|
PACEMAKER SENSIA DR
|
Facility
|
IP
|
$21,540.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270637991
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,231.00 |
| Max. Negotiated Rate |
$5,212.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,308.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,212.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,231.00
|
|
|
PACEMAKER SENSIA SR
|
Facility
|
IP
|
$15,680.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270638082
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,352.00 |
| Max. Negotiated Rate |
$3,794.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,136.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,794.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,352.00
|
|
|
PACEMAKER SENSIA SR
|
Facility
|
OP
|
$15,680.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270638082
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$445.31 |
| Max. Negotiated Rate |
$7,840.00 |
| Rate for Payer: Aetna Commercial |
$5,958.40
|
| Rate for Payer: Aetna Medicare Advantage |
$4,704.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,998.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,998.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,136.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,998.40
|
| Rate for Payer: Cigna Commercial |
$7,840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,794.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,352.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$495.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$445.31
|
|
|
PACEMAKER,SING,CHAM.JADEIIS,SI
|
Facility
|
IP
|
$5,158.00
|
|
| Hospital Charge Code |
270335376
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$773.70 |
| Max. Negotiated Rate |
$1,248.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,031.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,248.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$773.70
|
|
|
PACEMAKER,SING,CHAM.JADEIIS,SI
|
Facility
|
OP
|
$5,158.00
|
|
| Hospital Charge Code |
270335376
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$146.49 |
| Max. Negotiated Rate |
$2,579.00 |
| Rate for Payer: Aetna Commercial |
$1,960.04
|
| Rate for Payer: Aetna Medicare Advantage |
$1,547.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,315.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,315.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,031.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,315.29
|
| Rate for Payer: Cigna Commercial |
$2,579.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,248.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$773.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$162.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$146.49
|
|
|
PACEMAKER SORIN SR ICV1102
|
Facility
|
OP
|
$24,500.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270660758N
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$695.80 |
| Max. Negotiated Rate |
$12,250.00 |
| Rate for Payer: Aetna Commercial |
$9,310.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,247.50
|
| Rate for Payer: Cigna Commercial |
$12,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,929.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,675.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$774.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$695.80
|
|
|
PACEMAKER SORIN SR ICV1102
|
Facility
|
IP
|
$24,500.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270660758N
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,675.00 |
| Max. Negotiated Rate |
$5,929.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,929.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,675.00
|
|
|
PACEMAKER SORIN SR ICV1102
|
Facility
|
OP
|
$13,737.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270660758
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$390.13 |
| Max. Negotiated Rate |
$6,868.50 |
| Rate for Payer: Aetna Commercial |
$5,220.06
|
| Rate for Payer: Aetna Medicare Advantage |
$4,121.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,502.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,502.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,747.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,502.93
|
| Rate for Payer: Cigna Commercial |
$6,868.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,324.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,060.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$434.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$390.13
|
|
|
PACEMAKER SORIN SR ICV1102
|
Facility
|
IP
|
$13,737.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270660758
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,060.55 |
| Max. Negotiated Rate |
$3,324.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,747.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,324.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,060.55
|
|
|
PACEMAKER WEARABLE INSERTABLE
|
Facility
|
IP
|
$300.65
|
|
|
Service Code
|
HCPCS 93284
|
| Hospital Charge Code |
5100276
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$45.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.10
|
|
|
PACEMAKER WEARABLE INSERTABLE
|
Facility
|
OP
|
$300.65
|
|
|
Service Code
|
HCPCS 93284
|
| Hospital Charge Code |
5100276
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Medicare Advantage |
$143.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$44.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$58.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.84
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: Cigna Medicare Advantage |
$44.34
|
| Rate for Payer: Clover Medicare Advantage |
$42.12
|
| Rate for Payer: EmblemHealth Commercial |
$133.02
|
| Rate for Payer: Humana Medicare Advantage |
$45.67
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$44.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$78.17
|
| Rate for Payer: Oxford Commercial |
$2,441.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.54
|
|
|
PACEMAKER XTDR AZURE SURESCAN
|
Facility
|
OP
|
$27,175.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270681677S
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$771.77 |
| Max. Negotiated Rate |
$13,587.50 |
| Rate for Payer: Aetna Commercial |
$10,326.50
|
| Rate for Payer: Aetna Medicare Advantage |
$8,152.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,929.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,929.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,929.62
|
| Rate for Payer: Cigna Commercial |
$13,587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,576.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,076.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$858.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$771.77
|
|
|
PACEMAKER XTDR AZURE SURESCAN
|
Facility
|
IP
|
$27,175.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270681677S
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,076.25 |
| Max. Negotiated Rate |
$6,576.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,435.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,576.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,076.25
|
|
|
PACEMAKER XTDR AZURE SURESCAN
|
Facility
|
IP
|
$27,175.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270681677N
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,076.25 |
| Max. Negotiated Rate |
$6,576.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,435.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,576.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,076.25
|
|
|
PACEMAKER XTDR AZURE SURESCAN
|
Facility
|
OP
|
$27,175.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270681677N
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$771.77 |
| Max. Negotiated Rate |
$13,587.50 |
| Rate for Payer: Aetna Commercial |
$10,326.50
|
| Rate for Payer: Aetna Medicare Advantage |
$8,152.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,929.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,929.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,929.62
|
| Rate for Payer: Cigna Commercial |
$13,587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,576.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,076.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$858.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$771.77
|
|
|
PACEMAKER XT SR AZURE SURESCAN
|
Facility
|
OP
|
$18,683.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270681678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.61 |
| Max. Negotiated Rate |
$9,341.75 |
| Rate for Payer: Aetna Commercial |
$7,099.73
|
| Rate for Payer: Aetna Medicare Advantage |
$5,605.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,764.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,764.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,736.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,764.29
|
| Rate for Payer: Cigna Commercial |
$9,341.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,521.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,802.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$590.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$530.61
|
|
|
PACEMAKER XT SR AZURE SURESCAN
|
Facility
|
IP
|
$21,725.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270681678C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,258.75 |
| Max. Negotiated Rate |
$5,257.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,345.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,257.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,258.75
|
|
|
PACEMAKER XT SR AZURE SURESCAN
|
Facility
|
IP
|
$18,683.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270681678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.53 |
| Max. Negotiated Rate |
$4,521.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,736.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,521.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,802.53
|
|
|
PACEMAKER XT SR AZURE SURESCAN
|
Facility
|
IP
|
$27,125.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270681678N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,068.75 |
| Max. Negotiated Rate |
$6,564.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,564.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,068.75
|
|
|
PACEMAKER XT SR AZURE SURESCAN
|
Facility
|
OP
|
$27,125.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270681678N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.35 |
| Max. Negotiated Rate |
$13,562.50 |
| Rate for Payer: Aetna Commercial |
$10,307.50
|
| Rate for Payer: Aetna Medicare Advantage |
$8,137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,916.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,916.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,425.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,916.88
|
| Rate for Payer: Cigna Commercial |
$13,562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,564.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,068.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$857.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$770.35
|
|
|
PACEMAKER XT SR AZURE SURESCAN
|
Facility
|
OP
|
$21,725.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
270681678C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.99 |
| Max. Negotiated Rate |
$10,862.50 |
| Rate for Payer: Aetna Commercial |
$8,255.50
|
| Rate for Payer: Aetna Medicare Advantage |
$6,517.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,539.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,539.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,345.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,539.88
|
| Rate for Payer: Cigna Commercial |
$10,862.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,257.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,258.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$686.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$616.99
|
|
|
PACEMAKER ZEPHYR XLSR SIR 5626
|
Facility
|
OP
|
$25,175.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270645677C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$714.97 |
| Max. Negotiated Rate |
$12,587.50 |
| Rate for Payer: Aetna Commercial |
$9,566.50
|
| Rate for Payer: Aetna Medicare Advantage |
$7,552.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,419.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,419.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,035.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,419.62
|
| Rate for Payer: Cigna Commercial |
$12,587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,092.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,776.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$795.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$714.97
|
|
|
PACEMAKER ZEPHYR XLSR SIR 5626
|
Facility
|
IP
|
$25,175.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270645677C
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,776.25 |
| Max. Negotiated Rate |
$6,092.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,035.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,092.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,776.25
|
|
|
PACEMAKER ZEPHYR XLSR SIR 5626
|
Facility
|
OP
|
$30,210.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270645677N
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$857.96 |
| Max. Negotiated Rate |
$15,105.00 |
| Rate for Payer: Aetna Commercial |
$11,479.80
|
| Rate for Payer: Aetna Medicare Advantage |
$9,063.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,703.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,703.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,042.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,703.55
|
| Rate for Payer: Cigna Commercial |
$15,105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,310.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,531.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$954.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$857.96
|
|
|
PACEMAKER ZEPHYR XLSR SIR 5626
|
Facility
|
IP
|
$30,210.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
270645677N
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,531.50 |
| Max. Negotiated Rate |
$7,310.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,042.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,310.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,531.50
|
|
