|
PACEMAKER MEDT 8962iB
|
Facility
|
IP
|
$19,656.00
|
|
| Hospital Charge Code |
270602715
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,948.40 |
| Max. Negotiated Rate |
$4,756.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,931.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,756.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,948.40
|
|
|
PACEMAKER MEDT 8964B
|
Facility
|
OP
|
$16,128.00
|
|
| Hospital Charge Code |
270608892
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$8,064.00 |
| Rate for Payer: Aetna Commercial |
$4,838.40
|
| Rate for Payer: Aetna Medicare Advantage |
$4,838.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,112.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,112.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,112.64
|
| Rate for Payer: Cigna Commercial |
$8,064.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,419.20
|
|
|
PACEMAKER MEDT 8964B
|
Facility
|
IP
|
$16,128.00
|
|
| Hospital Charge Code |
270608892
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$3,902.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,419.20
|
|
|
PACEMAKER MEDT 8964i
|
Facility
|
OP
|
$17,539.25
|
|
| Hospital Charge Code |
270608016
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,630.89 |
| Max. Negotiated Rate |
$8,769.62 |
| Rate for Payer: Aetna Commercial |
$5,261.77
|
| Rate for Payer: Aetna Medicare Advantage |
$5,261.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,472.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,472.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,507.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,472.51
|
| Rate for Payer: Cigna Commercial |
$8,769.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,244.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,630.89
|
|
|
PACEMAKER MEDT 8964i
|
Facility
|
IP
|
$17,539.25
|
|
| Hospital Charge Code |
270608016
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,630.89 |
| Max. Negotiated Rate |
$4,244.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,507.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,244.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,630.89
|
|
|
PACEMAKER MEDT 8964iB
|
Facility
|
OP
|
$16,128.00
|
|
| Hospital Charge Code |
270602727
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$8,064.00 |
| Rate for Payer: Aetna Commercial |
$4,838.40
|
| Rate for Payer: Aetna Medicare Advantage |
$4,838.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,112.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,112.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,112.64
|
| Rate for Payer: Cigna Commercial |
$8,064.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,419.20
|
|
|
PACEMAKER MEDT 8964iB
|
Facility
|
IP
|
$16,128.00
|
|
| Hospital Charge Code |
270602727
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$3,902.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,419.20
|
|
|
PACEMAKER MEDT 8964iU
|
Facility
|
IP
|
$16,128.00
|
|
| Hospital Charge Code |
270602728
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$3,902.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,419.20
|
|
|
PACEMAKER MEDT 8964iU
|
Facility
|
OP
|
$16,128.00
|
|
| Hospital Charge Code |
270602728
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$8,064.00 |
| Rate for Payer: Aetna Commercial |
$4,838.40
|
| Rate for Payer: Aetna Medicare Advantage |
$4,838.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,112.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,112.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,112.64
|
| Rate for Payer: Cigna Commercial |
$8,064.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,419.20
|
|
|
PACEMAKER MEDT 8965i
|
Facility
|
IP
|
$16,128.00
|
|
| Hospital Charge Code |
270602729
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$3,902.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,419.20
|
|
|
PACEMAKER MEDT 8965i
|
Facility
|
OP
|
$16,128.00
|
|
| Hospital Charge Code |
270602729
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$8,064.00 |
| Rate for Payer: Aetna Commercial |
$4,838.40
|
| Rate for Payer: Aetna Medicare Advantage |
$4,838.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,112.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,112.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,112.64
|
| Rate for Payer: Cigna Commercial |
$8,064.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,419.20
|
|
|
PACEMAKER MEDT 8966i
|
Facility
|
IP
|
$16,128.00
|
|
| Hospital Charge Code |
270602730
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$3,902.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,419.20
|
|
|
PACEMAKER MEDT 8966i
|
Facility
|
OP
|
$16,128.00
|
|
| Hospital Charge Code |
270602730
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,419.20 |
| Max. Negotiated Rate |
$8,064.00 |
| Rate for Payer: Aetna Commercial |
$4,838.40
|
| Rate for Payer: Aetna Medicare Advantage |
$4,838.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,112.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,112.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,225.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,112.64
|
| Rate for Payer: Cigna Commercial |
$8,064.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,902.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,419.20
|
|
|
PACEMAKER MEDT B SDR303
|
Facility
|
OP
|
$18,144.00
|
|
| Hospital Charge Code |
270617980C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,721.60 |
| Max. Negotiated Rate |
$9,072.00 |
| Rate for Payer: Aetna Commercial |
$5,443.20
|
| Rate for Payer: Aetna Medicare Advantage |
$5,443.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,626.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,626.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,628.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,626.72
|
| Rate for Payer: Cigna Commercial |
$9,072.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,390.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,721.60
|
|
|
PACEMAKER MEDT B SDR303
|
Facility
|
IP
|
$18,144.00
|
|
| Hospital Charge Code |
270617980C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,721.60 |
| Max. Negotiated Rate |
$4,390.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,628.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,390.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,721.60
|
|
|
PACEMAKER MEDT DR403B
|
Facility
|
OP
|
$24,998.45
|
|
| Hospital Charge Code |
270607710C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,749.77 |
| Max. Negotiated Rate |
$12,499.23 |
| Rate for Payer: Aetna Commercial |
$7,499.53
|
| Rate for Payer: Aetna Medicare Advantage |
$7,499.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,374.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,374.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,999.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,374.60
|
| Rate for Payer: Cigna Commercial |
$12,499.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,049.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,749.77
|
|
|
PACEMAKER MEDT DR403B
|
Facility
|
OP
|
$24,998.45
|
|
| Hospital Charge Code |
270607710
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,749.77 |
| Max. Negotiated Rate |
$12,499.23 |
| Rate for Payer: Aetna Commercial |
$7,499.53
|
| Rate for Payer: Aetna Medicare Advantage |
$7,499.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,374.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,374.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,999.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,374.60
|
| Rate for Payer: Cigna Commercial |
$12,499.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,049.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,749.77
|
|
|
PACEMAKER MEDT DR403B
|
Facility
|
OP
|
$19,998.75
|
|
| Hospital Charge Code |
270607438
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,999.81 |
| Max. Negotiated Rate |
$9,999.38 |
| Rate for Payer: Aetna Commercial |
$5,999.62
|
| Rate for Payer: Aetna Medicare Advantage |
$5,999.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,099.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,099.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,999.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,099.68
|
| Rate for Payer: Cigna Commercial |
$9,999.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,839.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,999.81
|
|
|
PACEMAKER MEDT DR403B
|
Facility
|
IP
|
$24,998.45
|
|
| Hospital Charge Code |
270607710C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,749.77 |
| Max. Negotiated Rate |
$6,049.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,999.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,049.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,749.77
|
|
|
PACEMAKER MEDT DR403B
|
Facility
|
IP
|
$24,998.45
|
|
| Hospital Charge Code |
270607710
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,749.77 |
| Max. Negotiated Rate |
$6,049.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,999.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,049.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,749.77
|
|
|
PACEMAKER MEDT DR403B
|
Facility
|
IP
|
$19,998.75
|
|
| Hospital Charge Code |
270607438
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,999.81 |
| Max. Negotiated Rate |
$4,839.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,999.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,839.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,999.81
|
|
|
PACEMAKER MEDT KDR401B
|
Facility
|
OP
|
$20,000.65
|
|
| Hospital Charge Code |
270609352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,000.10 |
| Max. Negotiated Rate |
$10,000.33 |
| Rate for Payer: Aetna Commercial |
$6,000.19
|
| Rate for Payer: Aetna Medicare Advantage |
$6,000.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,100.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,100.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,100.17
|
| Rate for Payer: Cigna Commercial |
$10,000.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.10
|
|
|
PACEMAKER MEDT KDR401B
|
Facility
|
IP
|
$20,000.65
|
|
| Hospital Charge Code |
270609352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,000.10 |
| Max. Negotiated Rate |
$4,840.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.10
|
|
|
PACEMAKER MEDT KDR601
|
Facility
|
IP
|
$21,873.65
|
|
| Hospital Charge Code |
270615845C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,281.05 |
| Max. Negotiated Rate |
$5,293.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,374.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,293.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,281.05
|
|
|
PACEMAKER MEDT KDR601
|
Facility
|
OP
|
$21,873.65
|
|
| Hospital Charge Code |
270615845C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,281.05 |
| Max. Negotiated Rate |
$10,936.83 |
| Rate for Payer: Aetna Commercial |
$6,562.10
|
| Rate for Payer: Aetna Medicare Advantage |
$6,562.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,577.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,577.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,374.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,577.78
|
| Rate for Payer: Cigna Commercial |
$10,936.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,293.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,281.05
|
|