|
COMPNT BMT FEM RT 65MM 145112
|
Facility
|
OP
|
$6,900.85
|
|
| Hospital Charge Code |
270609080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.13 |
| Max. Negotiated Rate |
$3,450.43 |
| Rate for Payer: Aetna Commercial |
$2,070.26
|
| Rate for Payer: Aetna Medicare Advantage |
$2,070.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,759.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,759.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,380.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,759.72
|
| Rate for Payer: Cigna Commercial |
$3,450.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,670.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,035.13
|
|
|
COMPNT BMT FEM RT 65MM 145112
|
Facility
|
IP
|
$6,900.85
|
|
| Hospital Charge Code |
270609080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.13 |
| Max. Negotiated Rate |
$1,670.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,380.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,670.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,035.13
|
|
|
COMPNT BMT FEM RT 65MM 145152
|
Facility
|
IP
|
$13,420.00
|
|
| Hospital Charge Code |
270629062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,013.00 |
| Max. Negotiated Rate |
$3,247.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,684.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,247.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,013.00
|
|
|
COMPNT BMT FEM RT 65MM 145152
|
Facility
|
OP
|
$13,420.00
|
|
| Hospital Charge Code |
270629062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,013.00 |
| Max. Negotiated Rate |
$6,710.00 |
| Rate for Payer: Aetna Commercial |
$4,026.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,026.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,422.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,422.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,684.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,422.10
|
| Rate for Payer: Cigna Commercial |
$6,710.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,247.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,013.00
|
|
|
COMPNT BMT FEM RT 70MM 145113
|
Facility
|
IP
|
$7,396.00
|
|
| Hospital Charge Code |
270621914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.40 |
| Max. Negotiated Rate |
$1,789.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,479.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,789.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,109.40
|
|
|
COMPNT BMT FEM RT 70MM 145113
|
Facility
|
OP
|
$7,396.00
|
|
| Hospital Charge Code |
270621914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.40 |
| Max. Negotiated Rate |
$3,698.00 |
| Rate for Payer: Aetna Commercial |
$2,218.80
|
| Rate for Payer: Aetna Medicare Advantage |
$2,218.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,885.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,885.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,479.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,885.98
|
| Rate for Payer: Cigna Commercial |
$3,698.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,789.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,109.40
|
|
|
COMPNT ZIM CR TIB 6 59704502
|
Facility
|
OP
|
$4,629.65
|
|
| Hospital Charge Code |
270617732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$694.45 |
| Max. Negotiated Rate |
$2,314.82 |
| Rate for Payer: Aetna Commercial |
$1,388.89
|
| Rate for Payer: Aetna Medicare Advantage |
$1,388.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,180.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,180.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$925.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,180.56
|
| Rate for Payer: Cigna Commercial |
$2,314.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,120.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$694.45
|
|
|
COMPNT ZIM CR TIB 6 59704502
|
Facility
|
IP
|
$4,629.65
|
|
| Hospital Charge Code |
270617732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$694.45 |
| Max. Negotiated Rate |
$1,120.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$925.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,120.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$694.45
|
|
|
COMPNT ZIM FEM LT 52 5790-28
|
Facility
|
IP
|
$6,623.25
|
|
| Hospital Charge Code |
270626739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.49 |
| Max. Negotiated Rate |
$1,602.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,602.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.49
|
|
|
COMPNT ZIM FEM LT 52 5790-28
|
Facility
|
OP
|
$6,623.25
|
|
| Hospital Charge Code |
270626739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.49 |
| Max. Negotiated Rate |
$3,311.62 |
| Rate for Payer: Aetna Commercial |
$1,986.97
|
| Rate for Payer: Aetna Medicare Advantage |
$1,986.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,688.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,688.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,324.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,688.93
|
| Rate for Payer: Cigna Commercial |
$3,311.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,602.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$993.49
|
|
|
COMPNT ZIM FEM LT SZ 5 5992161
|
Facility
|
IP
|
$13,734.25
|
|
| Hospital Charge Code |
270623446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.14 |
| Max. Negotiated Rate |
$3,323.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,746.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,323.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,060.14
|
|
|
COMPNT ZIM FEM LT SZ 5 5992161
|
Facility
|
OP
|
$13,734.25
|
|
| Hospital Charge Code |
270623446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.14 |
| Max. Negotiated Rate |
$6,867.12 |
| Rate for Payer: Aetna Commercial |
$4,120.27
|
| Rate for Payer: Aetna Medicare Advantage |
$4,120.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,502.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,502.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,746.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,502.23
|
| Rate for Payer: Cigna Commercial |
$6,867.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,323.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,060.14
|
|
|
COMPNT ZIM FEM LT SZ D 5972141
|
Facility
|
IP
|
$14,901.45
|
|
| Hospital Charge Code |
270608587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.22 |
| Max. Negotiated Rate |
$3,606.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,980.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,606.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.22
|
|
|
COMPNT ZIM FEM LT SZ D 5972141
|
Facility
|
OP
|
$14,901.45
|
|
| Hospital Charge Code |
270608587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.22 |
| Max. Negotiated Rate |
$7,450.73 |
| Rate for Payer: Aetna Commercial |
$4,470.44
|
| Rate for Payer: Aetna Medicare Advantage |
$4,470.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,799.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,799.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,980.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,799.87
|
| Rate for Payer: Cigna Commercial |
$7,450.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,606.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.22
|
|
|
COMPNT ZIM FEM LT SZ D 5982141
|
Facility
|
IP
|
$9,928.00
|
|
| Hospital Charge Code |
270614952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,489.20 |
| Max. Negotiated Rate |
$2,402.58 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,985.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,402.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,489.20
|
|
|
COMPNT ZIM FEM LT SZ D 5982141
|
Facility
|
OP
|
$9,928.00
|
|
| Hospital Charge Code |
270614952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,489.20 |
| Max. Negotiated Rate |
$4,964.00 |
| Rate for Payer: Aetna Commercial |
$2,978.40
|
| Rate for Payer: Aetna Medicare Advantage |
$2,978.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,531.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,531.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,985.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,531.64
|
| Rate for Payer: Cigna Commercial |
$4,964.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,402.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,489.20
|
|
|
COMPNT ZIM FEM LT SZ D 5992141
|
Facility
|
IP
|
$15,867.05
|
|
| Hospital Charge Code |
270625483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.06 |
| Max. Negotiated Rate |
$3,839.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,173.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,839.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,380.06
|
|
|
COMPNT ZIM FEM LT SZ D 5992141
|
Facility
|
OP
|
$15,867.05
|
|
| Hospital Charge Code |
270625483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.06 |
| Max. Negotiated Rate |
$7,933.52 |
| Rate for Payer: Aetna Commercial |
$4,760.11
|
| Rate for Payer: Aetna Medicare Advantage |
$4,760.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,046.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,046.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,173.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,046.10
|
| Rate for Payer: Cigna Commercial |
$7,933.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,839.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,380.06
|
|
|
COMPNT ZIM FEM LT SZ E 5972151
|
Facility
|
IP
|
$14,901.45
|
|
| Hospital Charge Code |
270608719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.22 |
| Max. Negotiated Rate |
$3,606.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,980.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,606.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.22
|
|
|
COMPNT ZIM FEM LT SZ E 5972151
|
Facility
|
OP
|
$14,901.45
|
|
| Hospital Charge Code |
270608719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.22 |
| Max. Negotiated Rate |
$7,450.73 |
| Rate for Payer: Aetna Commercial |
$4,470.44
|
| Rate for Payer: Aetna Medicare Advantage |
$4,470.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,799.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,799.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,980.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,799.87
|
| Rate for Payer: Cigna Commercial |
$7,450.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,606.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.22
|
|
|
COMPNT ZIM FEM LT SZ E 5980151
|
Facility
|
IP
|
$8,796.00
|
|
| Hospital Charge Code |
270608664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.40 |
| Max. Negotiated Rate |
$2,128.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,759.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,128.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,319.40
|
|
|
COMPNT ZIM FEM LT SZ E 5980151
|
Facility
|
OP
|
$8,796.00
|
|
| Hospital Charge Code |
270608664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.40 |
| Max. Negotiated Rate |
$4,398.00 |
| Rate for Payer: Aetna Commercial |
$2,638.80
|
| Rate for Payer: Aetna Medicare Advantage |
$2,638.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,242.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,242.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,759.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,242.98
|
| Rate for Payer: Cigna Commercial |
$4,398.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,128.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,319.40
|
|
|
COMPNT ZIM FEM LT SZ E 5992151
|
Facility
|
IP
|
$15,867.05
|
|
| Hospital Charge Code |
270628377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.06 |
| Max. Negotiated Rate |
$3,839.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,173.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,839.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,380.06
|
|
|
COMPNT ZIM FEM LT SZ E 5992151
|
Facility
|
OP
|
$15,867.05
|
|
| Hospital Charge Code |
270628377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.06 |
| Max. Negotiated Rate |
$7,933.52 |
| Rate for Payer: Aetna Commercial |
$4,760.11
|
| Rate for Payer: Aetna Medicare Advantage |
$4,760.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,046.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,046.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,173.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,046.10
|
| Rate for Payer: Cigna Commercial |
$7,933.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,839.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,380.06
|
|
|
COMPNT ZIM FEM LT SZ F 5972161
|
Facility
|
OP
|
$14,213.65
|
|
| Hospital Charge Code |
270607174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,132.05 |
| Max. Negotiated Rate |
$7,106.82 |
| Rate for Payer: Aetna Commercial |
$4,264.10
|
| Rate for Payer: Aetna Medicare Advantage |
$4,264.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,624.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,624.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,842.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,624.48
|
| Rate for Payer: Cigna Commercial |
$7,106.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,439.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,132.05
|
|