|
STENT RX XPEDITION 2.5x38
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658764
|
|
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 RX XPEDITION 2 75x12
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658766
|
|
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 RX XPEDITION 2 75x12
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658766
|
|
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 RX XPEDITION 2 75x12
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658766S
|
|
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 RX XPEDITION 2 75x12
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658766S
|
|
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 RX XPEDITION 2.75X23
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658769
|
|
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 RX XPEDITION 2.75X23
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658769
|
|
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 RX XPEDITION 2.75X28
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658770
|
|
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 RX XPEDITION 2.75X28
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658770
|
|
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 RX XPEDITION 2.75X33
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270658771
|
|
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 RX XPEDITION 2.75X33
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270658771
|
|
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 RX XPEDITION 2.75X38
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270658772
|
|
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 RX XPEDITION 2.75X38
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270658772
|
|
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 RX XPEDITION 3.0X08
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658773
|
|
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 RX XPEDITION 3.0X08
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658773
|
|
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 RX XPEDITION 3.0X18
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658776S
|
|
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 RX XPEDITION 3.0X18
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658776S
|
|
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 RX XPEDITION 3.0X18
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658776
|
|
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 RX XPEDITION 3.0X18
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658776
|
|
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 RX XPEDITION 3.25x08
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658781
|
|
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 RX XPEDITION 3.25x08
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658781
|
|
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 RX XPEDITION 3.25x12
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658782
|
|
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 RX XPEDITION 3.25x12
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658782
|
|
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 RX XPEDITION 3.25x15
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658783
|
|
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 RX XPEDITION 3.25x15
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270658783
|
|
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
|
|
