|
NAIL BMT FEM 9 24 345924
|
Facility
|
IP
|
$3,263.25
|
|
| Hospital Charge Code |
270617174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.49 |
| Max. Negotiated Rate |
$789.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$652.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$789.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.49
|
|
|
NAIL BMT FEM 9 24 345924
|
Facility
|
OP
|
$3,263.25
|
|
| Hospital Charge Code |
270617174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.49 |
| Max. Negotiated Rate |
$1,631.62 |
| Rate for Payer: Aetna Commercial |
$978.98
|
| Rate for Payer: Aetna Medicare Advantage |
$978.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$832.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$832.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$652.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$832.13
|
| Rate for Payer: Cigna Commercial |
$1,631.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$789.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.49
|
|
|
NAIL BMT FEM 9 32 346332
|
Facility
|
IP
|
$4,288.85
|
|
| Hospital Charge Code |
270622879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.33 |
| Max. Negotiated Rate |
$1,037.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$857.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,037.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$643.33
|
|
|
NAIL BMT FEM 9 32 346332
|
Facility
|
OP
|
$4,288.85
|
|
| Hospital Charge Code |
270622879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.33 |
| Max. Negotiated Rate |
$2,144.43 |
| Rate for Payer: Aetna Commercial |
$1,286.65
|
| Rate for Payer: Aetna Medicare Advantage |
$1,286.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,093.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,093.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$857.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,093.66
|
| Rate for Payer: Cigna Commercial |
$2,144.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,037.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$643.33
|
|
|
NAIL BMT FEM 9 35 346335
|
Facility
|
IP
|
$3,263.25
|
|
| Hospital Charge Code |
270618656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.49 |
| Max. Negotiated Rate |
$789.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$652.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$789.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.49
|
|
|
NAIL BMT FEM 9 35 346335
|
Facility
|
OP
|
$3,263.25
|
|
| Hospital Charge Code |
270618656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.49 |
| Max. Negotiated Rate |
$1,631.62 |
| Rate for Payer: Aetna Commercial |
$978.98
|
| Rate for Payer: Aetna Medicare Advantage |
$978.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$832.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$832.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$652.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$832.13
|
| Rate for Payer: Cigna Commercial |
$1,631.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$789.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.49
|
|
|
NAIL BMT FEM 9 41 346341
|
Facility
|
IP
|
$3,263.25
|
|
| Hospital Charge Code |
270619018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.49 |
| Max. Negotiated Rate |
$789.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$652.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$789.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.49
|
|
|
NAIL BMT FEM 9 41 346341
|
Facility
|
OP
|
$3,263.25
|
|
| Hospital Charge Code |
270619018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.49 |
| Max. Negotiated Rate |
$1,631.62 |
| Rate for Payer: Aetna Commercial |
$978.98
|
| Rate for Payer: Aetna Medicare Advantage |
$978.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$832.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$832.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$652.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$832.13
|
| Rate for Payer: Cigna Commercial |
$1,631.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$789.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$489.49
|
|
|
NAIL BMT FEM RETR 12 32 343732
|
Facility
|
OP
|
$3,343.25
|
|
| Hospital Charge Code |
270614624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.49 |
| Max. Negotiated Rate |
$1,671.62 |
| Rate for Payer: Aetna Commercial |
$1,002.98
|
| Rate for Payer: Aetna Medicare Advantage |
$1,002.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$852.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$852.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$668.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$852.53
|
| Rate for Payer: Cigna Commercial |
$1,671.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$809.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$501.49
|
|
|
NAIL BMT FEM RETR 12 32 343732
|
Facility
|
IP
|
$3,343.25
|
|
| Hospital Charge Code |
270614624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.49 |
| Max. Negotiated Rate |
$809.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$668.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$809.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$501.49
|
|
|
NAIL BMT FEM RETRG 343738
|
Facility
|
IP
|
$3,036.85
|
|
| Hospital Charge Code |
270606458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.53 |
| Max. Negotiated Rate |
$734.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$607.37
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$734.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$455.53
|
|
|
NAIL BMT FEM RETRG 343738
|
Facility
|
OP
|
$3,036.85
|
|
| Hospital Charge Code |
270606458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.53 |
| Max. Negotiated Rate |
$1,518.42 |
| Rate for Payer: Aetna Commercial |
$911.05
|
| Rate for Payer: Aetna Medicare Advantage |
$911.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$774.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$774.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$607.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$774.40
|
| Rate for Payer: Cigna Commercial |
$1,518.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$734.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$455.53
|
|
|
NAIL BMT FEM TT 12 35 346235
|
Facility
|
OP
|
$4,797.65
|
|
| Hospital Charge Code |
270625330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.65 |
| Max. Negotiated Rate |
$2,398.82 |
| Rate for Payer: Aetna Commercial |
$1,439.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,439.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,223.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,223.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$959.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,223.40
|
| Rate for Payer: Cigna Commercial |
$2,398.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,161.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$719.65
|
|
|
NAIL BMT FEM TT 12 35 346235
|
Facility
|
IP
|
$4,797.65
|
|
| Hospital Charge Code |
270625330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.65 |
| Max. Negotiated Rate |
$1,161.03 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$959.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,161.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$719.65
|
|
|
NAIL BMT HUMERAL 8 20CM 340620
|
Facility
|
IP
|
$7,950.00
|
|
| Hospital Charge Code |
270622378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.50 |
| Max. Negotiated Rate |
$1,923.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,590.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,923.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,192.50
|
|
|
NAIL BMT HUMERAL 8 20CM 340620
|
Facility
|
OP
|
$7,950.00
|
|
| Hospital Charge Code |
270622378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.50 |
| Max. Negotiated Rate |
$3,975.00 |
| Rate for Payer: Aetna Commercial |
$2,385.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,385.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,027.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,027.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,590.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,027.25
|
| Rate for Payer: Cigna Commercial |
$3,975.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,923.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,192.50
|
|
|
NAIL BMT HUMERAL 8 22CM 340622
|
Facility
|
IP
|
$4,592.00
|
|
| Hospital Charge Code |
270623837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.80 |
| Max. Negotiated Rate |
$1,111.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$918.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,111.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$688.80
|
|
|
NAIL BMT HUMERAL 8 22CM 340622
|
Facility
|
OP
|
$4,592.00
|
|
| Hospital Charge Code |
270623837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.80 |
| Max. Negotiated Rate |
$2,296.00 |
| Rate for Payer: Aetna Commercial |
$1,377.60
|
| Rate for Payer: Aetna Medicare Advantage |
$1,377.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,170.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,170.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$918.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,170.96
|
| Rate for Payer: Cigna Commercial |
$2,296.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,111.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$688.80
|
|
|
NAIL BMT HUMERAL 8 26CM 340626
|
Facility
|
OP
|
$2,690.45
|
|
| Hospital Charge Code |
270610793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.57 |
| Max. Negotiated Rate |
$1,345.22 |
| Rate for Payer: Aetna Commercial |
$807.13
|
| Rate for Payer: Aetna Medicare Advantage |
$807.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$686.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$686.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$538.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$686.06
|
| Rate for Payer: Cigna Commercial |
$1,345.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$651.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$403.57
|
|
|
NAIL BMT HUMERAL 8 26CM 340626
|
Facility
|
IP
|
$2,690.45
|
|
| Hospital Charge Code |
270610793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.57 |
| Max. Negotiated Rate |
$651.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$538.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$651.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$403.57
|
|
|
NAIL BMT HUMERAL 9 22CM 340722
|
Facility
|
IP
|
$3,174.45
|
|
| Hospital Charge Code |
270614910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.17 |
| Max. Negotiated Rate |
$768.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$634.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$768.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$476.17
|
|
|
NAIL BMT HUMERAL 9 22CM 340722
|
Facility
|
OP
|
$3,174.45
|
|
| Hospital Charge Code |
270614910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.17 |
| Max. Negotiated Rate |
$1,587.22 |
| Rate for Payer: Aetna Commercial |
$952.34
|
| Rate for Payer: Aetna Medicare Advantage |
$952.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$809.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$809.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$634.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$809.48
|
| Rate for Payer: Cigna Commercial |
$1,587.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$768.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$476.17
|
|
|
NAIL BMT HUMERAL 9 26CM 340726
|
Facility
|
OP
|
$2,690.45
|
|
| Hospital Charge Code |
270610874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.57 |
| Max. Negotiated Rate |
$1,345.22 |
| Rate for Payer: Aetna Commercial |
$807.13
|
| Rate for Payer: Aetna Medicare Advantage |
$807.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$686.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$686.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$538.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$686.06
|
| Rate for Payer: Cigna Commercial |
$1,345.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$651.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$403.57
|
|
|
NAIL BMT HUMERAL 9 26CM 340726
|
Facility
|
IP
|
$2,690.45
|
|
| Hospital Charge Code |
270610874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.57 |
| Max. Negotiated Rate |
$651.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$538.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$651.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$403.57
|
|
|
NAIL BMT HUMERAL 9 28CM 340728
|
Facility
|
OP
|
$5,317.20
|
|
| Hospital Charge Code |
270624981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.58 |
| Max. Negotiated Rate |
$2,658.60 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare Advantage |
$1,595.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,355.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,355.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,063.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,355.89
|
| Rate for Payer: Cigna Commercial |
$2,658.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,286.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$797.58
|
|