|
GUIDWIRE - TRAPEASE 6FR 502521
|
Facility
|
IP
|
$34.75
|
|
| Hospital Charge Code |
270629861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.41
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.21
|
|
|
GUIDWIRE - TRAPEASE 6FR 502521
|
Facility
|
OP
|
$34.75
|
|
| Hospital Charge Code |
270629861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Medicare Advantage |
$10.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.86
|
| Rate for Payer: Cigna Commercial |
$17.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.41
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.21
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.92
|
|
|
GUIDWIR NON THRD 2.0x250 27591
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270639194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna Commercial |
$262.20
|
| Rate for Payer: Aetna Medicare Advantage |
$207.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$175.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$175.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$175.95
|
| Rate for Payer: Cigna Commercial |
$345.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$166.98
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$151.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.29
|
|
|
GUIDWIR NON THRD 2.0x250 27591
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270639194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$166.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$138.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$166.98
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$151.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.50
|
|
|
GUIDWR BMW UNV II 190c1009664J
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,425.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$956.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$956.25
|
| Rate for Payer: Cigna Commercial |
$1,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$907.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$825.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$90.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$99.38
|
|
|
GUIDWR BMW UNV II 190c1009664J
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$907.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$825.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$562.50
|
|
|
GUIDZEBRA UROLOGICAL
|
Facility
|
OP
|
$453.77
|
|
| Hospital Charge Code |
270653658
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$226.88 |
| Rate for Payer: Aetna Commercial |
$172.43
|
| Rate for Payer: Aetna Medicare Advantage |
$136.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$115.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$115.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$115.71
|
| Rate for Payer: Cigna Commercial |
$226.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$136.13
|
| Rate for Payer: Oxford Commercial |
$90.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$90.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.02
|
|
|
GUIDZEBRA UROLOGICAL
|
Facility
|
IP
|
$453.77
|
|
| Hospital Charge Code |
270653658
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$68.07 |
| Max. Negotiated Rate |
$68.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.07
|
|
|
GUI WIR .09Mx100m .03K100.09S
|
Facility
|
IP
|
$37.50
|
|
| Hospital Charge Code |
270639854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.62
|
|
|
GUI WIR .09Mx100m .03K100.09S
|
Facility
|
OP
|
$37.50
|
|
| Hospital Charge Code |
270639854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: Aetna Medicare Advantage |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.56
|
| Rate for Payer: Cigna Commercial |
$18.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.25
|
| Rate for Payer: Oxford Commercial |
$7.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.99
|
|
|
GUI WIR 1.1Mx100m .045K10011S
|
Facility
|
IP
|
$37.50
|
|
| Hospital Charge Code |
270639855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.62
|
|
|
GUI WIR 1.1Mx100m .045K10011S
|
Facility
|
OP
|
$37.50
|
|
| Hospital Charge Code |
270639855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: Aetna Medicare Advantage |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.56
|
| Rate for Payer: Cigna Commercial |
$18.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.25
|
| Rate for Payer: Oxford Commercial |
$7.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.99
|
|
|
GUI/WIRE AMPLATZ STIFF.035/180
|
Facility
|
OP
|
$202.74
|
|
| Hospital Charge Code |
2709000697
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$101.37 |
| Rate for Payer: Aetna Commercial |
$77.04
|
| Rate for Payer: Aetna Medicare Advantage |
$60.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.70
|
| Rate for Payer: Cigna Commercial |
$101.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.82
|
| Rate for Payer: Oxford Commercial |
$40.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.37
|
|
|
GUI/WIRE AMPLATZ STIFF.035/180
|
Facility
|
IP
|
$202.74
|
|
| Hospital Charge Code |
2709000697
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$30.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.41
|
|
|
GUN INFLATION ALLIANCE II
|
Facility
|
OP
|
$778.95
|
|
| Hospital Charge Code |
270658166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$389.48 |
| Rate for Payer: Aetna Commercial |
$296.00
|
| Rate for Payer: Aetna Medicare Advantage |
$233.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$198.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$198.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$198.63
|
| Rate for Payer: Cigna Commercial |
$389.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$188.51
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$171.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.64
|
|
|
GUN INFLATION ALLIANCE II
|
Facility
|
IP
|
$778.95
|
|
| Hospital Charge Code |
270658166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$188.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$155.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$188.51
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$171.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.84
|
|
|
GUN MAXCORE 18G 16cm
|
Facility
|
IP
|
$177.09
|
|
| Hospital Charge Code |
270624452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.56 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.56
|
|
|
GUN MAXCORE 18G 16cm
|
Facility
|
OP
|
$177.09
|
|
| Hospital Charge Code |
270624452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$88.55 |
| Rate for Payer: Aetna Commercial |
$67.29
|
| Rate for Payer: Aetna Medicare Advantage |
$53.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.16
|
| Rate for Payer: Cigna Commercial |
$88.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.13
|
| Rate for Payer: Oxford Commercial |
$35.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.42
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.69
|
|
|
Gun Max Core 18G x 10CM
|
Facility
|
OP
|
$29.20
|
|
| Hospital Charge Code |
270655482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Aetna Commercial |
$11.10
|
| Rate for Payer: Aetna Medicare Advantage |
$8.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7.45
|
| Rate for Payer: Cigna Commercial |
$14.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.76
|
| Rate for Payer: Oxford Commercial |
$5.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.77
|
|
|
Gun Max Core 18G x 10CM
|
Facility
|
IP
|
$29.20
|
|
| Hospital Charge Code |
270655482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.38
|
|
|
GUN MAX CORE 18G X 10CM
|
Facility
|
OP
|
$146.00
|
|
| Hospital Charge Code |
2709001228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$55.48
|
| Rate for Payer: Aetna Medicare Advantage |
$43.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.23
|
| Rate for Payer: Cigna Commercial |
$73.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.80
|
| Rate for Payer: Oxford Commercial |
$29.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.87
|
|
|
GUN MAX CORE 18G X 10CM
|
Facility
|
IP
|
$146.00
|
|
| Hospital Charge Code |
2709001228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$21.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.90
|
|
|
GUN MAX CORE 18G X 16CM 5/BX
|
Facility
|
OP
|
$146.00
|
|
| Hospital Charge Code |
2706000706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$55.48
|
| Rate for Payer: Aetna Medicare Advantage |
$43.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.23
|
| Rate for Payer: Cigna Commercial |
$73.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.80
|
| Rate for Payer: Oxford Commercial |
$29.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.87
|
|
|
GUN MAX CORE 18G X 16CM 5/BX
|
Facility
|
IP
|
$146.00
|
|
| Hospital Charge Code |
2706000706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$21.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.90
|
|
|
GUN MAX CORE 18G X 16CM 5/BX
|
Facility
|
IP
|
$146.00
|
|
| Hospital Charge Code |
2706000702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$21.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.90
|
|