|
PACEMAKER MEDT 7940U***
|
Facility
|
OP
|
$17,820.00
|
|
| Hospital Charge Code |
270602698
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,673.00 |
| Max. Negotiated Rate |
$8,910.00 |
| Rate for Payer: Aetna Commercial |
$5,346.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,346.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,544.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,544.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,564.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,544.10
|
| Rate for Payer: Cigna Commercial |
$8,910.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,312.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,673.00
|
|
|
PACEMAKER MEDT 7940U***
|
Facility
|
IP
|
$17,820.00
|
|
| Hospital Charge Code |
270602698
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,673.00 |
| Max. Negotiated Rate |
$4,312.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,564.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,312.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,673.00
|
|
|
PACEMAKER MEDT 7941***
|
Facility
|
IP
|
$17,820.00
|
|
| Hospital Charge Code |
270602699
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,673.00 |
| Max. Negotiated Rate |
$4,312.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,564.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,312.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,673.00
|
|
|
PACEMAKER MEDT 7941***
|
Facility
|
OP
|
$17,820.00
|
|
| Hospital Charge Code |
270602699
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,673.00 |
| Max. Negotiated Rate |
$8,910.00 |
| Rate for Payer: Aetna Commercial |
$5,346.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,346.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,544.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,544.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,564.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,544.10
|
| Rate for Payer: Cigna Commercial |
$8,910.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,312.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,673.00
|
|
|
PACEMAKER MEDT 7942***
|
Facility
|
IP
|
$17,820.00
|
|
| Hospital Charge Code |
270602700
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,673.00 |
| Max. Negotiated Rate |
$4,312.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,564.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,312.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,673.00
|
|
|
PACEMAKER MEDT 7942***
|
Facility
|
OP
|
$17,820.00
|
|
| Hospital Charge Code |
270602700
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,673.00 |
| Max. Negotiated Rate |
$8,910.00 |
| Rate for Payer: Aetna Commercial |
$5,346.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,346.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,544.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,544.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,564.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,544.10
|
| Rate for Payer: Cigna Commercial |
$8,910.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,312.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,673.00
|
|
|
PACEMAKER MEDT 7944B***
|
Facility
|
IP
|
$17,280.00
|
|
| Hospital Charge Code |
270602706
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,592.00 |
| Max. Negotiated Rate |
$4,181.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,456.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,181.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,592.00
|
|
|
PACEMAKER MEDT 7944B***
|
Facility
|
OP
|
$17,280.00
|
|
| Hospital Charge Code |
270602706
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,592.00 |
| Max. Negotiated Rate |
$8,640.00 |
| Rate for Payer: Aetna Commercial |
$5,184.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,184.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,406.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,406.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,456.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,406.40
|
| Rate for Payer: Cigna Commercial |
$8,640.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,181.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,592.00
|
|
|
PACEMAKER MEDT 7944U***
|
Facility
|
OP
|
$17,280.00
|
|
| Hospital Charge Code |
270602707
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,592.00 |
| Max. Negotiated Rate |
$8,640.00 |
| Rate for Payer: Aetna Commercial |
$5,184.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,184.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,406.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,406.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,456.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,406.40
|
| Rate for Payer: Cigna Commercial |
$8,640.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,181.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,592.00
|
|
|
PACEMAKER MEDT 7944U***
|
Facility
|
IP
|
$17,280.00
|
|
| Hospital Charge Code |
270602707
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,592.00 |
| Max. Negotiated Rate |
$4,181.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,456.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,181.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,592.00
|
|
|
PACEMAKER MEDT 7946***
|
Facility
|
IP
|
$17,280.00
|
|
| Hospital Charge Code |
270602709
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,592.00 |
| Max. Negotiated Rate |
$4,181.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,456.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,181.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,592.00
|
|
|
PACEMAKER MEDT 7946***
|
Facility
|
OP
|
$17,280.00
|
|
| Hospital Charge Code |
270602709
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,592.00 |
| Max. Negotiated Rate |
$8,640.00 |
| Rate for Payer: Aetna Commercial |
$5,184.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,184.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,406.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,406.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,456.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,406.40
|
| Rate for Payer: Cigna Commercial |
$8,640.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,181.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,592.00
|
|
|
PACEMAKER MEDT 7960iB
|
Facility
|
OP
|
$24,192.00
|
|
| Hospital Charge Code |
270602693
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,628.80 |
| Max. Negotiated Rate |
$12,096.00 |
| Rate for Payer: Aetna Commercial |
$7,257.60
|
| Rate for Payer: Aetna Medicare Advantage |
$7,257.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,838.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,168.96
|
| Rate for Payer: Cigna Commercial |
$12,096.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,854.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,628.80
|
|
|
PACEMAKER MEDT 7960iB
|
Facility
|
IP
|
$24,192.00
|
|
| Hospital Charge Code |
270602693
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,628.80 |
| Max. Negotiated Rate |
$5,854.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,838.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,854.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,628.80
|
|
|
PACEMAKER MEDT 7960IB
|
Facility
|
OP
|
$24,192.00
|
|
| Hospital Charge Code |
270602693C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,628.80 |
| Max. Negotiated Rate |
$12,096.00 |
| Rate for Payer: Aetna Commercial |
$7,257.60
|
| Rate for Payer: Aetna Medicare Advantage |
$7,257.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,838.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,168.96
|
| Rate for Payer: Cigna Commercial |
$12,096.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,854.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,628.80
|
|
|
PACEMAKER MEDT 7960IB
|
Facility
|
IP
|
$24,192.00
|
|
| Hospital Charge Code |
270602693C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,628.80 |
| Max. Negotiated Rate |
$5,854.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,838.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,854.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,628.80
|
|
|
PACEMAKER MEDT 7960iU***
|
Facility
|
OP
|
$21,600.00
|
|
| Hospital Charge Code |
270602694
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$10,800.00 |
| Rate for Payer: Aetna Commercial |
$6,480.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,508.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,508.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,320.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,508.00
|
| Rate for Payer: Cigna Commercial |
$10,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,227.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,240.00
|
|
|
PACEMAKER MEDT 7960iU***
|
Facility
|
IP
|
$21,600.00
|
|
| Hospital Charge Code |
270602694
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$5,227.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,320.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,227.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,240.00
|
|
|
PACEMAKER MEDT 7961Li***
|
Facility
|
OP
|
$21,600.00
|
|
| Hospital Charge Code |
270602695
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$10,800.00 |
| Rate for Payer: Aetna Commercial |
$6,480.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,508.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,508.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,320.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,508.00
|
| Rate for Payer: Cigna Commercial |
$10,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,227.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,240.00
|
|
|
PACEMAKER MEDT 7961Li***
|
Facility
|
IP
|
$21,600.00
|
|
| Hospital Charge Code |
270602695
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$5,227.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,320.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,227.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,240.00
|
|
|
PACEMAKER MEDT 7962B
|
Facility
|
OP
|
$24,192.00
|
|
| Hospital Charge Code |
270608508
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,628.80 |
| Max. Negotiated Rate |
$12,096.00 |
| Rate for Payer: Aetna Commercial |
$7,257.60
|
| Rate for Payer: Aetna Medicare Advantage |
$7,257.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,838.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,168.96
|
| Rate for Payer: Cigna Commercial |
$12,096.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,854.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,628.80
|
|
|
PACEMAKER MEDT 7962B
|
Facility
|
IP
|
$24,192.00
|
|
| Hospital Charge Code |
270608508
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,628.80 |
| Max. Negotiated Rate |
$5,854.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,838.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,854.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,628.80
|
|
|
PACEMAKER MEDT 7962i***
|
Facility
|
IP
|
$21,600.00
|
|
| Hospital Charge Code |
270604619
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$5,227.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,320.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,227.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,240.00
|
|
|
PACEMAKER MEDT 7962i***
|
Facility
|
OP
|
$21,600.00
|
|
| Hospital Charge Code |
270604619
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$10,800.00 |
| Rate for Payer: Aetna Commercial |
$6,480.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,480.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,508.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,508.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,320.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,508.00
|
| Rate for Payer: Cigna Commercial |
$10,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,227.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,240.00
|
|
|
PACEMAKER MEDT 7962iB***
|
Facility
|
IP
|
$21,600.00
|
|
| Hospital Charge Code |
270602696
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,240.00 |
| Max. Negotiated Rate |
$5,227.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,320.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,227.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,240.00
|
|