|
STENT CYPHER RX 3.5x8 CXS08350
|
Facility
|
IP
|
$13,625.00
|
|
| Hospital Charge Code |
270636792C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.75 |
| Max. Negotiated Rate |
$3,297.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
|
|
STENT CYPHER RX 3.5X8MM
|
Facility
|
OP
|
$13,516.00
|
|
| Hospital Charge Code |
270636792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$325.74 |
| Max. Negotiated Rate |
$6,758.00 |
| Rate for Payer: Aetna Commercial |
$5,136.08
|
| Rate for Payer: Aetna Medicare Advantage |
$4,054.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,446.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,446.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,703.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,446.58
|
| Rate for Payer: Cigna Commercial |
$6,758.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,270.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,973.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,027.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$325.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$358.17
|
|
|
STENT CYPHER RX 3.5X8MM
|
Facility
|
IP
|
$13,516.00
|
|
| Hospital Charge Code |
270636792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,027.40 |
| Max. Negotiated Rate |
$3,270.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,703.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,270.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,973.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,027.40
|
|
|
STENT CYPHEX RX 2.5X13MM
|
Facility
|
OP
|
$13,625.00
|
|
| Hospital Charge Code |
270636793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.36 |
| Max. Negotiated Rate |
$6,812.50 |
| Rate for Payer: Aetna Commercial |
$5,177.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,474.38
|
| Rate for Payer: Cigna Commercial |
$6,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$361.06
|
|
|
STENT CYPHEX RX 2.5X13MM
|
Facility
|
IP
|
$13,625.00
|
|
| Hospital Charge Code |
270636793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.75 |
| Max. Negotiated Rate |
$3,297.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
|
|
STENT CYPHEX RX 2.5X13MM
|
Facility
|
OP
|
$13,516.00
|
|
| Hospital Charge Code |
270636793C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$325.74 |
| Max. Negotiated Rate |
$6,758.00 |
| Rate for Payer: Aetna Commercial |
$5,136.08
|
| Rate for Payer: Aetna Medicare Advantage |
$4,054.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,446.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,446.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,703.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,446.58
|
| Rate for Payer: Cigna Commercial |
$6,758.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,270.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,973.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,027.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$325.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$358.17
|
|
|
STENT CYPHEX RX 2.5X13MM
|
Facility
|
IP
|
$13,516.00
|
|
| Hospital Charge Code |
270636793C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,027.40 |
| Max. Negotiated Rate |
$3,270.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,703.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,270.87
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,973.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,027.40
|
|
|
STENT CYPHR RX 2.25X23 CXS2325
|
Facility
|
OP
|
$8,900.00
|
|
| Hospital Charge Code |
270643065C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.49 |
| Max. Negotiated Rate |
$4,450.00 |
| Rate for Payer: Aetna Commercial |
$3,382.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,670.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,269.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,269.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,780.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,269.50
|
| Rate for Payer: Cigna Commercial |
$4,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,153.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,958.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,335.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$235.85
|
|
|
STENT CYPHR RX 2.25X23 CXS2325
|
Facility
|
IP
|
$8,900.00
|
|
| Hospital Charge Code |
270643065C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,335.00 |
| Max. Negotiated Rate |
$2,153.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,780.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,153.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,958.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,335.00
|
|
|
STENT CYPHR RX 2 5x18 CXS18250
|
Facility
|
OP
|
$13,625.00
|
|
| Hospital Charge Code |
270637304C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.36 |
| Max. Negotiated Rate |
$6,812.50 |
| Rate for Payer: Aetna Commercial |
$5,177.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,474.38
|
| Rate for Payer: Cigna Commercial |
$6,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$361.06
|
|
|
STENT CYPHR RX 2 5x18 CXS18250
|
Facility
|
IP
|
$13,625.00
|
|
| Hospital Charge Code |
270637304C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.75 |
| Max. Negotiated Rate |
$3,297.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
|
|
STENT CYPHR RX 2 5X18 CXS18250
|
Facility
|
OP
|
$13,625.00
|
|
| Hospital Charge Code |
270637304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.36 |
| Max. Negotiated Rate |
$6,812.50 |
| Rate for Payer: Aetna Commercial |
$5,177.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,474.38
|
| Rate for Payer: Cigna Commercial |
$6,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$361.06
|
|
|
STENT CYPHR RX 2 5X18 CXS18250
|
Facility
|
IP
|
$13,625.00
|
|
| Hospital Charge Code |
270637304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.75 |
| Max. Negotiated Rate |
$3,297.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
|
|
STENT CYPHR RX 2 5X23 CXS23250
|
Facility
|
IP
|
$13,625.00
|
|
| Hospital Charge Code |
270636963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.75 |
| Max. Negotiated Rate |
$3,297.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
|
|
STENT CYPHR RX 2 5X23 CXS23250
|
Facility
|
OP
|
$13,625.00
|
|
| Hospital Charge Code |
270636963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.36 |
| Max. Negotiated Rate |
$6,812.50 |
| Rate for Payer: Aetna Commercial |
$5,177.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,474.38
|
| Rate for Payer: Cigna Commercial |
$6,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$361.06
|
|
|
STENT CYPHR RX 2 5X23 CXS23250
|
Facility
|
OP
|
$13,625.00
|
|
| Hospital Charge Code |
270636963C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.36 |
| Max. Negotiated Rate |
$6,812.50 |
| Rate for Payer: Aetna Commercial |
$5,177.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,474.38
|
| Rate for Payer: Cigna Commercial |
$6,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$361.06
|
|
|
STENT CYPHR RX 2 5X23 CXS23250
|
Facility
|
IP
|
$13,625.00
|
|
| Hospital Charge Code |
270636963C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.75 |
| Max. Negotiated Rate |
$3,297.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
|
|
STENT CYPHR RX 2.5x28 CXS28250
|
Facility
|
OP
|
$13,625.00
|
|
| Hospital Charge Code |
270637719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.36 |
| Max. Negotiated Rate |
$6,812.50 |
| Rate for Payer: Aetna Commercial |
$5,177.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,474.38
|
| Rate for Payer: Cigna Commercial |
$6,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$361.06
|
|
|
STENT CYPHR RX 2.5x28 CXS28250
|
Facility
|
IP
|
$13,625.00
|
|
| Hospital Charge Code |
270637719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.75 |
| Max. Negotiated Rate |
$3,297.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
|
|
STENT CYPHR RX 2 5X28 CXS28250
|
Facility
|
OP
|
$13,625.00
|
|
| Hospital Charge Code |
270637719C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.36 |
| Max. Negotiated Rate |
$6,812.50 |
| Rate for Payer: Aetna Commercial |
$5,177.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,474.38
|
| Rate for Payer: Cigna Commercial |
$6,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$361.06
|
|
|
STENT CYPHR RX 2 5X28 CXS28250
|
Facility
|
IP
|
$13,625.00
|
|
| Hospital Charge Code |
270637719C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.75 |
| Max. Negotiated Rate |
$3,297.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
|
|
STENT CYPHR RX 2.5X8 CXS08250
|
Facility
|
IP
|
$13,625.00
|
|
| Hospital Charge Code |
270637330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.75 |
| Max. Negotiated Rate |
$3,297.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
|
|
STENT CYPHR RX 2.5X8 CXS08250
|
Facility
|
OP
|
$13,625.00
|
|
| Hospital Charge Code |
270637330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.36 |
| Max. Negotiated Rate |
$6,812.50 |
| Rate for Payer: Aetna Commercial |
$5,177.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,474.38
|
| Rate for Payer: Cigna Commercial |
$6,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$361.06
|
|
|
STENT CYPHR RX 3 0X13 CXS13300
|
Facility
|
IP
|
$13,625.00
|
|
| Hospital Charge Code |
270637113C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.75 |
| Max. Negotiated Rate |
$3,297.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
|
|
STENT CYPHR RX 3 0X13 CXS13300
|
Facility
|
OP
|
$13,625.00
|
|
| Hospital Charge Code |
270637113C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.36 |
| Max. Negotiated Rate |
$6,812.50 |
| Rate for Payer: Aetna Commercial |
$5,177.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,474.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,725.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,474.38
|
| Rate for Payer: Cigna Commercial |
$6,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,297.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,997.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,043.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$328.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$361.06
|
|