.72
|
|
| Hospital Charge Code |
270671489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna Commercial |
$2.93
|
| Rate for Payer: Aetna Medicare Advantage |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.97
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.01
|
| Rate for Payer: Oxford Commercial |
$1.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.54
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.22
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
OP
|
$59.10
|
|
| Hospital Charge Code |
270672381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$29.55 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Medicare Advantage |
$17.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.07
|
| Rate for Payer: Cigna Commercial |
$29.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.37
|
| Rate for Payer: Oxford Commercial |
$11.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.68
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
IP
|
$59.10
|
|
| Hospital Charge Code |
270672381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.87
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
IP
|
$7.72
|
|
| Hospital Charge Code |
270671489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.16
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
OP
|
$7.20
|
|
| Hospital Charge Code |
270671454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Aetna Medicare Advantage |
$2.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.84
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.87
|
| Rate for Payer: Oxford Commercial |
$1.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.20
|
|
|
SUTURE VICRYL 1 CT-1
|
Facility
|
IP
|
$7.57
|
|
| Hospital Charge Code |
270671461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.14
|
|
|
SUTURE VICRYL 1CT-1 8X18 UNDYE
|
Facility
|
OP
|
$53.45
|
|
| Hospital Charge Code |
270694728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$26.73 |
| Rate for Payer: Aetna Commercial |
$20.31
|
| Rate for Payer: Aetna Medicare Advantage |
$16.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.63
|
| Rate for Payer: Cigna Commercial |
$26.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.90
|
| Rate for Payer: Oxford Commercial |
$10.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.69
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.52
|
|
|
SUTURE VICRYL 1CT-1 8X18 UNDYE
|
Facility
|
IP
|
$53.45
|
|
| Hospital Charge Code |
270694728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.02
|
|
|
SUTURE VICRYL 1CT1 CR 8X18
|
Facility
|
OP
|
$77.30
|
|
| Hospital Charge Code |
270698430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$38.65 |
| Rate for Payer: Aetna Commercial |
$29.37
|
| Rate for Payer: Aetna Medicare Advantage |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.71
|
| Rate for Payer: Cigna Commercial |
$38.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.10
|
| Rate for Payer: Oxford Commercial |
$15.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.46
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.20
|
|
|
SUTURE VICRYL 1CT1 CR 8X18
|
Facility
|
IP
|
$77.30
|
|
| Hospital Charge Code |
270698430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.60
|
|
|
SUTURE VICRYL 1 CT-1/GS-21
|
Facility
|
IP
|
$54.17
|
|
| Hospital Charge Code |
270655802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.13
|
|
|
SUTURE VICRYL 1 CT-1/GS-21
|
Facility
|
OP
|
$54.17
|
|
| Hospital Charge Code |
270655802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna Commercial |
$20.58
|
| Rate for Payer: Aetna Medicare Advantage |
$16.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.81
|
| Rate for Payer: Cigna Commercial |
$27.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.08
|
| Rate for Payer: Oxford Commercial |
$10.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.83
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.54
|
|
|
SUTURE VICRYL 1 GS-24
|
Facility
|
IP
|
$7.20
|
|
| Hospital Charge Code |
270675772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
|
|
SUTURE VICRYL 1 GS-24
|
Facility
|
IP
|
$7.65
|
|
| Hospital Charge Code |
270655701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.15
|
|
|
SUTURE VICRYL 1 GS-24
|
Facility
|
OP
|
$7.65
|
|
| Hospital Charge Code |
270655701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna Medicare Advantage |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.95
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.99
|
| Rate for Payer: Oxford Commercial |
$1.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.22
|
|
|
SUTURE VICRYL 1 GS-24
|
Facility
|
OP
|
$7.20
|
|
| Hospital Charge Code |
270675772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Aetna Medicare Advantage |
$2.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.84
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.87
|
| Rate for Payer: Oxford Commercial |
$1.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.20
|
|
|
SUTURE VICRYL 1 MO-4
|
Facility
|
IP
|
$11.02
|
|
| Hospital Charge Code |
270671471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.65
|
|
|
SUTURE VICRYL 1 MO-4
|
Facility
|
OP
|
$11.02
|
|
| Hospital Charge Code |
270671471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna Medicare Advantage |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.81
|
| Rate for Payer: Cigna Commercial |
$5.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.87
|
| Rate for Payer: Oxford Commercial |
$2.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.31
|
|
|
SUTURE VICRYL 1 MO-5 27INCH
|
Facility
|
OP
|
$82.70
|
|
| Hospital Charge Code |
270677187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$41.35 |
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Medicare Advantage |
$24.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.09
|
| Rate for Payer: Cigna Commercial |
$41.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.50
|
| Rate for Payer: Oxford Commercial |
$16.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.54
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.35
|
|
|
SUTURE VICRYL 1 MO-5 27INCH
|
Facility
|
IP
|
$82.70
|
|
| Hospital Charge Code |
270677187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$12.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.40
|
|
|
SUTURE VICRYL 1 OS-6
|
Facility
|
OP
|
$13.40
|
|
| Hospital Charge Code |
270672374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: Aetna Medicare Advantage |
$4.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.42
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.48
|
| Rate for Payer: Oxford Commercial |
$2.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.38
|
|