|
GUAIFENESN SYRUP ML
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
NDC 61787006204
|
| Hospital Charge Code |
6023147
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.67
|
|
|
GUAIFENISIN AC/COD 5ML UD
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
60635261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna Commercial |
$0.76
|
| Rate for Payer: Aetna Medicare Advantage |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.51
|
| Rate for Payer: Cigna Commercial |
$1.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.60
|
| Rate for Payer: Oxford Commercial |
$0.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.05
|
|
|
GUAIFENISIN AC/COD 5ML UD
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
60635261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.30
|
|
|
GUANFACINE 1 MG TAB
|
Facility
|
IP
|
$10.45
|
|
| Hospital Charge Code |
60627631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.57
|
|
|
GUANFACINE 1 MG TAB
|
Facility
|
OP
|
$10.45
|
|
| Hospital Charge Code |
60627631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$3.97
|
| Rate for Payer: Aetna Medicare Advantage |
$3.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.66
|
| Rate for Payer: Cigna Commercial |
$5.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.13
|
| Rate for Payer: Oxford Commercial |
$2.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.28
|
|
|
GUANFACINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$78.12
|
|
|
Service Code
|
NDC 54092051302
|
| Hospital Charge Code |
6063943203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$39.06 |
| Rate for Payer: Aetna Commercial |
$29.69
|
| Rate for Payer: Aetna Medicare Advantage |
$23.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$19.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$19.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$19.92
|
| Rate for Payer: Cigna Commercial |
$39.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.44
|
| Rate for Payer: Oxford Commercial |
$15.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.07
|
|
|
GUANFACINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$78.12
|
|
|
Service Code
|
NDC 54092051302
|
| Hospital Charge Code |
6063943203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$11.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.72
|
|
|
GUARD K-WIRE PINK 0.078 IN
|
Facility
|
OP
|
$8.94
|
|
| Hospital Charge Code |
270680462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna Medicare Advantage |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.28
|
| Rate for Payer: Cigna Commercial |
$4.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.68
|
| Rate for Payer: Oxford Commercial |
$1.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.24
|
|
|
GUARD K-WIRE PINK 0.078 IN
|
Facility
|
IP
|
$8.94
|
|
| Hospital Charge Code |
270680462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.34
|
|
|
GUARD K-WIRE WHITE 0.045IN
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
270624092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
GUARD K-WIRE WHITE 0.045IN
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
270624092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.20
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
GUARD NDL & BLADE PLAS BX LG
|
Facility
|
OP
|
$62.40
|
|
| Hospital Charge Code |
270655634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Medicare Advantage |
$18.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.91
|
| Rate for Payer: Cigna Commercial |
$31.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.72
|
| Rate for Payer: Oxford Commercial |
$12.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.65
|
|
|
GUARD NDL & BLADE PLAS BX LG
|
Facility
|
IP
|
$62.40
|
|
| Hospital Charge Code |
270655634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.36
|
|
|
GUARD TEETH ADULT WHITE
|
Facility
|
IP
|
$45.83
|
|
| Hospital Charge Code |
270656637
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.87
|
|
|
GUARD TEETH ADULT WHITE
|
Facility
|
OP
|
$45.83
|
|
| Hospital Charge Code |
270656637
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna Medicare Advantage |
$13.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.69
|
| Rate for Payer: Cigna Commercial |
$22.91
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.75
|
| Rate for Payer: Oxford Commercial |
$9.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.21
|
|
|
GUARDUS OVERTUBE
|
Facility
|
IP
|
$376.00
|
|
| Hospital Charge Code |
270325687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$56.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.40
|
|
|
GUARDUS OVERTUBE
|
Facility
|
OP
|
$376.00
|
|
| Hospital Charge Code |
270325687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$142.88
|
| Rate for Payer: Aetna Medicare Advantage |
$112.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.88
|
| Rate for Payer: Cigna Commercial |
$188.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.80
|
| Rate for Payer: Oxford Commercial |
$75.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.96
|
|
|
GUDEIWIRE CHCE PT 185C 3893101
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270653632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna Commercial |
$163.40
|
| Rate for Payer: Aetna Medicare Advantage |
$129.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.65
|
| Rate for Payer: Cigna Commercial |
$215.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$94.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.39
|
|
|
GUDEIWIRE CHCE PT 185C 3893101
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270653632S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna Commercial |
$163.40
|
| Rate for Payer: Aetna Medicare Advantage |
$129.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.65
|
| Rate for Payer: Cigna Commercial |
$215.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$94.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.39
|
|
|
GUDEIWIRE CHCE PT 185C 3893101
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270653632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$94.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.50
|
|
|
GUDEIWIRE CHCE PT 185C 3893101
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270653632N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.95 |
| Max. Negotiated Rate |
$187.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$154.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$170.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.95
|
|
|
GUDEIWIRE CHCE PT 185C 3893101
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270653632S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$86.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$94.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.50
|
|
|
GUDEIWIRE CHCE PT 185C 3893101
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270653632N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$386.50 |
| Rate for Payer: Aetna Commercial |
$293.74
|
| Rate for Payer: Aetna Medicare Advantage |
$231.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$154.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.12
|
| Rate for Payer: Cigna Commercial |
$386.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$187.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$170.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.48
|
|
|
GUIATUSS AC/120ML
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
60633060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
|
|
GUIATUSS AC/120ML
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
60633060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna Medicare Advantage |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.83
|
| Rate for Payer: Cigna Commercial |
$7.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.50
|
| Rate for Payer: Oxford Commercial |
$3.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.40
|
|
