|
STENT VIABAH 13x10x75 VB131001
|
Facility
|
IP
|
$12,152.00
|
|
| Hospital Charge Code |
270635161V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,822.80 |
| Max. Negotiated Rate |
$2,940.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,430.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,940.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,673.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,822.80
|
|
|
STENT VIABAH 13x10x75 VB131001
|
Facility
|
OP
|
$12,152.00
|
|
| Hospital Charge Code |
270635161V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.86 |
| Max. Negotiated Rate |
$6,076.00 |
| Rate for Payer: Aetna Commercial |
$4,617.76
|
| Rate for Payer: Aetna Medicare Advantage |
$3,645.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,098.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,098.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,430.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,098.76
|
| Rate for Payer: Cigna Commercial |
$6,076.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,940.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,673.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,822.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$292.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$322.03
|
|
|
STENT VIABAH 13x10x75 VB131001
|
Facility
|
IP
|
$12,152.00
|
|
| Hospital Charge Code |
270635161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,822.80 |
| Max. Negotiated Rate |
$2,940.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,430.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,940.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,673.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,822.80
|
|
|
STENT VIABAH 13X10X75 VB131001
|
Facility
|
OP
|
$13,400.00
|
|
| Hospital Charge Code |
270636760V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.94 |
| Max. Negotiated Rate |
$6,700.00 |
| Rate for Payer: Aetna Commercial |
$5,092.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,417.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,417.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,680.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,417.00
|
| Rate for Payer: Cigna Commercial |
$6,700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,242.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,948.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,010.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$322.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$355.10
|
|
|
STENT VIABAH 13X10X75 VB131001
|
Facility
|
IP
|
$13,400.00
|
|
| Hospital Charge Code |
270636760V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.00 |
| Max. Negotiated Rate |
$3,242.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,242.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,948.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,010.00
|
|
|
STENT VIABAH 7x10x75 VBA071001
|
Facility
|
OP
|
$12,152.00
|
|
| Hospital Charge Code |
270633716V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.86 |
| Max. Negotiated Rate |
$6,076.00 |
| Rate for Payer: Aetna Commercial |
$4,617.76
|
| Rate for Payer: Aetna Medicare Advantage |
$3,645.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,098.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,098.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,430.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,098.76
|
| Rate for Payer: Cigna Commercial |
$6,076.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,940.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,673.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,822.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$292.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$322.03
|
|
|
STENT VIABAH 7x10x75 VBA071001
|
Facility
|
IP
|
$12,152.00
|
|
| Hospital Charge Code |
270633716V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,822.80 |
| Max. Negotiated Rate |
$2,940.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,430.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,940.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,673.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,822.80
|
|
|
STENT VIABAH 7x10x75 VBA071001
|
Facility
|
OP
|
$12,152.00
|
|
| Hospital Charge Code |
270633716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.86 |
| Max. Negotiated Rate |
$6,076.00 |
| Rate for Payer: Aetna Commercial |
$4,617.76
|
| Rate for Payer: Aetna Medicare Advantage |
$3,645.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,098.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,098.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,430.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,098.76
|
| Rate for Payer: Cigna Commercial |
$6,076.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,940.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,673.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,822.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$292.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$322.03
|
|
|
STENT VIABAH 7x10x75 VBA071001
|
Facility
|
IP
|
$12,152.00
|
|
| Hospital Charge Code |
270633716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,822.80 |
| Max. Negotiated Rate |
$2,940.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,430.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,940.78
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,673.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,822.80
|
|
|
STENT VIABAH 7x5 100 VBA070502
|
Facility
|
IP
|
$10,168.00
|
|
| Hospital Charge Code |
270634384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.20 |
| Max. Negotiated Rate |
$2,460.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,033.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,460.66
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,236.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,525.20
|
|
|
STENT VIABAH 7x5 100 VBA070502
|
Facility
|
OP
|
$12,710.00
|
|
| Hospital Charge Code |
70634384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.31 |
| Max. Negotiated Rate |
$6,355.00 |
| Rate for Payer: Aetna Commercial |
$4,829.80
|
| Rate for Payer: Aetna Medicare Advantage |
$3,813.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,241.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,241.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,542.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,241.05
|
| Rate for Payer: Cigna Commercial |
$6,355.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,075.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,796.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,906.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$306.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$336.81
|
|
|
STENT VIABAH 7x5 100 VBA070502
|
Facility
|
IP
|
$12,710.00
|
|
| Hospital Charge Code |
70634384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,906.50 |
| Max. Negotiated Rate |
$3,075.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,542.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,075.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,796.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,906.50
|
|
|
STENT VIABAH 7x5 100 VBA070502
|
Facility
|
OP
|
$10,250.00
|
|
| Hospital Charge Code |
270634384V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.03 |
| Max. Negotiated Rate |
$5,125.00 |
| Rate for Payer: Aetna Commercial |
$3,895.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,075.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,613.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,613.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,613.75
|
| Rate for Payer: Cigna Commercial |
$5,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,480.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,255.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,537.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$247.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$271.62
|
|
|
STENT VIABAH 7x5 100 VBA070502
|
Facility
|
IP
|
$10,250.00
|
|
| Hospital Charge Code |
270634384V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.50 |
| Max. Negotiated Rate |
$2,480.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,480.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,255.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,537.50
|
|
|
STENT VIABAH 7x5 100 VBA070502
|
Facility
|
OP
|
$10,168.00
|
|
| Hospital Charge Code |
270634384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.05 |
| Max. Negotiated Rate |
$5,084.00 |
| Rate for Payer: Aetna Commercial |
$3,863.84
|
| Rate for Payer: Aetna Medicare Advantage |
$3,050.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,592.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,592.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,033.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,592.84
|
| Rate for Payer: Cigna Commercial |
$5,084.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,460.66
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,236.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,525.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.45
|
|
|
STENT VIABAHAN 8X10X120MM
|
Facility
|
IP
|
$20,550.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695023S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,082.50 |
| Max. Negotiated Rate |
$4,973.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,973.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,521.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,082.50
|
|
|
STENT VIABAHAN 8X10X120MM
|
Facility
|
OP
|
$20,550.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695023S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.25 |
| Max. Negotiated Rate |
$10,275.00 |
| Rate for Payer: Aetna Commercial |
$7,809.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,240.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,240.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,240.25
|
| Rate for Payer: Cigna Commercial |
$10,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,973.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,521.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,082.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$495.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$544.58
|
|
|
STENT VIABAHN .014 6MM X25 MM
|
Facility
|
OP
|
$36,175.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270690860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.82 |
| Max. Negotiated Rate |
$18,087.50 |
| Rate for Payer: Aetna Commercial |
$13,746.50
|
| Rate for Payer: Aetna Medicare Advantage |
$10,852.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,224.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,224.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,224.62
|
| Rate for Payer: Cigna Commercial |
$18,087.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,754.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,958.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,426.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$871.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$958.64
|
|
|
STENT VIABAHN .014 6MM X25 MM
|
Facility
|
IP
|
$36,175.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270690860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,426.25 |
| Max. Negotiated Rate |
$8,754.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,754.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,958.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,426.25
|
|
|
STENT VIABAHN .014 7MM X25 MM
|
Facility
|
IP
|
$36,175.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270690861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,426.25 |
| Max. Negotiated Rate |
$8,754.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,754.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,958.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,426.25
|
|
|
STENT VIABAHN .014 7MM X25 MM
|
Facility
|
OP
|
$36,175.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270690861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.82 |
| Max. Negotiated Rate |
$18,087.50 |
| Rate for Payer: Aetna Commercial |
$13,746.50
|
| Rate for Payer: Aetna Medicare Advantage |
$10,852.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,224.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,224.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,224.62
|
| Rate for Payer: Cigna Commercial |
$18,087.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,754.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,958.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,426.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$871.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$958.64
|
|
|
STENT VIABAHN 13MM 10CM 75CM
|
Facility
|
OP
|
$24,242.84
|
|
| Hospital Charge Code |
270636760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.25 |
| Max. Negotiated Rate |
$12,121.42 |
| Rate for Payer: Aetna Commercial |
$9,212.28
|
| Rate for Payer: Aetna Medicare Advantage |
$7,272.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,181.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,181.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,848.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,181.92
|
| Rate for Payer: Cigna Commercial |
$12,121.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,866.77
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,333.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,636.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$584.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$642.44
|
|
|
STENT VIABAHN 13MM 10CM 75CM
|
Facility
|
IP
|
$24,242.84
|
|
| Hospital Charge Code |
270636760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.43 |
| Max. Negotiated Rate |
$5,866.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,848.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,866.77
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,333.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,636.43
|
|
|
STENT VIABAHN 35 RO 8MM X 7.6
|
Facility
|
OP
|
$19,230.00
|
|
| Hospital Charge Code |
270689581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.44 |
| Max. Negotiated Rate |
$9,615.00 |
| Rate for Payer: Aetna Commercial |
$7,307.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5,769.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,903.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,903.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,903.65
|
| Rate for Payer: Cigna Commercial |
$9,615.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,769.00
|
| Rate for Payer: Oxford Commercial |
$3,846.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,884.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,846.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$463.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$509.60
|
|
|
STENT VIABAHN 35 RO 8MM X 7.6
|
Facility
|
IP
|
$19,230.00
|
|
| Hospital Charge Code |
270689581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,884.50 |
| Max. Negotiated Rate |
$2,884.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,884.50
|
|
