|
STENT SPUR 4.0x60x135
|
Facility
|
OP
|
$19,975.00
|
|
| Hospital Charge Code |
270705365
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,596.75 |
| Max. Negotiated Rate |
$9,987.50 |
| Rate for Payer: Aetna Commercial |
$5,992.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,992.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,093.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,093.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,093.62
|
| Rate for Payer: Cigna Commercial |
$9,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,596.75
|
| Rate for Payer: Oxford Commercial |
$9,987.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,996.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,987.50
|
|
|
STENT SPUR 4.0x60x135
|
Facility
|
IP
|
$19,975.00
|
|
| Hospital Charge Code |
270705365
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,996.25 |
| Max. Negotiated Rate |
$2,996.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,996.25
|
|
|
STENT ST BIL 10x40x80 C10040SB
|
Facility
|
IP
|
$8,225.00
|
|
| Hospital Charge Code |
270628011V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$1,990.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|
|
STENT ST BIL 10x40x80 C10040SB
|
Facility
|
IP
|
$8,159.25
|
|
| Hospital Charge Code |
270628011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.89 |
| Max. Negotiated Rate |
$1,974.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,631.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,974.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,223.89
|
|
|
STENT ST BIL 10x40x80 C10040SB
|
Facility
|
OP
|
$8,225.00
|
|
| Hospital Charge Code |
270628011V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$4,112.50 |
| Rate for Payer: Aetna Commercial |
$2,467.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,467.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,097.38
|
| Rate for Payer: Cigna Commercial |
$4,112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|
|
STENT ST BIL 10x40x80 C10040SB
|
Facility
|
OP
|
$8,159.25
|
|
| Hospital Charge Code |
270628011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.89 |
| Max. Negotiated Rate |
$4,079.62 |
| Rate for Payer: Aetna Commercial |
$2,447.78
|
| Rate for Payer: Aetna Medicare Advantage |
$2,447.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,080.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,080.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,631.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,080.61
|
| Rate for Payer: Cigna Commercial |
$4,079.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,974.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,223.89
|
|
|
STENT ST BIL 7x40x120 C07040MB
|
Facility
|
OP
|
$8,159.25
|
|
| Hospital Charge Code |
270632501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.89 |
| Max. Negotiated Rate |
$4,079.62 |
| Rate for Payer: Aetna Commercial |
$2,447.78
|
| Rate for Payer: Aetna Medicare Advantage |
$2,447.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,080.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,080.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,631.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,080.61
|
| Rate for Payer: Cigna Commercial |
$4,079.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,974.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,223.89
|
|
|
STENT ST BIL 7x40x120 C07040MB
|
Facility
|
IP
|
$8,225.00
|
|
| Hospital Charge Code |
270632501V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$1,990.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|
|
STENT ST BIL 7x40x120 C07040MB
|
Facility
|
OP
|
$8,225.00
|
|
| Hospital Charge Code |
270632501V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$4,112.50 |
| Rate for Payer: Aetna Commercial |
$2,467.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,467.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,097.38
|
| Rate for Payer: Cigna Commercial |
$4,112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|
|
STENT ST BIL 7x40x120 C07040MB
|
Facility
|
IP
|
$8,159.25
|
|
| Hospital Charge Code |
270632501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.89 |
| Max. Negotiated Rate |
$1,974.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,631.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,974.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,223.89
|
|
|
STENT ST BIL 7x60x120 C07060MB
|
Facility
|
IP
|
$8,159.25
|
|
| Hospital Charge Code |
270632502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.89 |
| Max. Negotiated Rate |
$1,974.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,631.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,974.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,223.89
|
|
|
STENT ST BIL 7x60x120 C07060MB
|
Facility
|
OP
|
$8,159.25
|
|
| Hospital Charge Code |
270632502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.89 |
| Max. Negotiated Rate |
$4,079.62 |
| Rate for Payer: Aetna Commercial |
$2,447.78
|
| Rate for Payer: Aetna Medicare Advantage |
$2,447.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,080.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,080.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,631.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,080.61
|
| Rate for Payer: Cigna Commercial |
$4,079.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,974.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,223.89
|
|
|
STENT ST BIL 7x60x120 C07060MB
|
Facility
|
IP
|
$8,225.00
|
|
| Hospital Charge Code |
270632502V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$1,990.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|
|
STENT ST BIL 7x60x120 C07060MB
|
Facility
|
OP
|
$8,225.00
|
|
| Hospital Charge Code |
270632502V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$4,112.50 |
| Rate for Payer: Aetna Commercial |
$2,467.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,467.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,097.38
|
| Rate for Payer: Cigna Commercial |
$4,112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|
|
STENT ST BIL 7x80x120 C07080MB
|
Facility
|
OP
|
$9,796.00
|
|
| Hospital Charge Code |
270632500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.40 |
| Max. Negotiated Rate |
$4,898.00 |
| Rate for Payer: Aetna Commercial |
$2,938.80
|
| Rate for Payer: Aetna Medicare Advantage |
$2,938.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,497.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,497.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,959.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,497.98
|
| Rate for Payer: Cigna Commercial |
$4,898.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,370.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,469.40
|
|
|
STENT ST BIL 7x80x120 C07080MB
|
Facility
|
IP
|
$9,796.00
|
|
| Hospital Charge Code |
270632500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,469.40 |
| Max. Negotiated Rate |
$2,370.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,959.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,370.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,469.40
|
|
|
STENT ST BIL 7x80x120 C07080MB
|
Facility
|
IP
|
$9,875.00
|
|
| Hospital Charge Code |
270632500V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.25 |
| Max. Negotiated Rate |
$2,389.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,389.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,481.25
|
|
|
STENT ST BIL 7x80x120 C07080MB
|
Facility
|
OP
|
$9,875.00
|
|
| Hospital Charge Code |
270632500V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.25 |
| Max. Negotiated Rate |
$4,937.50 |
| Rate for Payer: Aetna Commercial |
$2,962.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,962.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,518.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,518.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,518.12
|
| Rate for Payer: Cigna Commercial |
$4,937.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,389.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,481.25
|
|
|
STENT ST BILI 7x40x80 C07040SB
|
Facility
|
IP
|
$8,159.25
|
|
| Hospital Charge Code |
270632499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.89 |
| Max. Negotiated Rate |
$1,974.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,631.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,974.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,223.89
|
|
|
STENT ST BILI 7x40x80 C07040SB
|
Facility
|
OP
|
$8,159.25
|
|
| Hospital Charge Code |
270632499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.89 |
| Max. Negotiated Rate |
$4,079.62 |
| Rate for Payer: Aetna Commercial |
$2,447.78
|
| Rate for Payer: Aetna Medicare Advantage |
$2,447.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,080.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,080.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,631.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,080.61
|
| Rate for Payer: Cigna Commercial |
$4,079.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,974.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,223.89
|
|
|
STENT ST BILI 7x40x80 C07040SB
|
Facility
|
IP
|
$8,225.00
|
|
| Hospital Charge Code |
270632499V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$1,990.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|
|
STENT ST BILI 7x40x80 C07040SB
|
Facility
|
OP
|
$8,225.00
|
|
| Hospital Charge Code |
270632499V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$4,112.50 |
| Rate for Payer: Aetna Commercial |
$2,467.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,467.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,097.38
|
| Rate for Payer: Cigna Commercial |
$4,112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|
|
STENT ST BILI 7x60x80 C07060SB
|
Facility
|
IP
|
$8,159.25
|
|
| Hospital Charge Code |
270632503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.89 |
| Max. Negotiated Rate |
$1,974.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,631.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,974.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,223.89
|
|
|
STENT ST BILI 7x60x80 C07060SB
|
Facility
|
OP
|
$8,159.25
|
|
| Hospital Charge Code |
270632503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.89 |
| Max. Negotiated Rate |
$4,079.62 |
| Rate for Payer: Aetna Commercial |
$2,447.78
|
| Rate for Payer: Aetna Medicare Advantage |
$2,447.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,080.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,080.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,631.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,080.61
|
| Rate for Payer: Cigna Commercial |
$4,079.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,974.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,223.89
|
|
|
STENT ST BILI 7x60x80 C07060SB
|
Facility
|
OP
|
$8,225.00
|
|
| Hospital Charge Code |
270632503V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$4,112.50 |
| Rate for Payer: Aetna Commercial |
$2,467.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,467.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,097.38
|
| Rate for Payer: Cigna Commercial |
$4,112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|