|
STENT XCEED 8x40 80cm 1487001
|
Facility
|
OP
|
$5,952.00
|
|
| Hospital Charge Code |
270634996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.80 |
| Max. Negotiated Rate |
$2,976.00 |
| Rate for Payer: Aetna Commercial |
$1,785.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,785.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,517.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,517.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,190.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,517.76
|
| Rate for Payer: Cigna Commercial |
$2,976.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,440.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$892.80
|
|
|
STENT XCEED 8x40 80cm 1487001
|
Facility
|
OP
|
$5,952.00
|
|
| Hospital Charge Code |
270634996V
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.80 |
| Max. Negotiated Rate |
$2,976.00 |
| Rate for Payer: Aetna Commercial |
$1,785.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,785.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,517.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,517.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,190.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,517.76
|
| Rate for Payer: Cigna Commercial |
$2,976.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,440.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$892.80
|
|
|
STENT XIENCE 2.5X12M 100953912
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640905C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X12M 100953912
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640905C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X15MM 10095395
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640906C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X15MM 10095395
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640906C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X18MM
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640907C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X18MM
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640907C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X23MM
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640908C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X23MM
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640908C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X28M 100953928
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640909C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X28M 100953928
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640909C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X8 100953908
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640904C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.5X8 100953908
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640904C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X12 100954012
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640911C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X12 100954012
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640911C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X15 100953915
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640912C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X15 100953915
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640912C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X18M 10095401
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640913C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X18M 10095401
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640913C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X23 100954023
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640914C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X23 100954023
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640914C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X28 100954028
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640915C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X28 100954028
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640915C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$3,943.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|
|
STENT XIENCE 2.75X8 100954008
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640910C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,444.16 |
| Max. Negotiated Rate |
$8,147.19 |
| Rate for Payer: Aetna Commercial |
$4,888.31
|
| Rate for Payer: Aetna Medicare Advantage |
$4,888.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,155.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,258.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,155.06
|
| Rate for Payer: Cigna Commercial |
$8,147.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,943.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,444.16
|
|