|
STENT XIENCE ALPINE 2.5x12MM
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676001
|
|
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 XIENCE ALPINE 2.5X15mm
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
STENT XIENCE ALPINE 2.5X15mm
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,995.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.12
|
|
|
STENT XIENCE ALPINE 2.5x18MM
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676003
|
|
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 XIENCE ALPINE 2.5x18MM
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676003
|
|
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 XIENCE ALPINE 2.5x23MM
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676004
|
|
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 XIENCE ALPINE 2.5x23MM
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676004
|
|
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 XIENCE ALPINE 2.5x28MM
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676005
|
|
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 XIENCE ALPINE 2.5x28MM
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676005
|
|
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 XIENCE ALPINE 2.5x33MM
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,995.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.12
|
|
|
STENT XIENCE ALPINE 2.5x33MM
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
STENT XIENCE ALPINE 2.5x38MM
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,995.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.12
|
|
|
STENT XIENCE ALPINE 2.5x38MM
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
STENT XIENCE ALPINE 2.5x8MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270676000
|
|
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 XIENCE ALPINE 2.5x8MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270676000
|
|
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 XIENCE ALPINE 2.75X12MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270676009
|
|
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 XIENCE ALPINE 2.75X12MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270676009
|
|
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 XIENCE ALPINE 2.75x15MM
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676010
|
|
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 XIENCE ALPINE 2.75x15MM
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676010
|
|
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 XIENCE ALPINE 2.75x18MM
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,995.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.12
|
|
|
STENT XIENCE ALPINE 2.75x18MM
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
STENT XIENCE ALPINE 2.75x23MM
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676012
|
|
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 XIENCE ALPINE 2.75x23MM
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676012
|
|
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 XIENCE ALPINE 2.75x28MM
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
|
|
STENT XIENCE ALPINE 2.75x28MM
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
270676013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$1,995.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,338.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,338.75
|
| Rate for Payer: Cigna Commercial |
$2,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,270.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,155.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$787.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$139.12
|
|