|
STENT EVERFLEX 6MMx80MM 120CM
|
Facility
|
IP
|
$6,624.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637004S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.72 |
| Max. Negotiated Rate |
$1,603.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,603.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.72
|
|
|
STENT EVERFLEX 6MMx80MM 120CM
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637004N
|
|
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: Qualcare PPO/HMO/WC |
$675.00
|
|
|
STENT EVERFLEX 6MMx80MM 120CM
|
Facility
|
OP
|
$6,624.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.72 |
| Max. Negotiated Rate |
$3,312.40 |
| Rate for Payer: Aetna Commercial |
$1,987.44
|
| Rate for Payer: Aetna Medicare Advantage |
$1,987.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,689.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,689.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,689.32
|
| Rate for Payer: Cigna Commercial |
$3,312.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,603.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.72
|
|
|
STENT EVERFLEX 7MMx100MM 120CM
|
Facility
|
OP
|
$5,000.00
|
|
| Hospital Charge Code |
270638088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 7MMx100MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270638088S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 7MMx100MM 120CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270638088S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 7MMx100MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
| Hospital Charge Code |
270638088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 7MMx120MM 120CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270638403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 7MMx120MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270638403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 7MMx120MM 120CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270638403S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 7MMx120MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270638403S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 7MMx60MM 120CM
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270639645
|
|
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: Qualcare PPO/HMO/WC |
$675.00
|
|
|
STENT EVERFLEX 7MMx60MM 120CM
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270639645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,350.00
|
| 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: Qualcare PPO/HMO/WC |
$675.00
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007N
|
|
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: Qualcare PPO/HMO/WC |
$675.00
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
OP
|
$6,624.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.72 |
| Max. Negotiated Rate |
$3,312.40 |
| Rate for Payer: Aetna Commercial |
$1,987.44
|
| Rate for Payer: Aetna Medicare Advantage |
$1,987.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,689.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,689.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,689.32
|
| Rate for Payer: Cigna Commercial |
$3,312.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,603.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.72
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
IP
|
$6,624.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.72 |
| Max. Negotiated Rate |
$1,603.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,603.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.72
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007S
|
|
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: Qualcare PPO/HMO/WC |
$675.00
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,350.00
|
| 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: Qualcare PPO/HMO/WC |
$675.00
|
|
|
STENT EVERFLEX 7MMx80MM 120CM
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637007N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,350.00
|
| 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: Qualcare PPO/HMO/WC |
$675.00
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008A
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008A
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$1,210.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
STENT EVERFLEX 8MMx100MM 120CM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
270637008S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,210.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
