|
STENT EXPRESS 6x14 90cm
|
Facility
|
IP
|
$5,942.30
|
|
| Hospital Charge Code |
270634342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$1,438.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 6x14 90cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270634342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 6x18 90cm
|
Facility
|
IP
|
$5,942.30
|
|
| Hospital Charge Code |
270634343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$1,438.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 6x18 90cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270634343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 7x17 75cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270634111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 7x17 75cm
|
Facility
|
IP
|
$5,942.30
|
|
| Hospital Charge Code |
270634111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$1,438.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 7x19 90cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270634369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 7x19 90cm
|
Facility
|
IP
|
$5,942.30
|
|
| Hospital Charge Code |
270634369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$1,438.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 7x27 135cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270634365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 7x27 135cm
|
Facility
|
IP
|
$5,942.30
|
|
| Hospital Charge Code |
270634365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$1,438.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 7x27 3804773013
|
Facility
|
IP
|
$6,975.00
|
|
| Hospital Charge Code |
270634365V
|
|
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 EXPRESS 7x27 3804773013
|
Facility
|
OP
|
$6,975.00
|
|
| Hospital Charge Code |
270634365V
|
|
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 EXPRESS 8x27 135cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270634366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 8x27 135cm
|
Facility
|
IP
|
$5,942.30
|
|
| Hospital Charge Code |
270634366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$1,438.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 8x27 3804783013
|
Facility
|
OP
|
$6,919.25
|
|
| Hospital Charge Code |
270634366V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.89 |
| Max. Negotiated Rate |
$3,459.62 |
| Rate for Payer: Aetna Commercial |
$2,075.78
|
| Rate for Payer: Aetna Medicare Advantage |
$2,075.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,764.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,764.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,383.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,764.41
|
| Rate for Payer: Cigna Commercial |
$3,459.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,674.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,037.89
|
|
|
STENT EXPRESS 8x27 3804783013
|
Facility
|
IP
|
$6,919.25
|
|
| Hospital Charge Code |
270634366V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.89 |
| Max. Negotiated Rate |
$1,674.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,383.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,674.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,037.89
|
|
|
STENT EXPRESS 8x37 135cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270634114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 8x37 135cm
|
Facility
|
IP
|
$5,942.30
|
|
| Hospital Charge Code |
270634114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$1,438.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 8x37 75cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270628305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 8x37 75cm
|
Facility
|
IP
|
$5,942.30
|
|
| Hospital Charge Code |
270628305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$1,438.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 8x57 75cm
|
Facility
|
IP
|
$5,942.30
|
|
| Hospital Charge Code |
270630484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$1,438.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 8x57 75cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270630484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 9x37 135cm
|
Facility
|
IP
|
$5,942.30
|
|
| Hospital Charge Code |
270636468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$1,438.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 9x37 135cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270636468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|
|
STENT EXPRESS 9x37 75cm
|
Facility
|
OP
|
$5,942.30
|
|
| Hospital Charge Code |
270633222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.35 |
| Max. Negotiated Rate |
$2,971.15 |
| Rate for Payer: Aetna Commercial |
$1,782.69
|
| Rate for Payer: Aetna Medicare Advantage |
$1,782.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,515.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,188.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,515.29
|
| Rate for Payer: Cigna Commercial |
$2,971.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,438.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$891.35
|
|