|
STENT BIL PL 7x18x80 PB1870BSS
|
Facility
|
OP
|
$7,167.25
|
|
| Hospital Charge Code |
270635362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.73 |
| Max. Negotiated Rate |
$3,583.62 |
| Rate for Payer: Aetna Commercial |
$2,723.55
|
| Rate for Payer: Aetna Medicare Advantage |
$2,150.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,827.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,827.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,433.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,827.65
|
| Rate for Payer: Cigna Commercial |
$3,583.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,734.47
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,576.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,075.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$172.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$189.93
|
|
|
STENT BIL PL 7x18x80 PB1870BSS
|
Facility
|
IP
|
$7,167.25
|
|
| Hospital Charge Code |
270635362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.09 |
| Max. Negotiated Rate |
$1,734.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,433.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,734.47
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,576.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,075.09
|
|
|
STENT BIL SENT 8x81 38948-8807
|
Facility
|
OP
|
$7,475.00
|
|
| Hospital Charge Code |
270638511V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.15 |
| Max. Negotiated Rate |
$3,737.50 |
| Rate for Payer: Aetna Commercial |
$2,840.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,906.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,906.12
|
| Rate for Payer: Cigna Commercial |
$3,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,644.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$180.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.09
|
|
|
STENT BIL SENT 8x81 38948-8807
|
Facility
|
IP
|
$7,475.00
|
|
| Hospital Charge Code |
270638511V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.25 |
| Max. Negotiated Rate |
$1,808.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,808.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,644.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,121.25
|
|
|
STENT BIOMIM 3D SWIR FLW 5x100
|
Facility
|
IP
|
$5,750.00
|
|
| Hospital Charge Code |
270705366
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$862.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
STENT BIOMIM 3D SWIR FLW 5x100
|
Facility
|
OP
|
$5,750.00
|
|
| Hospital Charge Code |
270705366
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$138.57 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,185.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,725.00
|
| Rate for Payer: Oxford Commercial |
$1,150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$138.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$152.38
|
|
|
STENT BIOMIM 3D SWIR FLW 5x125
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
270705367
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$86.25 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
|
|
STENT BIOMIM 3D SWIR FLW 5x125
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
270705367
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$218.50
|
| Rate for Payer: Aetna Medicare Advantage |
$172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$146.62
|
| Rate for Payer: Cigna Commercial |
$287.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$172.50
|
| Rate for Payer: Oxford Commercial |
$115.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$86.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$115.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.24
|
|
|
STENT BIOMIM 3D SWIR FLW 5x150
|
Facility
|
OP
|
$5,750.00
|
|
| Hospital Charge Code |
270705368
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$138.57 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,185.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,725.00
|
| Rate for Payer: Oxford Commercial |
$1,150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$138.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$152.38
|
|
|
STENT BIOMIM 3D SWIR FLW 5x150
|
Facility
|
IP
|
$5,750.00
|
|
| Hospital Charge Code |
270705368
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$862.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
STENT BIOMIM 3D SWIR FLW 5x60
|
Facility
|
OP
|
$5,250.00
|
|
| Hospital Charge Code |
270705369
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,995.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,575.00
|
| Rate for Payer: Oxford Commercial |
$1,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.12
|
|
|
STENT BIOMIM 3D SWIR FLW 5x60
|
Facility
|
IP
|
$5,250.00
|
|
| Hospital Charge Code |
270705369
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
STENT BIOMIM 3D SWIR FLW 6x100
|
Facility
|
OP
|
$5,750.00
|
|
| Hospital Charge Code |
270705370
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$138.57 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,185.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,725.00
|
| Rate for Payer: Oxford Commercial |
$1,150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$138.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$152.38
|
|
|
STENT BIOMIM 3D SWIR FLW 6x100
|
Facility
|
IP
|
$5,750.00
|
|
| Hospital Charge Code |
270705370
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$862.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
STENT BIOMIM 3D SWIR FLW 6x125
|
Facility
|
OP
|
$5,750.00
|
|
| Hospital Charge Code |
270705371
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$138.57 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,185.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,725.00
|
| Rate for Payer: Oxford Commercial |
$1,150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$138.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$152.38
|
|
|
STENT BIOMIM 3D SWIR FLW 6x125
|
Facility
|
IP
|
$5,750.00
|
|
| Hospital Charge Code |
270705371
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$862.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
STENT BIOMIM 3D SWIR FLW 6x150
|
Facility
|
IP
|
$5,750.00
|
|
| Hospital Charge Code |
270705440
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$862.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|
|
STENT BIOMIM 3D SWIR FLW 6x150
|
Facility
|
OP
|
$5,750.00
|
|
| Hospital Charge Code |
270705440
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$138.57 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,185.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,466.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,466.25
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,725.00
|
| Rate for Payer: Oxford Commercial |
$1,150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$138.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$152.38
|
|
|
STENT BIOMIM 3D SWIR FLW 6x60
|
Facility
|
OP
|
$5,250.00
|
|
| Hospital Charge Code |
270705377
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,995.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,575.00
|
| Rate for Payer: Oxford Commercial |
$1,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.12
|
|
|
STENT BIOMIM 3D SWIR FLW 6x60
|
Facility
|
IP
|
$5,250.00
|
|
| Hospital Charge Code |
270705373
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
STENT BIOMIM 3D SWIR FLW 6x60
|
Facility
|
IP
|
$5,250.00
|
|
| Hospital Charge Code |
270705377
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
STENT BIOMIM 3D SWIR FLW 6x60
|
Facility
|
OP
|
$5,250.00
|
|
| Hospital Charge Code |
270705373
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,995.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,575.00
|
| Rate for Payer: Oxford Commercial |
$1,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.12
|
|
|
STENT BIOMIM 3D SWIR FLW 6x80
|
Facility
|
IP
|
$5,250.00
|
|
| Hospital Charge Code |
270705374
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
STENT BIOMIM 3D SWIR FLW 6x80
|
Facility
|
OP
|
$5,250.00
|
|
| Hospital Charge Code |
270705374
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,995.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,575.00
|
| Rate for Payer: Oxford Commercial |
$1,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.12
|
|
|
STENT BIOMIM 3D SWIR FLW 7x100
|
Facility
|
IP
|
$5,750.00
|
|
| Hospital Charge Code |
270705375
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$862.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$862.50
|
|