|
GUANFACINE 1 MG TAB
|
Facility
|
OP
|
$10.45
|
|
| Hospital Charge Code |
60627631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| 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 |
$1.36
|
| Rate for Payer: Oxford Commercial |
$5.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.22
|
|
|
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
|
|
|
GUANFACINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$78.12
|
|
|
Service Code
|
NDC 54092051302
|
| Hospital Charge Code |
6063943203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$39.06 |
| Rate for Payer: Aetna Commercial |
$23.44
|
| 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 |
$10.16
|
| Rate for Payer: Oxford Commercial |
$39.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$11.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$39.06
|
|
|
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 PINK 0.078 IN
|
Facility
|
OP
|
$8.94
|
|
| Hospital Charge Code |
270680462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$2.68
|
| 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 |
$1.16
|
| Rate for Payer: Oxford Commercial |
$4.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.47
|
|
|
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 |
$0.52 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| 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 |
$0.52
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
|
|
GUARD NDL & BLADE PLAS BX LG
|
Facility
|
OP
|
$62.40
|
|
| Hospital Charge Code |
270655634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| 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 |
$8.11
|
| Rate for Payer: Oxford Commercial |
$31.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.20
|
|
|
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
|
OP
|
$45.83
|
|
| Hospital Charge Code |
270656637
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna Commercial |
$13.75
|
| 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 |
$5.96
|
| Rate for Payer: Oxford Commercial |
$22.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.91
|
|
|
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
|
|
|
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 |
$48.88 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$112.80
|
| 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 |
$48.88
|
| Rate for Payer: Oxford Commercial |
$188.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$188.00
|
|
|
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: 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: Qualcare PPO/HMO/WC |
$115.95
|
|
|
GUDEIWIRE CHCE PT 185C 3893101
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270653632S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna Commercial |
$129.00
|
| 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: 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 |
$115.95 |
| Max. Negotiated Rate |
$386.50 |
| Rate for Payer: Aetna Commercial |
$231.90
|
| 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: Qualcare PPO/HMO/WC |
$115.95
|
|
|
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: Qualcare PPO/HMO/WC |
$64.50
|
|
|
GUDEIWIRE CHCE PT 185C 3893101
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270653632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna Commercial |
$129.00
|
| 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: Qualcare PPO/HMO/WC |
$64.50
|
|
|
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 |
$1.95 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| 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 |
$1.95
|
| Rate for Payer: Oxford Commercial |
$7.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.50
|
|
|
GUIDANCE FOR NDL BRST-GL
|
Facility
|
OP
|
$306.45
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
85000050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.84 |
| Max. Negotiated Rate |
$3,933.12 |
| Rate for Payer: Aetna Commercial |
$91.94
|
| Rate for Payer: Aetna Medicare Advantage |
$91.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.14
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.84
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
GUIDANCE FOR NDL BRST-GL
|
Facility
|
IP
|
$306.45
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
85000050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.97 |
| Max. Negotiated Rate |
$45.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.97
|
|
|
GUIDANCE FOR NDL BRST-PC
|
Facility
|
IP
|
$147.20
|
|
|
Service Code
|
HCPCS 7703226
|
| Hospital Charge Code |
85000060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.08
|
|
|
GUIDANCE FOR NDL BRST-PC
|
Facility
|
OP
|
$147.20
|
|
|
Service Code
|
HCPCS 7703226
|
| Hospital Charge Code |
85000060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$44.16
|
| Rate for Payer: Aetna Medicare Advantage |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.54
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.14
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
