|
STENT CRD BILI 7.0F PG3980BPX
|
Facility
|
IP
|
$6,906.45
|
|
| Hospital Charge Code |
270624609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.97 |
| Max. Negotiated Rate |
$1,671.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,381.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,671.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,035.97
|
|
|
STENT CRD BILI 7.0F PG3980BPX
|
Facility
|
OP
|
$6,906.45
|
|
| Hospital Charge Code |
270624609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.97 |
| Max. Negotiated Rate |
$3,453.22 |
| Rate for Payer: Aetna Commercial |
$2,071.93
|
| Rate for Payer: Aetna Medicare Advantage |
$2,071.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,761.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,761.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,381.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,761.14
|
| Rate for Payer: Cigna Commercial |
$3,453.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,671.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,035.97
|
|
|
STENT CRD BILI 8 40 N840ABR
|
Facility
|
IP
|
$7,836.85
|
|
| Hospital Charge Code |
270622875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.53 |
| Max. Negotiated Rate |
$1,896.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,567.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,896.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,175.53
|
|
|
STENT CRD BILI 8 40 N840ABR
|
Facility
|
OP
|
$7,836.85
|
|
| Hospital Charge Code |
270622875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.53 |
| Max. Negotiated Rate |
$3,918.43 |
| Rate for Payer: Aetna Commercial |
$2,351.05
|
| Rate for Payer: Aetna Medicare Advantage |
$2,351.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,998.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,998.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,567.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,998.40
|
| Rate for Payer: Cigna Commercial |
$3,918.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,896.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,175.53
|
|
|
STENT CRD GENESIS PG3980BPS
|
Facility
|
OP
|
$6,906.45
|
|
| Hospital Charge Code |
270625225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.97 |
| Max. Negotiated Rate |
$3,453.22 |
| Rate for Payer: Aetna Commercial |
$2,071.93
|
| Rate for Payer: Aetna Medicare Advantage |
$2,071.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,761.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,761.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,381.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,761.14
|
| Rate for Payer: Cigna Commercial |
$3,453.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,671.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,035.97
|
|
|
STENT CRD GENESIS PG3980BPS
|
Facility
|
OP
|
$6,975.00
|
|
| Hospital Charge Code |
270625225V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$3,487.50 |
| Rate for Payer: Aetna Commercial |
$2,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,778.62
|
| Rate for Payer: Cigna Commercial |
$3,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
STENT CRD GENESIS PG3980BPS
|
Facility
|
IP
|
$6,975.00
|
|
| Hospital Charge Code |
270625225V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$1,687.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
STENT CRD GENESIS PG3980BPS
|
Facility
|
IP
|
$6,906.45
|
|
| Hospital Charge Code |
270625225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.97 |
| Max. Negotiated Rate |
$1,671.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,381.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,671.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,035.97
|
|
|
STENT CRD IQ 6.0F 17 PQ185BJS
|
Facility
|
OP
|
$4,104.85
|
|
| Hospital Charge Code |
270623579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.73 |
| Max. Negotiated Rate |
$2,052.43 |
| Rate for Payer: Aetna Commercial |
$1,231.45
|
| Rate for Payer: Aetna Medicare Advantage |
$1,231.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,046.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,046.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$820.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,046.74
|
| Rate for Payer: Cigna Commercial |
$2,052.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$993.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$615.73
|
|
|
STENT CRD IQ 6.0F 17 PQ185BJS
|
Facility
|
IP
|
$4,104.85
|
|
| Hospital Charge Code |
270623579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.73 |
| Max. Negotiated Rate |
$993.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$820.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$993.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$615.73
|
|
|
STENT CRD IQ 6.5F 22 PQ298BLX
|
Facility
|
OP
|
$4,104.85
|
|
| Hospital Charge Code |
270623578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.73 |
| Max. Negotiated Rate |
$2,052.43 |
| Rate for Payer: Aetna Commercial |
$1,231.45
|
| Rate for Payer: Aetna Medicare Advantage |
$1,231.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,046.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,046.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$820.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,046.74
|
| Rate for Payer: Cigna Commercial |
$2,052.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$993.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$615.73
|
|
|
STENT CRD IQ 6.5F 22 PQ298BLX
|
Facility
|
IP
|
$4,104.85
|
|
| Hospital Charge Code |
270623578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.73 |
| Max. Negotiated Rate |
$993.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$820.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$993.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$615.73
|
|
|
STENT CRD IQ 8.0F 18 PQ186BJS
|
Facility
|
IP
|
$4,104.85
|
|
| Hospital Charge Code |
270623580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.73 |
| Max. Negotiated Rate |
$993.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$820.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$993.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$615.73
|
|
|
STENT CRD IQ 8.0F 18 PQ186BJS
|
Facility
|
OP
|
$4,104.85
|
|
| Hospital Charge Code |
270623580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.73 |
| Max. Negotiated Rate |
$2,052.43 |
| Rate for Payer: Aetna Commercial |
$1,231.45
|
| Rate for Payer: Aetna Medicare Advantage |
$1,231.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,046.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,046.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$820.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,046.74
|
| Rate for Payer: Cigna Commercial |
$2,052.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$993.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$615.73
|
|
|
STENT CRD PTA DELIV PQ398BLS
|
Facility
|
OP
|
$6,028.00
|
|
| Hospital Charge Code |
270622622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.20 |
| Max. Negotiated Rate |
$3,014.00 |
| Rate for Payer: Aetna Commercial |
$1,808.40
|
| Rate for Payer: Aetna Medicare Advantage |
$1,808.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,537.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,537.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,205.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,537.14
|
| Rate for Payer: Cigna Commercial |
$3,014.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,458.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$904.20
|
|
|
STENT CRD PTA DELIV PQ398BLS
|
Facility
|
IP
|
$6,028.00
|
|
| Hospital Charge Code |
270622622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.20 |
| Max. Negotiated Rate |
$1,458.78 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,205.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,458.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$904.20
|
|
|
STENT CRD SMART 8x60 N860PBR
|
Facility
|
IP
|
$6,944.00
|
|
| Hospital Charge Code |
270625999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.60 |
| Max. Negotiated Rate |
$1,680.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,388.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,680.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,041.60
|
|
|
STENT CRD SMART 8x60 N860PBR
|
Facility
|
OP
|
$6,944.00
|
|
| Hospital Charge Code |
270625999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.60 |
| Max. Negotiated Rate |
$3,472.00 |
| Rate for Payer: Aetna Commercial |
$2,083.20
|
| Rate for Payer: Aetna Medicare Advantage |
$2,083.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,770.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,770.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,388.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,770.72
|
| Rate for Payer: Cigna Commercial |
$3,472.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,680.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,041.60
|
|
|
STENT CRD SMART BILI N840BBR
|
Facility
|
OP
|
$6,512.85
|
|
| Hospital Charge Code |
270624312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.93 |
| Max. Negotiated Rate |
$3,256.43 |
| Rate for Payer: Aetna Commercial |
$1,953.86
|
| Rate for Payer: Aetna Medicare Advantage |
$1,953.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,660.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,660.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,302.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,660.78
|
| Rate for Payer: Cigna Commercial |
$3,256.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,576.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$976.93
|
|
|
STENT CRD SMART BILI N840BBR
|
Facility
|
IP
|
$6,512.85
|
|
| Hospital Charge Code |
270624312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.93 |
| Max. Negotiated Rate |
$1,576.11 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,302.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,576.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$976.93
|
|
|
STENT CR GEN 8x39 80 PG3970BPS
|
Facility
|
IP
|
$6,975.00
|
|
| Hospital Charge Code |
270625998V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$1,687.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
STENT CR GEN 8x39 80 PG3970BPS
|
Facility
|
OP
|
$6,944.00
|
|
| Hospital Charge Code |
270625998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.60 |
| Max. Negotiated Rate |
$3,472.00 |
| Rate for Payer: Aetna Commercial |
$2,083.20
|
| Rate for Payer: Aetna Medicare Advantage |
$2,083.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,770.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,770.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,388.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,770.72
|
| Rate for Payer: Cigna Commercial |
$3,472.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,680.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,041.60
|
|
|
STENT CR GEN 8x39 80 PG3970BPS
|
Facility
|
OP
|
$6,975.00
|
|
| Hospital Charge Code |
270625998V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$3,487.50 |
| Rate for Payer: Aetna Commercial |
$2,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,395.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,778.62
|
| Rate for Payer: Cigna Commercial |
$3,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,687.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
STENT CR GEN 8x39 80 PG3970BPS
|
Facility
|
IP
|
$6,944.00
|
|
| Hospital Charge Code |
270625998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.60 |
| Max. Negotiated Rate |
$1,680.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,388.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,680.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,041.60
|
|
|
STENT CYPHER 2.25X8M CXS08255
|
Facility
|
OP
|
$9,500.00
|
|
| Hospital Charge Code |
270643934C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$4,750.00 |
| Rate for Payer: Aetna Commercial |
$2,850.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,422.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,422.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,422.50
|
| Rate for Payer: Cigna Commercial |
$4,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,299.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,425.00
|
|