|
PACEMAKER MEDT SSR303B
|
Facility
|
IP
|
$15,724.85
|
|
| Hospital Charge Code |
270616530
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,358.73 |
| Max. Negotiated Rate |
$3,805.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,144.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,805.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,358.73
|
|
|
PACEMAKER MEDT SSR303B
|
Facility
|
OP
|
$15,724.85
|
|
| Hospital Charge Code |
270616530
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,358.73 |
| Max. Negotiated Rate |
$7,862.43 |
| Rate for Payer: Aetna Commercial |
$4,717.45
|
| Rate for Payer: Aetna Medicare Advantage |
$4,717.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,009.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,009.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,144.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,009.84
|
| Rate for Payer: Cigna Commercial |
$7,862.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,805.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,358.73
|
|
|
Pacemaker MRI UMRI Assurity
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270687052
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,250.00 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,630.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,250.00
|
|
|
Pacemaker MRI UMRI Assurity
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270687052
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,250.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$4,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,825.00
|
| Rate for Payer: Cigna Commercial |
$7,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,630.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,250.00
|
|
|
PACEMAKER MRI UMRI ASSURITY
|
Facility
|
OP
|
$24,975.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270687052S
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,746.25 |
| Max. Negotiated Rate |
$12,487.50 |
| Rate for Payer: Aetna Commercial |
$7,492.50
|
| Rate for Payer: Aetna Medicare Advantage |
$7,492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,368.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,368.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,368.62
|
| Rate for Payer: Cigna Commercial |
$12,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,043.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,746.25
|
|
|
PACEMAKER MRI UMRI ASSURITY
|
Facility
|
IP
|
$24,975.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270687052S
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,746.25 |
| Max. Negotiated Rate |
$6,043.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,043.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,746.25
|
|
|
PACEMAKER PCSTR SR 5136
|
Facility
|
IP
|
$20,140.00
|
|
| Hospital Charge Code |
270621305
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,021.00 |
| Max. Negotiated Rate |
$4,873.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,028.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,873.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,021.00
|
|
|
PACEMAKER PCSTR SR 5136
|
Facility
|
IP
|
$20,140.00
|
|
| Hospital Charge Code |
270621305C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,021.00 |
| Max. Negotiated Rate |
$4,873.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,028.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,873.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,021.00
|
|
|
PACEMAKER PCSTR SR 5136
|
Facility
|
OP
|
$20,140.00
|
|
| Hospital Charge Code |
270621305C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,021.00 |
| Max. Negotiated Rate |
$10,070.00 |
| Rate for Payer: Aetna Commercial |
$6,042.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,042.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,135.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,135.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,028.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,135.70
|
| Rate for Payer: Cigna Commercial |
$10,070.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,873.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,021.00
|
|
|
PACEMAKER PCSTR SR 5136
|
Facility
|
OP
|
$20,140.00
|
|
| Hospital Charge Code |
270621305
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,021.00 |
| Max. Negotiated Rate |
$10,070.00 |
| Rate for Payer: Aetna Commercial |
$6,042.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,042.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,135.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,135.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,028.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,135.70
|
| Rate for Payer: Cigna Commercial |
$10,070.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,873.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,021.00
|
|
|
PACEMAKER PCSTR SR 5136
|
Facility
|
OP
|
$20,140.00
|
|
| Hospital Charge Code |
2702706213
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,021.00 |
| Max. Negotiated Rate |
$10,070.00 |
| Rate for Payer: Aetna Commercial |
$6,042.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,042.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,135.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,135.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,028.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,135.70
|
| Rate for Payer: Cigna Commercial |
$10,070.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,873.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,021.00
|
|
|
PACEMAKER PCSTR SR 5136
|
Facility
|
IP
|
$20,140.00
|
|
| Hospital Charge Code |
2702706213
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,021.00 |
| Max. Negotiated Rate |
$4,873.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,028.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,873.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,021.00
|
|
|
PACEMAKER PHILOS DR 331443
|
Facility
|
IP
|
$20,807.25
|
|
| Hospital Charge Code |
270630739
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,121.09 |
| Max. Negotiated Rate |
$5,035.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,161.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,035.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,121.09
|
|
|
PACEMAKER PHILOS DR 331443
|
Facility
|
OP
|
$20,807.25
|
|
| Hospital Charge Code |
270630739
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,121.09 |
| Max. Negotiated Rate |
$10,403.62 |
| Rate for Payer: Aetna Commercial |
$6,242.18
|
| Rate for Payer: Aetna Medicare Advantage |
$6,242.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,305.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,305.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,161.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,305.85
|
| Rate for Payer: Cigna Commercial |
$10,403.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,035.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,121.09
|
|
|
PACEMAKER PHILOS II DRT 343175
|
Facility
|
OP
|
$29,500.00
|
|
| Hospital Charge Code |
270641510C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,425.00 |
| Max. Negotiated Rate |
$14,750.00 |
| Rate for Payer: Aetna Commercial |
$8,850.00
|
| Rate for Payer: Aetna Medicare Advantage |
$8,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,522.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,522.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,522.50
|
| Rate for Payer: Cigna Commercial |
$14,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,139.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,425.00
|
|
|
PACEMAKER PHILOS II DRT 343175
|
Facility
|
OP
|
$29,500.00
|
|
| Hospital Charge Code |
270641510
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,425.00 |
| Max. Negotiated Rate |
$14,750.00 |
| Rate for Payer: Aetna Commercial |
$8,850.00
|
| Rate for Payer: Aetna Medicare Advantage |
$8,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,522.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,522.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,522.50
|
| Rate for Payer: Cigna Commercial |
$14,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,139.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,425.00
|
|
|
PACEMAKER PHILOS II DRT 343175
|
Facility
|
IP
|
$29,500.00
|
|
| Hospital Charge Code |
270641510C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,425.00 |
| Max. Negotiated Rate |
$7,139.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,139.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,425.00
|
|
|
PACEMAKER PHILOS II DRT 343175
|
Facility
|
IP
|
$29,500.00
|
|
| Hospital Charge Code |
270641510
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,425.00 |
| Max. Negotiated Rate |
$7,139.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,139.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,425.00
|
|
|
PACEMAKER PHILOS II SR 341824
|
Facility
|
IP
|
$29,975.00
|
|
| Hospital Charge Code |
270638834
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,496.25 |
| Max. Negotiated Rate |
$7,253.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,253.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,496.25
|
|
|
PACEMAKER PHILOS II SR 341824
|
Facility
|
OP
|
$29,975.00
|
|
| Hospital Charge Code |
270638834
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,496.25 |
| Max. Negotiated Rate |
$14,987.50 |
| Rate for Payer: Aetna Commercial |
$8,992.50
|
| Rate for Payer: Aetna Medicare Advantage |
$8,992.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,643.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,643.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,643.62
|
| Rate for Payer: Cigna Commercial |
$14,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,253.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,496.25
|
|
|
PACEMAKER PHILOS SR-B 331599
|
Facility
|
IP
|
$29,975.00
|
|
| Hospital Charge Code |
270639474C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,496.25 |
| Max. Negotiated Rate |
$7,253.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,253.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,496.25
|
|
|
PACEMAKER PHILOS SR-B 331599
|
Facility
|
OP
|
$29,975.00
|
|
| Hospital Charge Code |
270639474C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,496.25 |
| Max. Negotiated Rate |
$14,987.50 |
| Rate for Payer: Aetna Commercial |
$8,992.50
|
| Rate for Payer: Aetna Medicare Advantage |
$8,992.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,643.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,643.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,643.62
|
| Rate for Payer: Cigna Commercial |
$14,987.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,253.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,496.25
|
|
|
Pacemaker Pocket Revision
|
Facility
|
IP
|
$9,195.40
|
|
|
Service Code
|
HCPCS 33222
|
| Hospital Charge Code |
5100221
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,379.31 |
| Max. Negotiated Rate |
$1,379.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,379.31
|
|
|
Pacemaker Pocket Revision
|
Facility
|
OP
|
$9,195.40
|
|
|
Service Code
|
HCPCS 33222
|
| Hospital Charge Code |
5100221
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,195.40 |
| Max. Negotiated Rate |
$4,913.48 |
| Rate for Payer: Aetna Commercial |
$2,758.62
|
| Rate for Payer: Aetna Medicare Advantage |
$2,758.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,344.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,344.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,344.83
|
| Rate for Payer: Cigna Commercial |
$4,913.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,195.40
|
| Rate for Payer: Oxford Commercial |
$3,248.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,379.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,687.00
|
|
|
PACEMAKER QDT 1176
|
Facility
|
IP
|
$19,333.65
|
|
| Hospital Charge Code |
270617227
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,900.05 |
| Max. Negotiated Rate |
$4,678.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,866.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,678.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,900.05
|
|