|
PACEMAKER DUAL CHAMBER KDR903
|
Facility
|
IP
|
$30,692.85
|
|
| Hospital Charge Code |
270625757C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,603.93 |
| Max. Negotiated Rate |
$7,427.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,138.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,427.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,603.93
|
|
|
PACEMAKER DUAL CHAMBER KDR903
|
Facility
|
IP
|
$30,692.85
|
|
| Hospital Charge Code |
270625757
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,603.93 |
| Max. Negotiated Rate |
$7,427.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,138.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,427.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,603.93
|
|
|
PACEMAKER DUAL CHAMBER KDR903
|
Facility
|
OP
|
$30,692.85
|
|
| Hospital Charge Code |
270625757C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,603.93 |
| Max. Negotiated Rate |
$15,346.42 |
| Rate for Payer: Aetna Commercial |
$9,207.85
|
| Rate for Payer: Aetna Medicare Advantage |
$9,207.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,826.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,826.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,138.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,826.68
|
| Rate for Payer: Cigna Commercial |
$15,346.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,427.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,603.93
|
|
|
PACEMAKER DUAL CHMBR EVIA DR-T
|
Facility
|
OP
|
$20,815.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270675164
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,122.25 |
| Max. Negotiated Rate |
$10,407.50 |
| Rate for Payer: Aetna Commercial |
$6,244.50
|
| Rate for Payer: Aetna Medicare Advantage |
$6,244.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,163.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,307.82
|
| Rate for Payer: Cigna Commercial |
$10,407.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,037.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,122.25
|
|
|
PACEMAKER DUAL CHMBR EVIA DR-T
|
Facility
|
IP
|
$20,815.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270675164
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,122.25 |
| Max. Negotiated Rate |
$5,037.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,163.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,037.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,122.25
|
|
|
PACEMAKER EDORA 8 DR-T DUAL
|
Facility
|
OP
|
$34,975.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270687371
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,246.25 |
| Max. Negotiated Rate |
$17,487.50 |
| Rate for Payer: Aetna Commercial |
$10,492.50
|
| Rate for Payer: Aetna Medicare Advantage |
$10,492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,918.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,918.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,918.62
|
| Rate for Payer: Cigna Commercial |
$17,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,463.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,246.25
|
|
|
PACEMAKER EDORA 8 DR-T DUAL
|
Facility
|
IP
|
$34,975.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270687371
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,246.25 |
| Max. Negotiated Rate |
$8,463.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,463.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,246.25
|
|
|
PACEMAKER ENPULSE DR E2DR06
|
Facility
|
IP
|
$30,750.00
|
|
| Hospital Charge Code |
270635378C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,612.50 |
| Max. Negotiated Rate |
$7,441.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,441.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,612.50
|
|
|
PACEMAKER ENPULSE DR E2DR06
|
Facility
|
OP
|
$30,750.00
|
|
| Hospital Charge Code |
270635378C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,612.50 |
| Max. Negotiated Rate |
$15,375.00 |
| Rate for Payer: Aetna Commercial |
$9,225.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,841.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,841.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,841.25
|
| Rate for Payer: Cigna Commercial |
$15,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,441.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,612.50
|
|
|
PACEMAKER ENPULSE DUAL E2DR01
|
Facility
|
OP
|
$30,504.00
|
|
| Hospital Charge Code |
207633460
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,575.60 |
| Max. Negotiated Rate |
$15,252.00 |
| Rate for Payer: Aetna Commercial |
$9,151.20
|
| Rate for Payer: Aetna Medicare Advantage |
$9,151.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,778.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,778.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,778.52
|
| Rate for Payer: Cigna Commercial |
$15,252.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,381.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,575.60
|
|
|
PACEMAKER ENPULSE DUAL E2DR01
|
Facility
|
IP
|
$30,504.00
|
|
| Hospital Charge Code |
207633460
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,575.60 |
| Max. Negotiated Rate |
$7,381.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,100.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,381.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,575.60
|
|
|
PACEMAKER ENPULSE SR E2SR01
|
Facility
|
OP
|
$24,056.00
|
|
| Hospital Charge Code |
270633602C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,608.40 |
| Max. Negotiated Rate |
$12,028.00 |
| Rate for Payer: Aetna Commercial |
$7,216.80
|
| Rate for Payer: Aetna Medicare Advantage |
$7,216.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,134.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,134.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,811.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,134.28
|
| Rate for Payer: Cigna Commercial |
$12,028.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,821.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,608.40
|
|
|
PACEMAKER ENPULSE SR E2SR01
|
Facility
|
IP
|
$24,056.00
|
|
| Hospital Charge Code |
270633602C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,608.40 |
| Max. Negotiated Rate |
$5,821.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,811.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,821.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,608.40
|
|
|
PACEMAKER ENPULSE SR E2SR01
|
Facility
|
OP
|
$26,263.25
|
|
| Hospital Charge Code |
270633602
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,939.49 |
| Max. Negotiated Rate |
$13,131.62 |
| Rate for Payer: Aetna Commercial |
$7,878.98
|
| Rate for Payer: Aetna Medicare Advantage |
$7,878.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,697.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,697.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,252.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,697.13
|
| Rate for Payer: Cigna Commercial |
$13,131.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,355.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,939.49
|
|
|
PACEMAKER ENPULSE SR E2SR01
|
Facility
|
IP
|
$26,263.25
|
|
| Hospital Charge Code |
270633602
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,939.49 |
| Max. Negotiated Rate |
$6,355.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,252.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,355.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,939.49
|
|
|
PACEMAKER ENRHYTHM P1501DR
|
Facility
|
OP
|
$32,984.00
|
|
| Hospital Charge Code |
270635792C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,947.60 |
| Max. Negotiated Rate |
$16,492.00 |
| Rate for Payer: Aetna Medicare Advantage |
$9,895.20
|
| Rate for Payer: Aetna Commercial |
$9,895.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,410.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,410.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,596.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,410.92
|
| Rate for Payer: Cigna Commercial |
$16,492.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,982.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,947.60
|
|
|
PACEMAKER ENRHYTHM P1501DR
|
Facility
|
IP
|
$32,984.00
|
|
| Hospital Charge Code |
270635792C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,947.60 |
| Max. Negotiated Rate |
$7,982.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,596.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,982.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,947.60
|
|
|
PACEMAKER ENRHYTHM P1501DR
|
Facility
|
OP
|
$32,984.00
|
|
| Hospital Charge Code |
270635792
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,947.60 |
| Max. Negotiated Rate |
$16,492.00 |
| Rate for Payer: Aetna Commercial |
$9,895.20
|
| Rate for Payer: Aetna Medicare Advantage |
$9,895.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,410.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,410.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,596.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,410.92
|
| Rate for Payer: Cigna Commercial |
$16,492.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,982.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,947.60
|
|
|
PACEMAKER ENRHYTHM P1501DR
|
Facility
|
IP
|
$32,984.00
|
|
| Hospital Charge Code |
270635792
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,947.60 |
| Max. Negotiated Rate |
$7,982.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,596.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,982.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,947.60
|
|
|
PACEMAKER EVIA DR-T
|
Facility
|
IP
|
$20,815.00
|
|
| Hospital Charge Code |
270675681
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,122.25 |
| Max. Negotiated Rate |
$5,037.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,163.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,037.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,122.25
|
|
|
PACEMAKER EVIA DR-T
|
Facility
|
OP
|
$20,815.00
|
|
| Hospital Charge Code |
270675681
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,122.25 |
| Max. Negotiated Rate |
$10,407.50 |
| Rate for Payer: Aetna Commercial |
$6,244.50
|
| Rate for Payer: Aetna Medicare Advantage |
$6,244.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,163.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,307.82
|
| Rate for Payer: Cigna Commercial |
$10,407.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,037.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,122.25
|
|
|
PACEMAKER EVIA SR-T
|
Facility
|
IP
|
$18,915.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270673069
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,837.25 |
| Max. Negotiated Rate |
$4,577.43 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,783.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,577.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,837.25
|
|
|
PACEMAKER EVIA SR-T
|
Facility
|
OP
|
$18,915.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270673069
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,837.25 |
| Max. Negotiated Rate |
$9,457.50 |
| Rate for Payer: Aetna Commercial |
$5,674.50
|
| Rate for Payer: Aetna Medicare Advantage |
$5,674.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,823.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,823.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,783.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,823.32
|
| Rate for Payer: Cigna Commercial |
$9,457.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,577.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,837.25
|
|
|
PACEMAKER FLUORO
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
7411159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Medicare Advantage |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$92.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$131.58
|
| Rate for Payer: Cigna Commercial |
$568.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.08
|
| Rate for Payer: Oxford Commercial |
$1,311.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,489.00
|
|
|
PACEMAKER FLUORO
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
7411159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.40
|
|