|
GLIDEWIRE GM 45 GED 180CM
|
Facility
|
OP
|
$662.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$331.25 |
| Rate for Payer: Aetna Commercial |
$251.75
|
| Rate for Payer: Aetna Medicare Advantage |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.94
|
| Rate for Payer: Cigna Commercial |
$331.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.32
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.56
|
|
|
GLIDEWIRE GM 45 GED 180CM
|
Facility
|
IP
|
$662.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.38 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.32
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.38
|
|
|
GLIDEWIRE GM 45 GED 180CM
|
Facility
|
OP
|
$662.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663283S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$331.25 |
| Rate for Payer: Aetna Commercial |
$251.75
|
| Rate for Payer: Aetna Medicare Advantage |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.94
|
| Rate for Payer: Cigna Commercial |
$331.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.32
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$145.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.56
|
|
|
GLIDEWIRE GM 75 DEG 180CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
270663284
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$296.40
|
| Rate for Payer: Aetna Medicare Advantage |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$198.90
|
| Rate for Payer: Cigna Commercial |
$390.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$234.00
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$117.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.67
|
|
|
GLIDEWIRE GM 75 DEG 180CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
270663284
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$117.00
|
|
|
GLIDEWIRE GM 75 DEG 300C
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$275.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
GLIDEWIRE GM 75 DEG 300C
|
Facility
|
IP
|
$956.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663287S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.44 |
| Max. Negotiated Rate |
$231.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$191.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.41
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$210.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$143.44
|
|
|
GLIDEWIRE GM 75 DEG 300C
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$275.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.12
|
|
|
GLIDEWIRE GM 75 DEG 300C
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663287N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$49.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
|
|
GLIDEWIRE GM 75 DEG 300C
|
Facility
|
OP
|
$956.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663287S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$478.12 |
| Rate for Payer: Aetna Commercial |
$363.38
|
| Rate for Payer: Aetna Medicare Advantage |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$243.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$243.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$243.84
|
| Rate for Payer: Cigna Commercial |
$478.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$231.41
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$210.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$143.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.34
|
|
|
GLIDEWIRE GM 75 DEG 300C
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663287N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$57.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$57.38
|
| Rate for Payer: Cigna Commercial |
$112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$54.45
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$49.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.96
|
|
|
GLIDEWIREGOL70DEGANG 018X180CM
|
Facility
|
IP
|
$1,450.00
|
|
| Hospital Charge Code |
2709003496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$217.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.50
|
|
|
GLIDEWIREGOL70DEGANG 018X180CM
|
Facility
|
OP
|
$1,450.00
|
|
| Hospital Charge Code |
2709003496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Medicare Advantage |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$369.75
|
| Rate for Payer: Cigna Commercial |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$435.00
|
| Rate for Payer: Oxford Commercial |
$290.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$290.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.42
|
|
|
GLIDEWIRE GOLD 70 DEGREE ANGLE
|
Facility
|
IP
|
$1,450.00
|
|
| Hospital Charge Code |
270CH0068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$217.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.50
|
|
|
GLIDEWIRE GOLD 70 DEGREE ANGLE
|
Facility
|
OP
|
$1,450.00
|
|
| Hospital Charge Code |
270CH0068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Medicare Advantage |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$369.75
|
| Rate for Payer: Cigna Commercial |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$435.00
|
| Rate for Payer: Oxford Commercial |
$290.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$290.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.42
|
|
|
GLIDEWIRE GT 90/30 DBL ANGLE 0
|
Facility
|
IP
|
$985.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270638426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$238.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$216.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.82
|
|
|
GLIDEWIRE GT 90/30 DBL ANGLE 0
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270638426N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$266.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$242.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
|
|
GLIDEWIRE GT 90/30 DBL ANGLE 0
|
Facility
|
OP
|
$985.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270638426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$492.75 |
| Rate for Payer: Aetna Commercial |
$374.49
|
| Rate for Payer: Aetna Medicare Advantage |
$295.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$251.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$251.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$251.30
|
| Rate for Payer: Cigna Commercial |
$492.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.49
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$216.81
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.12
|
|
|
GLIDEWIRE GT 90/30 DBL ANGLE 0
|
Facility
|
IP
|
$985.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270638426S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.87 |
| Max. Negotiated Rate |
$238.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$216.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.87
|
|
|
GLIDEWIRE GT 90/30 DBL ANGLE 0
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270638426N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$418.00
|
| Rate for Payer: Aetna Medicare Advantage |
$330.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$280.50
|
| Rate for Payer: Cigna Commercial |
$550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$242.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$29.15
|
|
|
GLIDEWIRE GT 90/30 DBL ANGLE 0
|
Facility
|
OP
|
$985.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270638426S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$492.90 |
| Rate for Payer: Aetna Commercial |
$374.60
|
| Rate for Payer: Aetna Medicare Advantage |
$295.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$251.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$251.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$197.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$251.38
|
| Rate for Payer: Cigna Commercial |
$492.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.56
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$216.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.87
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.12
|
|
|
GLIDEWIRE HYDRO SM H20STDA1880
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270658300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$60.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$55.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
GLIDEWIRE HYDRO SM H20STDA1880
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270658300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$63.75
|
| Rate for Payer: Cigna Commercial |
$125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$55.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.62
|
|
|
GLIDEWIRE HYDRO SM H20STDA1880
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270658300S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$60.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$50.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$55.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$37.50
|
|
|
GLIDEWIRE HYDRO SM H20STDA1880
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270658300N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$62.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$57.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
