|
STENT ABRE 14MMX100MMX90CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695849Z
|
|
Hospital Revenue Code
|
278
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 14MMX 120MMX 90CM
|
Facility
|
OP
|
$7,975.00
|
|
| Hospital Charge Code |
270695850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.75 |
| Max. Negotiated Rate |
$3,987.50 |
| Rate for Payer: Aetna Commercial |
$2,392.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,392.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,033.62
|
| Rate for Payer: Cigna Commercial |
$3,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,036.75
|
| Rate for Payer: Oxford Commercial |
$3,987.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,987.50
|
|
|
STENT ABRE 14MMX 120MMX 90CM
|
Facility
|
IP
|
$7,975.00
|
|
| Hospital Charge Code |
270695850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$1,196.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
|
|
STENT ABRE 14MMX 120MMX90CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695850Z
|
|
Hospital Revenue Code
|
278
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 14MMX 120MMX90CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695850Z
|
|
Hospital Revenue Code
|
278
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 14MMX 150MMX 90CM
|
Facility
|
OP
|
$9,125.00
|
|
| Hospital Charge Code |
270695851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,186.25 |
| Max. Negotiated Rate |
$4,562.50 |
| Rate for Payer: Aetna Commercial |
$2,737.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,737.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,326.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,326.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,326.88
|
| Rate for Payer: Cigna Commercial |
$4,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,186.25
|
| Rate for Payer: Oxford Commercial |
$4,562.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,368.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,562.50
|
|
|
STENT ABRE 14MMX 150MMX 90CM
|
Facility
|
IP
|
$9,125.00
|
|
| Hospital Charge Code |
270695851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,368.75 |
| Max. Negotiated Rate |
$1,368.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,368.75
|
|
|
STENT ABRE 14MMX 150MMX90CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695851Z
|
|
Hospital Revenue Code
|
278
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 14MMX 150MMX90CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695851Z
|
|
Hospital Revenue Code
|
278
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 14MMX 80MMX 90CM
|
Facility
|
IP
|
$7,975.00
|
|
| Hospital Charge Code |
270695848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$1,196.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
|
|
STENT ABRE 14MMX 80MMX 90CM
|
Facility
|
OP
|
$7,975.00
|
|
| Hospital Charge Code |
270695848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.75 |
| Max. Negotiated Rate |
$3,987.50 |
| Rate for Payer: Aetna Commercial |
$2,392.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,392.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,033.62
|
| Rate for Payer: Cigna Commercial |
$3,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,036.75
|
| Rate for Payer: Oxford Commercial |
$3,987.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,987.50
|
|
|
STENT ABRE 14MMX80MMX90CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695848Z
|
|
Hospital Revenue Code
|
278
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 14MMX80MMX90CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695848Z
|
|
Hospital Revenue Code
|
278
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 16MMX100MMX90CM
|
Facility
|
OP
|
$7,975.00
|
|
| Hospital Charge Code |
270695853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.75 |
| Max. Negotiated Rate |
$3,987.50 |
| Rate for Payer: Aetna Commercial |
$2,392.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,392.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,033.62
|
| Rate for Payer: Cigna Commercial |
$3,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,036.75
|
| Rate for Payer: Oxford Commercial |
$3,987.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,987.50
|
|
|
STENT ABRE 16MMX100MMX90CM
|
Facility
|
IP
|
$7,975.00
|
|
| Hospital Charge Code |
270695853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$1,196.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
|
|
STENT ABRE 16MMX100MMX90CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695853Z
|
|
Hospital Revenue Code
|
278
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 16MMX100MMX90CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695853Z
|
|
Hospital Revenue Code
|
278
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 16MMX120MMX90CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695854Z
|
|
Hospital Revenue Code
|
278
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 16MMX120MMX90CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270695854Z
|
|
Hospital Revenue Code
|
278
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
STENT ABRE 16MMX120MMX90CM
|
Facility
|
OP
|
$7,975.00
|
|
| Hospital Charge Code |
270705320
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,036.75 |
| Max. Negotiated Rate |
$3,987.50 |
| Rate for Payer: Aetna Commercial |
$2,392.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,392.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,033.62
|
| Rate for Payer: Cigna Commercial |
$3,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,036.75
|
| Rate for Payer: Oxford Commercial |
$3,987.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,987.50
|
|
|
STENT ABRE 16MMX120MMX90CM
|
Facility
|
OP
|
$7,975.00
|
|
| Hospital Charge Code |
270695854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.75 |
| Max. Negotiated Rate |
$3,987.50 |
| Rate for Payer: Aetna Commercial |
$2,392.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,392.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,033.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,033.62
|
| Rate for Payer: Cigna Commercial |
$3,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,036.75
|
| Rate for Payer: Oxford Commercial |
$3,987.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,987.50
|
|
|
STENT ABRE 16MMX120MMX90CM
|
Facility
|
IP
|
$7,975.00
|
|
| Hospital Charge Code |
270695854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$1,196.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
|
|
STENT ABRE 16MMX120MMX90CM
|
Facility
|
IP
|
$7,975.00
|
|
| Hospital Charge Code |
270705320
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$1,196.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,196.25
|
|
|
STENT ABRE 16MMX150MMX90CM
|
Facility
|
OP
|
$9,125.00
|
|
| Hospital Charge Code |
270695855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,186.25 |
| Max. Negotiated Rate |
$4,562.50 |
| Rate for Payer: Aetna Commercial |
$2,737.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,737.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,326.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,326.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,326.88
|
| Rate for Payer: Cigna Commercial |
$4,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,186.25
|
| Rate for Payer: Oxford Commercial |
$4,562.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,368.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,562.50
|
|
|
STENT ABRE 16MMX150MMX90CM
|
Facility
|
IP
|
$9,125.00
|
|
| Hospital Charge Code |
270695855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,368.75 |
| Max. Negotiated Rate |
$1,368.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,368.75
|
|