|
GUIDEWIRE 0.18LT
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270652342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$100.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$83.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$62.25
|
|
|
GUIDEWIRE .025 J TIP FIXEDCORE
|
Facility
|
OP
|
$32.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270657705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$12.35
|
| Rate for Payer: Aetna Medicare Advantage |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.29
|
| Rate for Payer: Cigna Commercial |
$16.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.92
|
|
|
GUIDEWIRE .025 J TIP FIXEDCORE
|
Facility
|
IP
|
$32.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270657705S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$7.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.88
|
|
|
GUIDEWIRE .025 J TIP FIXEDCORE
|
Facility
|
OP
|
$32.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270657705S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$12.35
|
| Rate for Payer: Aetna Medicare Advantage |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.29
|
| Rate for Payer: Cigna Commercial |
$16.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.92
|
|
|
GUIDEWIRE .025 J TIP FIXEDCORE
|
Facility
|
OP
|
$6.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270657705N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Medicare Advantage |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.66
|
| Rate for Payer: Cigna Commercial |
$3.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.98
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.18
|
|
|
GUIDEWIRE .025 J TIP FIXEDCORE
|
Facility
|
IP
|
$6.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270657705N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.98
|
|
|
GUIDEWIRE .025 J TIP FIXEDCORE
|
Facility
|
IP
|
$32.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270657705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$7.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.88
|
|
|
GUIDEWIRE .035 145cm
|
Facility
|
IP
|
$51.50
|
|
| Hospital Charge Code |
270626851
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.72
|
|
|
GUIDEWIRE .035 145cm
|
Facility
|
OP
|
$51.50
|
|
| Hospital Charge Code |
270626851
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$25.75 |
| Rate for Payer: Aetna Commercial |
$19.57
|
| Rate for Payer: Aetna Medicare Advantage |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.13
|
| Rate for Payer: Cigna Commercial |
$25.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.39
|
| Rate for Payer: Oxford Commercial |
$10.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.46
|
|
|
GUIDEWIRE 0.35 260cm
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270645893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$304.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.72
|
|
|
GUIDEWIRE 0.35 260cm
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270645893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$193.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$160.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$193.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
GUIDEWIRE .035 260CM ANGL
|
Facility
|
IP
|
$1,612.50
|
|
| Hospital Charge Code |
270642562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.88 |
| Max. Negotiated Rate |
$390.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$322.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$390.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$241.88
|
|
|
GUIDEWIRE .035 260CM ANGL
|
Facility
|
OP
|
$1,612.50
|
|
| Hospital Charge Code |
270642562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$806.25 |
| Rate for Payer: Aetna Commercial |
$612.75
|
| Rate for Payer: Aetna Medicare Advantage |
$483.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$411.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$411.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$322.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$411.19
|
| Rate for Payer: Cigna Commercial |
$806.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$390.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$241.88
|
| Rate for Payer: UnitedHealthcare Community & State |
$50.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.80
|
|
|
GUIDEWIRE .035 260CM ANGL
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642562S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$55.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
|
|
GUIDEWIRE .035 260CM ANGL
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642562S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Medicare Advantage |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.65
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.53
|
|
|
GUIDEWIRE .035 DUAL FLEX STR
|
Facility
|
OP
|
$374.66
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270625399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$187.33 |
| Rate for Payer: Aetna Commercial |
$142.37
|
| Rate for Payer: Aetna Medicare Advantage |
$112.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.54
|
| Rate for Payer: Cigna Commercial |
$187.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.64
|
|
|
GUIDEWIRE .035 DUAL FLEX STR
|
Facility
|
IP
|
$374.66
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270625399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$90.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.20
|
|
|
GUIDEWIRE .035 MM
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270682455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$22.99 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.25
|
|
|
GUIDEWIRE .035 MM
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270682455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Medicare Advantage |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$19.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.23
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.99
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.70
|
|
|
GUIDEWIRE .035x150CM
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270676578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.52
|
|
|
GUIDEWIRE .035x150CM
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270676578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
GUIDEWIRE .035x150CM
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270676578N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.52
|
|
|
GUIDEWIRE .035x150CM
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270676578N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
GUIDEWIRE .038 STRAIGHT TIP
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
270331441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Medicare Advantage |
$24.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.91
|
| Rate for Payer: Cigna Commercial |
$41.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.33
|
|
|
GUIDEWIRE .038 STRAIGHT TIP
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
270331441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.30
|
|