|
STENT GENESIS 5x15 135cm
|
Facility
|
OP
|
$7,375.00
|
|
| Hospital Charge Code |
270635767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,687.50 |
| Rate for Payer: Aetna Commercial |
$2,212.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,212.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,880.62
|
| Rate for Payer: Cigna Commercial |
$3,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 5x18 PG1850BAS
|
Facility
|
IP
|
$7,316.00
|
|
| Hospital Charge Code |
270630177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$1,770.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,463.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,770.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,097.40
|
|
|
STENT GENESIS 5x18 PG1850BAS
|
Facility
|
OP
|
$7,375.00
|
|
| Hospital Charge Code |
270630177V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,687.50 |
| Rate for Payer: Aetna Commercial |
$2,212.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,212.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,880.62
|
| Rate for Payer: Cigna Commercial |
$3,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 5x18 PG1850BAS
|
Facility
|
OP
|
$7,316.00
|
|
| Hospital Charge Code |
270630177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,658.00 |
| Rate for Payer: Aetna Commercial |
$2,194.80
|
| Rate for Payer: Aetna Medicare Advantage |
$2,194.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,865.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,865.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,865.58
|
| Rate for Payer: Cigna Commercial |
$3,658.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,770.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,097.40
|
|
|
STENT GENESIS 5x18 PG1850BAS
|
Facility
|
IP
|
$7,375.00
|
|
| Hospital Charge Code |
270630177V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$1,784.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 6.0x17 PG1560BAS
|
Facility
|
IP
|
$7,316.00
|
|
| Hospital Charge Code |
270631234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$1,770.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,463.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,770.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,097.40
|
|
|
STENT GENESIS 6.0x17 PG1560BAS
|
Facility
|
OP
|
$7,375.00
|
|
| Hospital Charge Code |
270631234V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,687.50 |
| Rate for Payer: Aetna Commercial |
$2,212.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,212.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,880.62
|
| Rate for Payer: Cigna Commercial |
$3,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 6.0x17 PG1560BAS
|
Facility
|
IP
|
$7,375.00
|
|
| Hospital Charge Code |
270631234V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$1,784.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 6.0x17 PG1560BAS
|
Facility
|
OP
|
$7,316.00
|
|
| Hospital Charge Code |
270631234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,658.00 |
| Rate for Payer: Aetna Commercial |
$2,194.80
|
| Rate for Payer: Aetna Medicare Advantage |
$2,194.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,865.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,865.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,865.58
|
| Rate for Payer: Cigna Commercial |
$3,658.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,770.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,097.40
|
|
|
STENT GENESIS 6.0x20 PG1860BAS
|
Facility
|
IP
|
$7,375.00
|
|
| Hospital Charge Code |
270631235V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$1,784.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 6.0x20 PG1860BAS
|
Facility
|
IP
|
$7,316.00
|
|
| Hospital Charge Code |
270631235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$1,770.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,463.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,770.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,097.40
|
|
|
STENT GENESIS 6.0x20 PG1860BAS
|
Facility
|
OP
|
$7,375.00
|
|
| Hospital Charge Code |
270631235V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,687.50 |
| Rate for Payer: Aetna Commercial |
$2,212.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,212.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,880.62
|
| Rate for Payer: Cigna Commercial |
$3,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 6.0x20 PG1860BAS
|
Facility
|
OP
|
$7,316.00
|
|
| Hospital Charge Code |
270631235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,658.00 |
| Rate for Payer: Aetna Commercial |
$2,194.80
|
| Rate for Payer: Aetna Medicare Advantage |
$2,194.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,865.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,865.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,865.58
|
| Rate for Payer: Cigna Commercial |
$3,658.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,770.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,097.40
|
|
|
STENT GENESIS 6x18 135cm
|
Facility
|
IP
|
$7,375.00
|
|
| Hospital Charge Code |
270639109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$1,784.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 6x18 135cm
|
Facility
|
OP
|
$7,375.00
|
|
| Hospital Charge Code |
270639109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,687.50 |
| Rate for Payer: Aetna Commercial |
$2,212.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,212.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,880.62
|
| Rate for Payer: Cigna Commercial |
$3,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 7.0x15 PG1570BAS
|
Facility
|
IP
|
$7,316.00
|
|
| Hospital Charge Code |
270631632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$1,770.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,463.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,770.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,097.40
|
|
|
STENT GENESIS 7.0x15 PG1570BAS
|
Facility
|
IP
|
$7,375.00
|
|
| Hospital Charge Code |
270631632V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$1,784.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 7.0x15 PG1570BAS
|
Facility
|
OP
|
$7,316.00
|
|
| Hospital Charge Code |
270631632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,658.00 |
| Rate for Payer: Aetna Commercial |
$2,194.80
|
| Rate for Payer: Aetna Medicare Advantage |
$2,194.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,865.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,865.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,865.58
|
| Rate for Payer: Cigna Commercial |
$3,658.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,770.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,097.40
|
|
|
STENT GENESIS 7.0x15 PG1570BAS
|
Facility
|
OP
|
$7,375.00
|
|
| Hospital Charge Code |
270631632V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,687.50 |
| Rate for Payer: Aetna Commercial |
$2,212.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,212.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,880.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,475.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,880.62
|
| Rate for Payer: Cigna Commercial |
$3,687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,784.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,106.25
|
|
|
STENT GENESIS 7x18 PG187OBSS
|
Facility
|
IP
|
$6,820.00
|
|
| Hospital Charge Code |
270630178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$1,650.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,364.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,650.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,023.00
|
|
|
STENT GENESIS 7x18 PG187OBSS
|
Facility
|
OP
|
$6,820.00
|
|
| Hospital Charge Code |
270630178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,410.00 |
| Rate for Payer: Aetna Commercial |
$2,046.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,046.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,739.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,739.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,364.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,739.10
|
| Rate for Payer: Cigna Commercial |
$3,410.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,650.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,023.00
|
|
|
STENT GENESIS 7x18 PG187OBSS
|
Facility
|
IP
|
$6,820.00
|
|
| Hospital Charge Code |
270630178V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$1,650.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,364.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,650.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,023.00
|
|
|
STENT GENESIS 7x18 PG187OBSS
|
Facility
|
OP
|
$6,820.00
|
|
| Hospital Charge Code |
270630178V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,410.00 |
| Rate for Payer: Aetna Commercial |
$2,046.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,046.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,739.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,739.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,364.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,739.10
|
| Rate for Payer: Cigna Commercial |
$3,410.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,650.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,023.00
|
|
|
STENT GENESIS 7X39 135CM
|
Facility
|
IP
|
$6,975.00
|
|
| Hospital Charge Code |
270639532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$1,687.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
| 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
|
|
|
STENT GENESIS 7X39 135CM
|
Facility
|
OP
|
$6,975.00
|
|
| Hospital Charge Code |
270639532
|
|
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
|
|