|
COMPNT ZIM FEM LT SZ F 5972161
|
Facility
|
IP
|
$14,213.65
|
|
| Hospital Charge Code |
270607174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,132.05 |
| Max. Negotiated Rate |
$3,439.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,842.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,439.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,132.05
|
|
|
COMPNT ZIM FEM LT SZ F 5994161
|
Facility
|
OP
|
$13,020.00
|
|
| Hospital Charge Code |
270625218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.00 |
| Max. Negotiated Rate |
$6,510.00 |
| Rate for Payer: Aetna Commercial |
$3,906.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,906.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,320.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,320.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,604.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,320.10
|
| Rate for Payer: Cigna Commercial |
$6,510.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,150.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,953.00
|
|
|
COMPNT ZIM FEM LT SZ F 5994161
|
Facility
|
IP
|
$13,020.00
|
|
| Hospital Charge Code |
270625218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.00 |
| Max. Negotiated Rate |
$3,150.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,604.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,150.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,953.00
|
|
|
COMPNT ZIM FEM LT SZ G 5972171
|
Facility
|
IP
|
$13,777.20
|
|
| Hospital Charge Code |
270612872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,066.58 |
| Max. Negotiated Rate |
$3,334.08 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,755.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,334.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,066.58
|
|
|
COMPNT ZIM FEM LT SZ G 5972171
|
Facility
|
OP
|
$13,777.20
|
|
| Hospital Charge Code |
270612872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,066.58 |
| Max. Negotiated Rate |
$6,888.60 |
| Rate for Payer: Aetna Commercial |
$4,133.16
|
| Rate for Payer: Aetna Medicare Advantage |
$4,133.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,513.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,513.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,755.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,513.19
|
| Rate for Payer: Cigna Commercial |
$6,888.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,334.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,066.58
|
|
|
COMPNT ZIM FEM LT SZ G 5992171
|
Facility
|
IP
|
$12,681.35
|
|
| Hospital Charge Code |
270619814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,902.20 |
| Max. Negotiated Rate |
$3,068.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,536.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,068.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,902.20
|
|
|
COMPNT ZIM FEM LT SZ G 5992171
|
Facility
|
OP
|
$12,681.35
|
|
| Hospital Charge Code |
270619814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,902.20 |
| Max. Negotiated Rate |
$6,340.68 |
| Rate for Payer: Aetna Commercial |
$3,804.41
|
| Rate for Payer: Aetna Medicare Advantage |
$3,804.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,233.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,233.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,536.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,233.74
|
| Rate for Payer: Cigna Commercial |
$6,340.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,068.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,902.20
|
|
|
COMPNT ZIM FEM LT SZ G 5992179
|
Facility
|
IP
|
$12,812.00
|
|
| Hospital Charge Code |
270626990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,921.80 |
| Max. Negotiated Rate |
$3,100.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,562.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,100.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,921.80
|
|
|
COMPNT ZIM FEM LT SZ G 5992179
|
Facility
|
OP
|
$12,812.00
|
|
| Hospital Charge Code |
270626990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,921.80 |
| Max. Negotiated Rate |
$6,406.00 |
| Rate for Payer: Aetna Commercial |
$3,843.60
|
| Rate for Payer: Aetna Medicare Advantage |
$3,843.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,267.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,267.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,562.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,267.06
|
| Rate for Payer: Cigna Commercial |
$6,406.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,100.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,921.80
|
|
|
COMPNT ZIM FEM RT SZ C 5980132
|
Facility
|
IP
|
$8,796.00
|
|
| Hospital Charge Code |
270607662
|
|
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 RT SZ C 5980132
|
Facility
|
OP
|
$8,796.00
|
|
| Hospital Charge Code |
270607662
|
|
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 RT SZ D 5972142
|
Facility
|
OP
|
$14,213.75
|
|
| Hospital Charge Code |
270616332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,132.06 |
| Max. Negotiated Rate |
$7,106.88 |
| Rate for Payer: Aetna Commercial |
$4,264.12
|
| Rate for Payer: Aetna Medicare Advantage |
$4,264.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,624.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,624.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,842.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,624.51
|
| Rate for Payer: Cigna Commercial |
$7,106.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,439.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,132.06
|
|
|
COMPNT ZIM FEM RT SZ D 5972142
|
Facility
|
IP
|
$14,213.75
|
|
| Hospital Charge Code |
270616332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,132.06 |
| Max. Negotiated Rate |
$3,439.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,842.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,439.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,132.06
|
|
|
COMPNT ZIM FEM RT SZ D 5992142
|
Facility
|
OP
|
$16,501.75
|
|
| Hospital Charge Code |
270623541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.26 |
| Max. Negotiated Rate |
$8,250.88 |
| Rate for Payer: Aetna Commercial |
$4,950.52
|
| Rate for Payer: Aetna Medicare Advantage |
$4,950.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,207.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,207.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,300.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,207.95
|
| Rate for Payer: Cigna Commercial |
$8,250.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,993.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.26
|
|
|
COMPNT ZIM FEM RT SZ D 5992142
|
Facility
|
IP
|
$16,501.75
|
|
| Hospital Charge Code |
270623541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.26 |
| Max. Negotiated Rate |
$3,993.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,300.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,993.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,475.26
|
|
|
COMPNT ZIM FEM RT SZ E 5972152
|
Facility
|
OP
|
$13,667.00
|
|
| Hospital Charge Code |
270607476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,050.05 |
| Max. Negotiated Rate |
$6,833.50 |
| Rate for Payer: Aetna Commercial |
$4,100.10
|
| Rate for Payer: Aetna Medicare Advantage |
$4,100.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,485.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,485.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,733.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,485.09
|
| Rate for Payer: Cigna Commercial |
$6,833.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,307.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,050.05
|
|
|
COMPNT ZIM FEM RT SZ E 5972152
|
Facility
|
IP
|
$13,667.00
|
|
| Hospital Charge Code |
270607476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,050.05 |
| Max. Negotiated Rate |
$3,307.41 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,733.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,307.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,050.05
|
|
|
COMPNT ZIM FEM RT SZ E 5980152
|
Facility
|
OP
|
$7,962.45
|
|
| Hospital Charge Code |
270617627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.37 |
| Max. Negotiated Rate |
$3,981.22 |
| Rate for Payer: Aetna Commercial |
$2,388.74
|
| Rate for Payer: Aetna Medicare Advantage |
$2,388.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,030.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,030.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,592.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,030.42
|
| Rate for Payer: Cigna Commercial |
$3,981.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,926.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,194.37
|
|
|
COMPNT ZIM FEM RT SZ E 5980152
|
Facility
|
IP
|
$7,962.45
|
|
| Hospital Charge Code |
270617627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.37 |
| Max. Negotiated Rate |
$1,926.91 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,592.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,926.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,194.37
|
|
|
COMPNT ZIM FEM RT SZ E 5982152
|
Facility
|
OP
|
$9,928.00
|
|
| Hospital Charge Code |
270615588
|
|
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 RT SZ E 5982152
|
Facility
|
IP
|
$9,928.00
|
|
| Hospital Charge Code |
270615588
|
|
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 RT SZ E 5992152
|
Facility
|
IP
|
$15,867.05
|
|
| Hospital Charge Code |
270624571
|
|
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 RT SZ E 5992152
|
Facility
|
OP
|
$15,867.05
|
|
| Hospital Charge Code |
270624571
|
|
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 RT SZ F 5970162
|
Facility
|
IP
|
$8,215.25
|
|
| Hospital Charge Code |
270607687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.29 |
| Max. Negotiated Rate |
$1,988.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,643.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,988.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,232.29
|
|
|
COMPNT ZIM FEM RT SZ F 5970162
|
Facility
|
OP
|
$8,215.25
|
|
| Hospital Charge Code |
270607687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.29 |
| Max. Negotiated Rate |
$4,107.62 |
| Rate for Payer: Aetna Commercial |
$2,464.57
|
| Rate for Payer: Aetna Medicare Advantage |
$2,464.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,094.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,094.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,643.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,094.89
|
| Rate for Payer: Cigna Commercial |
$4,107.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,988.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,232.29
|
|