|
PACEMAKER REMOV PUL GEN SNGL
|
Facility
|
OP
|
$11,838.15
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
74110022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.30 |
| Max. Negotiated Rate |
$35,488.33 |
| Rate for Payer: Aetna Commercial |
$26,741.35
|
| Rate for Payer: Aetna Medicare Advantage |
$31,853.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9,831.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35,488.33
|
| Rate for Payer: Cigna Commercial |
$19,706.96
|
| Rate for Payer: Cigna Medicare Advantage |
$9,831.38
|
| Rate for Payer: Clover Medicare Advantage |
$9,339.81
|
| Rate for Payer: EmblemHealth Commercial |
$29,494.14
|
| Rate for Payer: Humana Medicare Advantage |
$10,126.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9,831.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,551.45
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,775.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$285.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$313.71
|
|
|
PACEMAKER REMOV PUL GEN SNGL
|
Facility
|
IP
|
$11,838.15
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
5100210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,775.72 |
| Max. Negotiated Rate |
$1,775.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,775.72
|
|
|
PACEMAKER REMOV PUL GEN SNGL
|
Facility
|
IP
|
$11,838.15
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
74110022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,775.72 |
| Max. Negotiated Rate |
$1,775.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,775.72
|
|
|
PACEMAKER REPLACE DUAL***
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
5100198
|
|
Hospital Revenue Code
|
489
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.50
|
|
|
PACEMAKER REPLACE DUAL***
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
5100198
|
|
Hospital Revenue Code
|
489
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$44,822.55 |
| Rate for Payer: Aetna Commercial |
$33,774.92
|
| Rate for Payer: Aetna Medicare Advantage |
$40,231.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44,822.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44,822.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,417.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$437.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44,822.55
|
| Rate for Payer: Cigna Commercial |
$24,890.32
|
| Rate for Payer: Cigna Medicare Advantage |
$12,417.25
|
| Rate for Payer: Clover Medicare Advantage |
$11,796.39
|
| Rate for Payer: EmblemHealth Commercial |
$37,251.75
|
| Rate for Payer: Humana Medicare Advantage |
$12,789.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12,417.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.00
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,417.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,417.25
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$17,126.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.04
|
|
|
PACEMAKER REPLACE PULSE GEN***
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
5100197
|
|
Hospital Revenue Code
|
489
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$77.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.55
|
|
|
PACEMAKER REPLACE PULSE GEN***
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
5100197
|
|
Hospital Revenue Code
|
489
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$35,488.33 |
| Rate for Payer: Aetna Commercial |
$26,741.35
|
| Rate for Payer: Aetna Medicare Advantage |
$31,853.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9,831.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$384.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35,488.33
|
| Rate for Payer: Cigna Commercial |
$19,706.96
|
| Rate for Payer: Cigna Medicare Advantage |
$9,831.38
|
| Rate for Payer: Clover Medicare Advantage |
$9,339.81
|
| Rate for Payer: EmblemHealth Commercial |
$29,494.14
|
| Rate for Payer: Humana Medicare Advantage |
$10,126.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9,831.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$155.10
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.46
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.70
|
|
|
PACEMAKER REPLC PUL GEN DUAL
|
Facility
|
IP
|
$49,497.70
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
5100290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,424.65 |
| Max. Negotiated Rate |
$7,424.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,424.65
|
|
|
PACEMAKER REPLC PUL GEN DUAL
|
Facility
|
OP
|
$49,497.70
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
5100290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,192.89 |
| Max. Negotiated Rate |
$44,822.55 |
| Rate for Payer: Aetna Commercial |
$33,774.92
|
| Rate for Payer: Aetna Medicare Advantage |
$40,231.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44,822.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44,822.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,417.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44,822.55
|
| Rate for Payer: Cigna Commercial |
$24,890.32
|
| Rate for Payer: Cigna Medicare Advantage |
$12,417.25
|
| Rate for Payer: Clover Medicare Advantage |
$11,796.39
|
| Rate for Payer: EmblemHealth Commercial |
$37,251.75
|
| Rate for Payer: Humana Medicare Advantage |
$12,789.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12,417.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14,849.31
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,424.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,192.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,417.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,417.25
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$17,126.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16,790.24
|
|
|
PACEMAKER REPLC PUL GEN DUAL
|
Facility
|
OP
|
$49,497.70
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
74110032
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,192.89 |
| Max. Negotiated Rate |
$44,822.55 |
| Rate for Payer: Aetna Commercial |
$33,774.92
|
| Rate for Payer: Aetna Medicare Advantage |
$40,231.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$44,822.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$44,822.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12,417.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$44,822.55
|
| Rate for Payer: Cigna Commercial |
$24,890.32
|
| Rate for Payer: Cigna Medicare Advantage |
$12,417.25
|
| Rate for Payer: Clover Medicare Advantage |
$11,796.39
|
| Rate for Payer: EmblemHealth Commercial |
$37,251.75
|
| Rate for Payer: Humana Medicare Advantage |
$12,789.77
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12,417.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14,849.31
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,424.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,192.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12,417.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$12,417.25
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$17,126.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16,790.24
|
|
|
PACEMAKER REPLC PUL GEN DUAL
|
Facility
|
IP
|
$49,497.70
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
74110032
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,424.65 |
| Max. Negotiated Rate |
$7,424.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,424.65
|
|
|
PACEMAKER REPLC PUL GEN SNGL
|
Facility
|
OP
|
$43,734.25
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
5100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,054.00 |
| Max. Negotiated Rate |
$35,488.33 |
| Rate for Payer: Aetna Commercial |
$26,741.35
|
| Rate for Payer: Aetna Medicare Advantage |
$31,853.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9,831.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35,488.33
|
| Rate for Payer: Cigna Commercial |
$19,706.96
|
| Rate for Payer: Cigna Medicare Advantage |
$9,831.38
|
| Rate for Payer: Clover Medicare Advantage |
$9,339.81
|
| Rate for Payer: EmblemHealth Commercial |
$29,494.14
|
| Rate for Payer: Humana Medicare Advantage |
$10,126.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9,831.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13,120.27
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,560.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,054.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,158.96
|
|
|
PACEMAKER REPLC PUL GEN SNGL
|
Facility
|
OP
|
$43,734.25
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
74110031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,054.00 |
| Max. Negotiated Rate |
$35,488.33 |
| Rate for Payer: Aetna Commercial |
$26,741.35
|
| Rate for Payer: Aetna Medicare Advantage |
$31,853.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35,488.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9,831.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,355.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35,488.33
|
| Rate for Payer: Cigna Commercial |
$19,706.96
|
| Rate for Payer: Cigna Medicare Advantage |
$9,831.38
|
| Rate for Payer: Clover Medicare Advantage |
$9,339.81
|
| Rate for Payer: EmblemHealth Commercial |
$29,494.14
|
| Rate for Payer: Humana Medicare Advantage |
$10,126.32
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9,831.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13,120.27
|
| Rate for Payer: Oxford Commercial |
$9,689.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,560.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,605.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,054.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$9,831.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,158.96
|
|
|
PACEMAKER REPLC PUL GEN SNGL
|
Facility
|
IP
|
$43,734.25
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
74110031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,560.14 |
| Max. Negotiated Rate |
$6,560.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,560.14
|
|
|
PACEMAKER REPLC PUL GEN SNGL
|
Facility
|
IP
|
$43,734.25
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
5100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,560.14 |
| Max. Negotiated Rate |
$6,560.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,560.14
|
|
|
PACEMAKER REPROG DUAL
|
Facility
|
OP
|
$222.75
|
|
|
Service Code
|
HCPCS 93732
|
| Hospital Charge Code |
5100270
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna Commercial |
$84.64
|
| Rate for Payer: Aetna Medicare Advantage |
$66.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$56.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$56.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$56.80
|
| Rate for Payer: Cigna Commercial |
$111.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$66.83
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.90
|
|
|
PACEMAKER REPROG DUAL
|
Facility
|
IP
|
$222.75
|
|
|
Service Code
|
HCPCS 93732
|
| Hospital Charge Code |
5100270
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$33.41 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.41
|
|
|
PACEMAKER REPROG SNGL
|
Facility
|
OP
|
$136.35
|
|
|
Service Code
|
HCPCS 93735
|
| Hospital Charge Code |
5100260
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna Commercial |
$51.81
|
| Rate for Payer: Aetna Medicare Advantage |
$40.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.77
|
| Rate for Payer: Cigna Commercial |
$68.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.91
|
| Rate for Payer: Oxford Commercial |
$4,459.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,760.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.61
|
|
|
PACEMAKER REPROG SNGL
|
Facility
|
IP
|
$136.35
|
|
|
Service Code
|
HCPCS 93735
|
| Hospital Charge Code |
5100260
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.45
|
|
|
PACEMAKER SENSIA DR
|
Facility
|
OP
|
$21,540.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270637991
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$519.11 |
| Max. Negotiated Rate |
$10,770.00 |
| Rate for Payer: Aetna Commercial |
$8,185.20
|
| Rate for Payer: Aetna Medicare Advantage |
$6,462.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,492.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,492.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,308.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,492.70
|
| Rate for Payer: Cigna Commercial |
$10,770.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,212.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,738.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,231.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$519.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$570.81
|
|
|
PACEMAKER SENSIA DR
|
Facility
|
IP
|
$21,540.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270637991
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,231.00 |
| Max. Negotiated Rate |
$5,212.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,308.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,212.68
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,738.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,231.00
|
|
|
PACEMAKER SENSIA DR SEDR01
|
Facility
|
OP
|
$28,665.00
|
|
| Hospital Charge Code |
270637991C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$690.83 |
| Max. Negotiated Rate |
$14,332.50 |
| Rate for Payer: Aetna Commercial |
$10,892.70
|
| Rate for Payer: Aetna Medicare Advantage |
$8,599.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,309.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,309.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,733.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,309.57
|
| Rate for Payer: Cigna Commercial |
$14,332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,936.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,306.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,299.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$690.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$759.62
|
|
|
PACEMAKER SENSIA DR SEDR01
|
Facility
|
IP
|
$28,665.00
|
|
| Hospital Charge Code |
270637991C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,299.75 |
| Max. Negotiated Rate |
$6,936.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,733.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,936.93
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,306.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,299.75
|
|
|
PACEMAKER SENSIA SESR01
|
Facility
|
IP
|
$24,475.00
|
|
| Hospital Charge Code |
270638082C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,671.25 |
| Max. Negotiated Rate |
$5,922.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,895.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,922.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,384.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,671.25
|
|
|
PACEMAKER SENSIA SESR01
|
Facility
|
OP
|
$24,475.00
|
|
| Hospital Charge Code |
270638082C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$589.85 |
| Max. Negotiated Rate |
$12,237.50 |
| Rate for Payer: Aetna Commercial |
$9,300.50
|
| Rate for Payer: Aetna Medicare Advantage |
$7,342.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,241.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,241.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,895.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,241.12
|
| Rate for Payer: Cigna Commercial |
$12,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,922.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,384.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,671.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$589.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$648.59
|
|
