|
STENT XIENCE 2.75X8 100954008
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640910C
|
|
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 3.0X12 100954112
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640917C
|
|
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 3.0X12 100954112
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640917C
|
|
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 3.0X15 100954115
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640918C
|
|
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 3.0X15 100954115
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640918C
|
|
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 3.0X18M 100954118
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640919C
|
|
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 3.0X18M 100954118
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640919C
|
|
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 3.0X23 100954123
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640920C
|
|
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 3.0X23 100954123
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640920C
|
|
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 3.0X28 100954128
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640921C
|
|
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 3.0X28 100954128
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640921C
|
|
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 3.0X8M 100954108
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640916C
|
|
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 3.0X8M 100954108
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640916C
|
|
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 3.5X12M 100954212
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640939C
|
|
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 3.5X12M 100954212
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640939C
|
|
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 3.5X15M 100954215
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640942C
|
|
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 3.5X15M 100954215
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640942C
|
|
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 3.5X18 100954218
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640941C
|
|
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 3.5X18 100954218
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640941C
|
|
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 3.5X23M 100954223
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640944C
|
|
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 3.5X23M 100954223
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640944C
|
|
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 3.5X28 100954228
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640945V
|
|
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 3.5X28 100954228
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640945V
|
|
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 3.5X28 100954228
|
Facility
|
IP
|
$16,294.37
|
|
| Hospital Charge Code |
270640945C
|
|
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 3.5X28 100954228
|
Facility
|
OP
|
$16,294.37
|
|
| Hospital Charge Code |
270640945C
|
|
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
|
|