|
STENT VISIPRO 10x57x80
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270673711
|
|
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 VISIPRO 10x57x80
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270673711N
|
|
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 VISIPRO 10x57x80
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270673711
|
|
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 VISIPRO 10x57x80
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270673711N
|
|
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 VISIPRO .35 6/7FR
|
Facility
|
OP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270660328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.29 |
| Max. Negotiated Rate |
$2,599.45 |
| Rate for Payer: Aetna Commercial |
$1,975.58
|
| Rate for Payer: Aetna Medicare Advantage |
$1,559.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,325.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,325.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,325.72
|
| Rate for Payer: Cigna Commercial |
$2,599.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$125.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$137.77
|
|
|
STENT VISIPRO .35 6/7FR
|
Facility
|
IP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270660328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.84 |
| Max. Negotiated Rate |
$1,258.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
|
|
STENT VISIPRO .35 6/7FR
|
Facility
|
OP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270660328S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.05 |
| Max. Negotiated Rate |
$3,237.50 |
| Rate for Payer: Aetna Commercial |
$2,460.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,942.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,651.12
|
| Rate for Payer: Cigna Commercial |
$3,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,424.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$156.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$171.59
|
|
|
STENT VISIPRO .35 6/7FR
|
Facility
|
IP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270660328S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$1,566.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,424.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
|
|
STENT VISIPRO .35 6/7FR BILLIA
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270667199
|
|
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 VISIPRO .35 6/7FR BILLIA
|
Facility
|
OP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270667198S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.05 |
| Max. Negotiated Rate |
$3,237.50 |
| Rate for Payer: Aetna Commercial |
$2,460.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,942.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,651.12
|
| Rate for Payer: Cigna Commercial |
$3,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,424.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$156.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$171.59
|
|
|
STENT VISIPRO .35 6/7FR BILLIA
|
Facility
|
IP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270667198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$1,566.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,424.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
|
|
STENT VISIPRO .35 6/7FR BILLIA
|
Facility
|
OP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270667198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.05 |
| Max. Negotiated Rate |
$3,237.50 |
| Rate for Payer: Aetna Commercial |
$2,460.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,942.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,651.12
|
| Rate for Payer: Cigna Commercial |
$3,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,424.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$156.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$171.59
|
|
|
STENT VISIPRO .35 6/7FR BILLIA
|
Facility
|
IP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270667198S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$1,566.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,424.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
|
|
STENT VISIPRO .35 6/7FR BILLIA
|
Facility
|
IP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270667199S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$1,566.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,424.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
|
|
STENT VISIPRO .35 6/7FR BILLIA
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270667199
|
|
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 VISIPRO .35 6/7FR BILLIA
|
Facility
|
OP
|
$6,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270667199S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.05 |
| Max. Negotiated Rate |
$3,237.50 |
| Rate for Payer: Aetna Commercial |
$2,460.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,942.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,651.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,651.12
|
| Rate for Payer: Cigna Commercial |
$3,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,566.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,424.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$971.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$156.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$171.59
|
|
|
STENT VISI-PRO 5X12X80
|
Facility
|
IP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683568N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.84 |
| Max. Negotiated Rate |
$1,258.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
|
|
STENT VISI-PRO 5X12X80
|
Facility
|
IP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.84 |
| Max. Negotiated Rate |
$1,258.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
|
|
STENT VISI-PRO 5X12X80
|
Facility
|
OP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.29 |
| Max. Negotiated Rate |
$2,599.45 |
| Rate for Payer: Aetna Commercial |
$1,975.58
|
| Rate for Payer: Aetna Medicare Advantage |
$1,559.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,325.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,325.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,325.72
|
| Rate for Payer: Cigna Commercial |
$2,599.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$125.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$137.77
|
|
|
STENT VISI-PRO 5X12X80
|
Facility
|
OP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683568N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.29 |
| Max. Negotiated Rate |
$2,599.45 |
| Rate for Payer: Aetna Commercial |
$1,975.58
|
| Rate for Payer: Aetna Medicare Advantage |
$1,559.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,325.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,325.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,325.72
|
| Rate for Payer: Cigna Commercial |
$2,599.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$125.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$137.77
|
|
|
STENT VISI-PRO 5X17X80
|
Facility
|
OP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.29 |
| Max. Negotiated Rate |
$2,599.45 |
| Rate for Payer: Aetna Commercial |
$1,975.58
|
| Rate for Payer: Aetna Medicare Advantage |
$1,559.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,325.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,325.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,325.72
|
| Rate for Payer: Cigna Commercial |
$2,599.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$125.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$137.77
|
|
|
STENT VISI-PRO 5X17X80
|
Facility
|
IP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683567N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.84 |
| Max. Negotiated Rate |
$1,258.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
|
|
STENT VISI-PRO 5X17X80
|
Facility
|
OP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683567N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.29 |
| Max. Negotiated Rate |
$2,599.45 |
| Rate for Payer: Aetna Commercial |
$1,975.58
|
| Rate for Payer: Aetna Medicare Advantage |
$1,559.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,325.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,325.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,325.72
|
| Rate for Payer: Cigna Commercial |
$2,599.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
| Rate for Payer: UnitedHealthcare Community & State |
$125.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$137.77
|
|
|
STENT VISI-PRO 5X17X80
|
Facility
|
IP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.84 |
| Max. Negotiated Rate |
$1,258.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
|
|
STENT VISI-PRO 5X27X80
|
Facility
|
IP
|
$5,198.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270683566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.84 |
| Max. Negotiated Rate |
$1,258.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,039.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,258.13
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,143.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$779.84
|
|
