|
PACEMAKER MEDT 7962iB***
|
Facility
|
OP
|
$21,600.00
|
|
| Hospital Charge Code |
270602696
|
|
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 7965i***
|
Facility
|
IP
|
$18,360.00
|
|
| Hospital Charge Code |
270602704
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,754.00 |
| Max. Negotiated Rate |
$4,443.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,672.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,443.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,754.00
|
|
|
PACEMAKER MEDT 7965i***
|
Facility
|
OP
|
$18,360.00
|
|
| Hospital Charge Code |
270602704
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,754.00 |
| Max. Negotiated Rate |
$9,180.00 |
| Rate for Payer: Aetna Commercial |
$5,508.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,508.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,681.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,681.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,672.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,681.80
|
| Rate for Payer: Cigna Commercial |
$9,180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,443.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,754.00
|
|
|
PACEMAKER MEDT 7966i***
|
Facility
|
IP
|
$18,360.00
|
|
| Hospital Charge Code |
270602705
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,754.00 |
| Max. Negotiated Rate |
$4,443.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,672.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,443.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,754.00
|
|
|
PACEMAKER MEDT 7966i***
|
Facility
|
OP
|
$18,360.00
|
|
| Hospital Charge Code |
270602705
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,754.00 |
| Max. Negotiated Rate |
$9,180.00 |
| Rate for Payer: Aetna Commercial |
$5,508.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,508.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,681.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,681.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,672.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,681.80
|
| Rate for Payer: Cigna Commercial |
$9,180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,443.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,754.00
|
|
|
PACEMAKER MEDT 8340
|
Facility
|
OP
|
$14,515.25
|
|
| Hospital Charge Code |
270602734
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,177.29 |
| Max. Negotiated Rate |
$7,257.62 |
| Rate for Payer: Aetna Commercial |
$4,354.57
|
| Rate for Payer: Aetna Medicare Advantage |
$4,354.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,701.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,701.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,903.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,701.39
|
| Rate for Payer: Cigna Commercial |
$7,257.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,512.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,177.29
|
|
|
PACEMAKER MEDT 8340
|
Facility
|
IP
|
$14,515.25
|
|
| Hospital Charge Code |
270602734
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,177.29 |
| Max. Negotiated Rate |
$3,512.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,903.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,512.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,177.29
|
|
|
PACEMAKER MEDT 8341
|
Facility
|
OP
|
$14,515.25
|
|
| Hospital Charge Code |
270602735
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,177.29 |
| Max. Negotiated Rate |
$7,257.62 |
| Rate for Payer: Aetna Commercial |
$4,354.57
|
| Rate for Payer: Aetna Medicare Advantage |
$4,354.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,701.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,701.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,903.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,701.39
|
| Rate for Payer: Cigna Commercial |
$7,257.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,512.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,177.29
|
|
|
PACEMAKER MEDT 8341
|
Facility
|
IP
|
$14,515.25
|
|
| Hospital Charge Code |
270602735
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,177.29 |
| Max. Negotiated Rate |
$3,512.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,903.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,512.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,177.29
|
|
|
PACEMAKER MEDT 8341M
|
Facility
|
IP
|
$14,515.25
|
|
| Hospital Charge Code |
270602736
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,177.29 |
| Max. Negotiated Rate |
$3,512.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,903.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,512.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,177.29
|
|
|
PACEMAKER MEDT 8341M
|
Facility
|
OP
|
$14,515.25
|
|
| Hospital Charge Code |
270602736
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,177.29 |
| Max. Negotiated Rate |
$7,257.62 |
| Rate for Payer: Aetna Commercial |
$4,354.57
|
| Rate for Payer: Aetna Medicare Advantage |
$4,354.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,701.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,701.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,903.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,701.39
|
| Rate for Payer: Cigna Commercial |
$7,257.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,512.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,177.29
|
|
|
PACEMAKER MEDT 8342
|
Facility
|
IP
|
$14,515.25
|
|
| Hospital Charge Code |
270602737
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,177.29 |
| Max. Negotiated Rate |
$3,512.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,903.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,512.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,177.29
|
|
|
PACEMAKER MEDT 8342
|
Facility
|
OP
|
$14,515.25
|
|
| Hospital Charge Code |
270602737
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,177.29 |
| Max. Negotiated Rate |
$7,257.62 |
| Rate for Payer: Aetna Commercial |
$4,354.57
|
| Rate for Payer: Aetna Medicare Advantage |
$4,354.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,701.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,701.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,903.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,701.39
|
| Rate for Payer: Cigna Commercial |
$7,257.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,512.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,177.29
|
|
|
PACEMAKER MEDT 8416
|
Facility
|
OP
|
$16,531.25
|
|
| Hospital Charge Code |
270602723
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$8,265.62 |
| Rate for Payer: Aetna Commercial |
$4,959.38
|
| Rate for Payer: Aetna Medicare Advantage |
$4,959.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,215.47
|
| Rate for Payer: Cigna Commercial |
$8,265.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8416
|
Facility
|
IP
|
$16,531.25
|
|
| Hospital Charge Code |
270602723
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$4,000.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8417
|
Facility
|
IP
|
$16,531.25
|
|
| Hospital Charge Code |
270602724
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$4,000.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8417
|
Facility
|
OP
|
$16,531.25
|
|
| Hospital Charge Code |
270602724
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$8,265.62 |
| Rate for Payer: Aetna Commercial |
$4,959.38
|
| Rate for Payer: Aetna Medicare Advantage |
$4,959.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,215.47
|
| Rate for Payer: Cigna Commercial |
$8,265.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8418
|
Facility
|
OP
|
$16,531.25
|
|
| Hospital Charge Code |
270602725
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$8,265.62 |
| Rate for Payer: Aetna Commercial |
$4,959.38
|
| Rate for Payer: Aetna Medicare Advantage |
$4,959.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,215.47
|
| Rate for Payer: Cigna Commercial |
$8,265.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8418
|
Facility
|
IP
|
$16,531.25
|
|
| Hospital Charge Code |
270602725
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$4,000.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8424
|
Facility
|
OP
|
$16,531.25
|
|
| Hospital Charge Code |
270602720
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$8,265.62 |
| Rate for Payer: Aetna Commercial |
$4,959.38
|
| Rate for Payer: Aetna Medicare Advantage |
$4,959.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,215.47
|
| Rate for Payer: Cigna Commercial |
$8,265.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8424
|
Facility
|
IP
|
$16,531.25
|
|
| Hospital Charge Code |
270602720
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$4,000.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8426
|
Facility
|
IP
|
$16,531.25
|
|
| Hospital Charge Code |
270602721
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$4,000.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8426
|
Facility
|
OP
|
$16,531.25
|
|
| Hospital Charge Code |
270602721
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$8,265.62 |
| Rate for Payer: Aetna Commercial |
$4,959.38
|
| Rate for Payer: Aetna Medicare Advantage |
$4,959.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,215.47
|
| Rate for Payer: Cigna Commercial |
$8,265.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8427
|
Facility
|
IP
|
$16,531.25
|
|
| Hospital Charge Code |
270602722
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$4,000.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|
|
PACEMAKER MEDT 8427
|
Facility
|
OP
|
$16,531.25
|
|
| Hospital Charge Code |
270602722
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,479.69 |
| Max. Negotiated Rate |
$8,265.62 |
| Rate for Payer: Aetna Commercial |
$4,959.38
|
| Rate for Payer: Aetna Medicare Advantage |
$4,959.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,215.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,215.47
|
| Rate for Payer: Cigna Commercial |
$8,265.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,000.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,479.69
|
|