|
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 180CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
270663284
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$22.15 |
| 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 |
$202.80
|
| 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 |
$24.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.15
|
|
|
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: Qualcare PPO/HMO/WC |
$143.44
|
|
|
GLIDEWIRE GM 75 DEG 300C
|
Facility
|
OP
|
$956.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663287S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.16 |
| 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: Qualcare PPO/HMO/WC |
$143.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.16
|
|
|
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: Qualcare PPO/HMO/WC |
$187.50
|
|
|
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 |
$35.50 |
| 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: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.50
|
|
|
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: Qualcare PPO/HMO/WC |
$33.75
|
|
|
GLIDEWIRE GM 75 DEG 300C
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270663287N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.39 |
| 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: Qualcare PPO/HMO/WC |
$33.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.39
|
|
|
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 |
$31.24 |
| 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: Qualcare PPO/HMO/WC |
$165.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.24
|
|
|
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: Qualcare PPO/HMO/WC |
$165.00
|
|
|
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: Qualcare PPO/HMO/WC |
$147.87
|
|
|
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 |
$28.00 |
| 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: Qualcare PPO/HMO/WC |
$147.87
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.00
|
|
|
GLIDEWIRE GT 90/30 DBL ANGLE 0
|
Facility
|
OP
|
$985.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270638426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| 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: Qualcare PPO/HMO/WC |
$147.87
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.00
|
|
|
GLIDEWIRE GT 90/30 DBL ANGLE 0
|
Facility
|
IP
|
$985.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270638426
|
|
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: Qualcare PPO/HMO/WC |
$147.87
|
|
|
GLIDEWIRE HYDRO SM H20STDA1880
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270658300N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Medicare Advantage |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$66.30
|
| Rate for Payer: Cigna Commercial |
$130.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.38
|
|
|
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: Qualcare PPO/HMO/WC |
$39.00
|
|
|
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: 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 |
$7.10 |
| 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: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.10
|
|
|
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: Qualcare PPO/HMO/WC |
$37.50
|
|
|
GLIDEWIRE HYDRO SM H20STDA1880
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270658300S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.10 |
| 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: Qualcare PPO/HMO/WC |
$37.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.10
|
|
|
GLIDEWIRE MT .025 46-125
|
Facility
|
OP
|
$305.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270620431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$152.62 |
| Rate for Payer: Aetna Commercial |
$116.00
|
| Rate for Payer: Aetna Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$77.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$77.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$77.84
|
| Rate for Payer: Cigna Commercial |
$152.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.67
|
|
|
GLIDEWIRE MT .025 46-125
|
Facility
|
IP
|
$305.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270620431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$61.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.79
|
|
|
GLIDEWIRE STD .035 260CM 3CM
|
Facility
|
IP
|
$289.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270698331S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.48 |
| Max. Negotiated Rate |
$70.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.48
|
|
|
GLIDEWIRE STD .035 260CM 3CM
|
Facility
|
OP
|
$289.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270698331S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$144.93 |
| Rate for Payer: Aetna Commercial |
$110.14
|
| Rate for Payer: Aetna Medicare Advantage |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$73.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$73.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$57.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$73.91
|
| Rate for Payer: Cigna Commercial |
$144.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.16
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.23
|
|
|
GLIDEWIRE STIFF SHAFT
|
Facility
|
IP
|
$242.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270658279S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$58.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$48.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$58.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.34
|
|
