|
STENT VIABAHN VBX
|
Facility
|
OP
|
$17,850.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270679851N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.19 |
| Max. Negotiated Rate |
$8,925.00 |
| Rate for Payer: Aetna Commercial |
$6,783.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,551.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,551.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,570.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,551.75
|
| Rate for Payer: Cigna Commercial |
$8,925.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,319.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,927.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,677.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$430.19
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$473.02
|
|
|
STENT VIABAHN VBX
|
Facility
|
OP
|
$18,295.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270679851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.91 |
| Max. Negotiated Rate |
$9,147.50 |
| Rate for Payer: Aetna Commercial |
$6,952.10
|
| Rate for Payer: Aetna Medicare Advantage |
$5,488.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,665.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,665.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,659.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,665.23
|
| Rate for Payer: Cigna Commercial |
$9,147.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,427.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,024.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,744.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$440.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$484.82
|
|
|
STENT VIABAHN VBX
|
Facility
|
IP
|
$18,295.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270679850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,744.25 |
| Max. Negotiated Rate |
$4,427.39 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,659.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,427.39
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,024.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,744.25
|
|
|
STENT VIABH 13x10x110 VB131002
|
Facility
|
OP
|
$24,242.84
|
|
| Hospital Charge Code |
270635160V
|
|
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 VIABH 13x10x110 VB131002
|
Facility
|
IP
|
$24,242.84
|
|
| Hospital Charge Code |
270635160V
|
|
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 VIABH 13x10x110 VB131002
|
Facility
|
OP
|
$12,152.00
|
|
| Hospital Charge Code |
270635160
|
|
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 VIABH 13x10x110 VB131002
|
Facility
|
IP
|
$12,152.00
|
|
| Hospital Charge Code |
270635160
|
|
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 VIABHAN 13X10 12
|
Facility
|
IP
|
$18,760.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270692539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,814.00 |
| Max. Negotiated Rate |
$4,539.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,752.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,539.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,127.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,814.00
|
|
|
STENT VIABHAN 13X10 12
|
Facility
|
OP
|
$18,760.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270692539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.12 |
| Max. Negotiated Rate |
$9,380.00 |
| Rate for Payer: Aetna Commercial |
$7,128.80
|
| Rate for Payer: Aetna Medicare Advantage |
$5,628.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,783.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,783.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,752.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,783.80
|
| Rate for Payer: Cigna Commercial |
$9,380.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,539.92
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,127.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,814.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$452.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$497.14
|
|
|
STENT VIABHN 7FR 5*10 120CM
|
Facility
|
OP
|
$15,850.00
|
|
| Hospital Charge Code |
270646985C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.99 |
| Max. Negotiated Rate |
$7,925.00 |
| Rate for Payer: Aetna Commercial |
$6,023.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,755.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,041.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,041.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,170.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,041.75
|
| Rate for Payer: Cigna Commercial |
$7,925.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,835.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,377.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$381.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$420.02
|
|
|
STENT VIABHN 7FR 5*10 120CM
|
Facility
|
IP
|
$15,850.00
|
|
| Hospital Charge Code |
270646985C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,377.50 |
| Max. Negotiated Rate |
$3,835.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,170.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,835.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,377.50
|
|
|
STENT VIABHN 7X5X120 VBJ070502
|
Facility
|
OP
|
$14,710.00
|
|
| Hospital Charge Code |
270648640C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.51 |
| Max. Negotiated Rate |
$7,355.00 |
| Rate for Payer: Aetna Commercial |
$5,589.80
|
| Rate for Payer: Aetna Medicare Advantage |
$4,413.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,751.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,751.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,942.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,751.05
|
| Rate for Payer: Cigna Commercial |
$7,355.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,559.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,236.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,206.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$354.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$389.81
|
|
|
STENT VIABHN 7X5X120 VBJ070502
|
Facility
|
IP
|
$14,710.00
|
|
| Hospital Charge Code |
270648640C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.50 |
| Max. Negotiated Rate |
$3,559.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,942.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,559.82
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,236.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,206.50
|
|
|
STENT VIABN 8F 8X10 VBH081002
|
Facility
|
IP
|
$24,242.84
|
|
| Hospital Charge Code |
270639500C
|
|
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 VIABN 8F 8X10 VBH081002
|
Facility
|
OP
|
$24,242.84
|
|
| Hospital Charge Code |
270639500C
|
|
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 VICI 12 MM X 60 MM X 100
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4046688659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$3,420.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,980.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$216.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$238.50
|
|
|
STENT VICI 12 MM X 60 MM X 100
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4046688659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,980.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
|
|
STENT VICI 12 MM X 60 MM X 100
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270688659V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$3,420.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,980.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$216.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$238.50
|
|
|
STENT VICI 12 MM X 60 MM X 100
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270688659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,980.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
|
|
STENT VICI 12 MM X 60 MM X 100
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270688659V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,980.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
|
|
STENT VICI 12 MM X 60 MM X 100
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270688659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$3,420.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,980.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$216.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$238.50
|
|
|
STENT VICI 12 MM X 90 MM X 100
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270688661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$3,420.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,980.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$216.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$238.50
|
|
|
STENT VICI 12 MM X 90 MM X 100
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4046688661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,980.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
|
|
STENT VICI 12 MM X 90 MM X 100
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4046688661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$3,420.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,980.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$216.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$238.50
|
|
|
STENT VICI 12 MM X 90 MM X 100
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270688661V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$3,420.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,980.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$216.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$238.50
|
|
