|
STENT RESOLUTE 40.0X18 DES RX
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270650361C
|
|
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 RESOLUTE 40.0X22 DES RX
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270650362C
|
|
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 RESOLUTE 40.0X22 DES RX
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270650362C
|
|
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 RESOLUTE 40.0X26 DES RX
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270650363C
|
|
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 RESOLUTE 40.0X26 DES RX
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270650363C
|
|
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 RESOLUTE 40.0X30 DES RX
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270650364C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,540.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
STENT RESOLUTE 40.0X30 DES RX
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270650364C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.70 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,540.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$168.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$185.50
|
|
|
STENT RESOLUTE 4.0X12 DES RX
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270650359C
|
|
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 RESOLUTE 4.0X12 DES RX
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270650359C
|
|
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 RESOLUTE ONYX 2.00 x 12
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.49 |
| Max. Negotiated Rate |
$2,437.50 |
| Rate for Payer: Aetna Commercial |
$1,852.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,243.12
|
| Rate for Payer: Cigna Commercial |
$2,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,072.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$731.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$117.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$129.19
|
|
|
STENT RESOLUTE ONYX 2.00 x 12
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.25 |
| Max. Negotiated Rate |
$1,179.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,072.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$731.25
|
|
|
STENT RESOLUTE ONYX 2.00 x 15
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.25 |
| Max. Negotiated Rate |
$1,179.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,072.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$731.25
|
|
|
STENT RESOLUTE ONYX 2.00 x 15
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.49 |
| Max. Negotiated Rate |
$2,437.50 |
| Rate for Payer: Aetna Commercial |
$1,852.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,243.12
|
| Rate for Payer: Cigna Commercial |
$2,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,072.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$731.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$117.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$129.19
|
|
|
STENT RESOLUTE ONYX 2.00 x 18
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.49 |
| Max. Negotiated Rate |
$2,437.50 |
| Rate for Payer: Aetna Commercial |
$1,852.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,243.12
|
| Rate for Payer: Cigna Commercial |
$2,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,072.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$731.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$117.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$129.19
|
|
|
STENT RESOLUTE ONYX 2.00 x 18
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.25 |
| Max. Negotiated Rate |
$1,179.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,072.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$731.25
|
|
|
STENT RESOLUTE ONYX 2.00 x 22
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.55 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,090.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$132.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$145.75
|
|
|
STENT RESOLUTE ONYX 2.00 x 22
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
STENT RESOLUTE ONYX 2.00 x 26
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.25 |
| Max. Negotiated Rate |
$1,179.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,072.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$731.25
|
|
|
STENT RESOLUTE ONYX 2.00 x 26
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.49 |
| Max. Negotiated Rate |
$2,437.50 |
| Rate for Payer: Aetna Commercial |
$1,852.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,243.12
|
| Rate for Payer: Cigna Commercial |
$2,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,072.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$731.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$117.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$129.19
|
|
|
STENT RESOLUTE ONYX 2.00 x 30
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.25 |
| Max. Negotiated Rate |
$1,179.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,072.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$731.25
|
|
|
STENT RESOLUTE ONYX 2.00 x 30
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.49 |
| Max. Negotiated Rate |
$2,437.50 |
| Rate for Payer: Aetna Commercial |
$1,852.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,243.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,243.12
|
| Rate for Payer: Cigna Commercial |
$2,437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,179.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,072.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$731.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$117.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$129.19
|
|
|
STENT RESOLUTE ONYX 2.00 x 8
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
|
|
STENT RESOLUTE ONYX 2.00 x 8
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.55 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,090.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,402.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,331.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$825.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$132.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$145.75
|
|
|
STENT RESOLUTE ONYX 2.25 x 08
|
Facility
|
OP
|
$5,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.51 |
| Max. Negotiated Rate |
$2,562.50 |
| Rate for Payer: Aetna Commercial |
$1,947.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,537.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,306.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,306.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,025.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,306.88
|
| Rate for Payer: Cigna Commercial |
$2,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,240.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,127.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$768.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$123.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$135.81
|
|
|
STENT RESOLUTE ONYX 2.25 x 08
|
Facility
|
IP
|
$5,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270682646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.75 |
| Max. Negotiated Rate |
$1,240.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,025.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,240.25
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,127.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$768.75
|
|