|
STENT EVERFLEX 7MMx120MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270638403S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 7MMx60MM 120CM
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270639645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.45 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$990.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$108.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$119.25
|
|
|
STENT EVERFLEX 7MMx60MM 120CM
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270639645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$990.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$990.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.45 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$990.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$108.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$119.25
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.45 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$2,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$990.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$108.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$119.25
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
IP
|
$6,624.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.72 |
| Max. Negotiated Rate |
$1,603.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,603.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,457.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.72
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
OP
|
$6,624.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.66 |
| Max. Negotiated Rate |
$3,312.40 |
| Rate for Payer: Aetna Commercial |
$2,517.42
|
| Rate for Payer: Aetna Medicare Advantage |
$1,987.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,689.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,689.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,689.32
|
| Rate for Payer: Cigna Commercial |
$3,312.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,603.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,457.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.72
|
| Rate for Payer: UnitedHealthcare Community & State |
$159.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$175.56
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$990.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$675.00
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$120.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$132.50
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008A
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008A
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$120.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$132.50
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$120.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$132.50
|
|
|
STENT EVERFLEX PROT G 5X20X12
|
Facility
|
IP
|
$6,624.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.72 |
| Max. Negotiated Rate |
$1,603.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,603.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,457.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.72
|
|
|
STENT EVERFLEX PROT G 5X20X12
|
Facility
|
OP
|
$6,624.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683572N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.66 |
| Max. Negotiated Rate |
$3,312.40 |
| Rate for Payer: Aetna Commercial |
$2,517.42
|
| Rate for Payer: Aetna Medicare Advantage |
$1,987.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,689.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,689.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,689.32
|
| Rate for Payer: Cigna Commercial |
$3,312.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,603.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,457.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.72
|
| Rate for Payer: UnitedHealthcare Community & State |
$159.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$175.56
|
|
|
STENT EVERFLEX PROT G 5X20X12
|
Facility
|
OP
|
$6,624.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.66 |
| Max. Negotiated Rate |
$3,312.40 |
| Rate for Payer: Aetna Commercial |
$2,517.42
|
| Rate for Payer: Aetna Medicare Advantage |
$1,987.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,689.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,689.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,689.32
|
| Rate for Payer: Cigna Commercial |
$3,312.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,603.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,457.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.72
|
| Rate for Payer: UnitedHealthcare Community & State |
$159.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$175.56
|
|
|
STENT EVERFLEX PROT G 5X20X12
|
Facility
|
IP
|
$6,624.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683572N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.72 |
| Max. Negotiated Rate |
$1,603.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,603.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,457.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.72
|
|
|
STENT EVER PROT 8 0X20
|
Facility
|
IP
|
$7,350.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270662303S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.50 |
| Max. Negotiated Rate |
$1,778.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,470.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,778.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,617.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,102.50
|
|
|
STENT EVER PROT 8 0X20
|
Facility
|
IP
|
$7,350.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270662303N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.50 |
| Max. Negotiated Rate |
$1,778.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,470.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,778.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,617.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,102.50
|
|
|
STENT EVER PROT 8 0X20
|
Facility
|
OP
|
$7,350.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270662303N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.13 |
| Max. Negotiated Rate |
$3,675.00 |
| Rate for Payer: Aetna Commercial |
$2,793.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,874.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,874.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,874.25
|
| Rate for Payer: Cigna Commercial |
$3,675.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,778.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,617.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,102.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$177.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$194.78
|
|
|
STENT EVER PROT 8 0X20
|
Facility
|
OP
|
$7,350.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270662303S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.13 |
| Max. Negotiated Rate |
$3,675.00 |
| Rate for Payer: Aetna Commercial |
$2,793.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,874.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,874.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,874.25
|
| Rate for Payer: Cigna Commercial |
$3,675.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,778.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,617.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,102.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$177.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$194.78
|
|
|
STENT EVER PROT 8 0X20
|
Facility
|
OP
|
$7,350.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270662303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.13 |
| Max. Negotiated Rate |
$3,675.00 |
| Rate for Payer: Aetna Commercial |
$2,793.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,874.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,874.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,874.25
|
| Rate for Payer: Cigna Commercial |
$3,675.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,778.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,617.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,102.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$177.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$194.78
|
|
|
STENT EVER PROT 8 0X20
|
Facility
|
IP
|
$7,350.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270662303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.50 |
| Max. Negotiated Rate |
$1,778.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,470.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,778.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,617.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,102.50
|
|
