|
GUIDEWIRE NIT 18X60 MAK001N60
|
Facility
|
IP
|
$164.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270660310S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$39.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$32.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$36.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.71
|
|
|
GUIDEWIRE NIT 18X60 MAK001N60
|
Facility
|
OP
|
$171.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270660310N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$85.75 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna Medicare Advantage |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.73
|
| Rate for Payer: Cigna Commercial |
$85.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$37.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.54
|
|
|
GUIDEWIRE NIT 18X60 MAK001N60
|
Facility
|
IP
|
$171.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270660310N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$41.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$37.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.73
|
|
|
GUIDEWIRE NITINOL 1.4 MMX457
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270692234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$110.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.25
|
|
|
GUIDEWIRE NITINOL 1.4 MMX457
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270692234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$110.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
GUIDE WIRE NON COLORED 2x230MM
|
Facility
|
OP
|
$168.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270645547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$63.99
|
| Rate for Payer: Aetna Medicare Advantage |
$50.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.94
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$37.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.26
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.46
|
|
|
GUIDE WIRE NON COLORED 2x230MM
|
Facility
|
IP
|
$168.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270645547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$40.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$33.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$37.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.26
|
|
|
GUIDEWIRE NONTHREAD 1.25X150MM
|
Facility
|
IP
|
$125.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$30.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.46
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$27.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.88
|
|
|
GUIDEWIRE NONTHREAD 1.25X150MM
|
Facility
|
OP
|
$125.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$62.92 |
| Rate for Payer: Aetna Commercial |
$47.82
|
| Rate for Payer: Aetna Medicare Advantage |
$37.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.09
|
| Rate for Payer: Cigna Commercial |
$62.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.46
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$27.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.34
|
|
|
GUIDEWIRE NOVAGOLD .018 260cm
|
Facility
|
IP
|
$977.45
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270675453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.62 |
| Max. Negotiated Rate |
$236.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.54
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$215.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.62
|
|
|
GUIDEWIRE NOVAGOLD .018 260cm
|
Facility
|
OP
|
$977.45
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270675453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$488.73 |
| Rate for Payer: Aetna Commercial |
$371.43
|
| Rate for Payer: Aetna Medicare Advantage |
$293.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$249.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$249.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$249.25
|
| Rate for Payer: Cigna Commercial |
$488.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.54
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$215.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.90
|
|
|
GUIDEWIRE NOVA GOLD 0.18x450cm
|
Facility
|
IP
|
$977.45
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270683529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.62 |
| Max. Negotiated Rate |
$236.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.54
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$215.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.62
|
|
|
GUIDEWIRE NOVA GOLD 0.18x450cm
|
Facility
|
OP
|
$977.45
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270683529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$488.73 |
| Rate for Payer: Aetna Commercial |
$371.43
|
| Rate for Payer: Aetna Medicare Advantage |
$293.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$249.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$249.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$195.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$249.25
|
| Rate for Payer: Cigna Commercial |
$488.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.54
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$215.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.90
|
|
|
GUIDEWIRE PANTA2 3.2X600MM
|
Facility
|
OP
|
$1,905.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.91 |
| Max. Negotiated Rate |
$952.50 |
| Rate for Payer: Aetna Commercial |
$723.90
|
| Rate for Payer: Aetna Medicare Advantage |
$571.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$485.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$485.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$381.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$485.77
|
| Rate for Payer: Cigna Commercial |
$952.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$461.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$419.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.48
|
|
|
GUIDEWIRE PANTA2 3.2X600MM
|
Facility
|
IP
|
$1,905.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.75 |
| Max. Negotiated Rate |
$461.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$381.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$461.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$419.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.75
|
|
|
GUIDEWIRE PRIMEWIRE J DS 185CM
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270646539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.25 |
| Max. Negotiated Rate |
$816.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$675.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$816.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$742.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
|
|
GUIDEWIRE PRIMEWIRE J DS 185CM
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270646539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.34 |
| Max. Negotiated Rate |
$1,687.50 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,012.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.62
|
| Rate for Payer: Cigna Commercial |
$1,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$816.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$742.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$81.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$89.44
|
|
|
GUIDEWIRE PRIMEWIRE J DS 185CM
|
Facility
|
IP
|
$3,375.00
|
|
| Hospital Charge Code |
270643087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.25 |
| Max. Negotiated Rate |
$816.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$675.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$816.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$742.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
|
|
GUIDEWIRE PRIMEWIRE J DS 185CM
|
Facility
|
OP
|
$3,125.00
|
|
| Hospital Charge Code |
270643087C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.31 |
| Max. Negotiated Rate |
$1,562.50 |
| Rate for Payer: Aetna Commercial |
$1,187.50
|
| Rate for Payer: Aetna Medicare Advantage |
$937.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$796.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$796.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$625.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$796.88
|
| Rate for Payer: Cigna Commercial |
$1,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$756.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$687.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$468.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$75.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.81
|
|
|
GUIDEWIRE PRIMEWIRE J DS 185CM
|
Facility
|
IP
|
$3,125.00
|
|
| Hospital Charge Code |
270643087C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.75 |
| Max. Negotiated Rate |
$756.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$756.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$687.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$468.75
|
|
|
GUIDEWIRE PRIMEWIRE J DS 185CM
|
Facility
|
OP
|
$3,375.00
|
|
| Hospital Charge Code |
270643087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.34 |
| Max. Negotiated Rate |
$1,687.50 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,012.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.62
|
| Rate for Payer: Cigna Commercial |
$1,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$816.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$742.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$81.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$89.44
|
|
|
GUIDEWIRE PROWATER 180 1277601
|
Facility
|
OP
|
$1,700.00
|
|
| Hospital Charge Code |
270363741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.97 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$646.00
|
| Rate for Payer: Aetna Medicare Advantage |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$433.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$433.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$433.50
|
| Rate for Payer: Cigna Commercial |
$850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$510.00
|
| Rate for Payer: Oxford Commercial |
$340.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$340.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$40.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.05
|
|
|
GUIDEWIRE PROWATER 180 1277601
|
Facility
|
IP
|
$1,700.00
|
|
| Hospital Charge Code |
270363741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$255.00
|
|
|
GUIDEWIRE PROWATER 300 1493501
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$27.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.83
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$25.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
|
|
GUIDEWIRE PROWATER 300 1493501
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270636742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare Advantage |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.32
|
| Rate for Payer: Cigna Commercial |
$57.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.83
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$25.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.05
|
|
