|
PLATE ZIM PRTC 10H 23470110
|
Facility
|
OP
|
$4,023.25
|
|
| Hospital Charge Code |
270611485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.49 |
| Max. Negotiated Rate |
$2,011.62 |
| Rate for Payer: Aetna Commercial |
$1,206.97
|
| Rate for Payer: Aetna Medicare Advantage |
$1,206.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,025.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,025.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$804.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,025.93
|
| Rate for Payer: Cigna Commercial |
$2,011.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$973.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$603.49
|
|
|
PLATE ZIM PRTC 10H 23470110
|
Facility
|
IP
|
$4,023.25
|
|
| Hospital Charge Code |
270611485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.49 |
| Max. Negotiated Rate |
$973.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$804.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$973.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$603.49
|
|
|
PLATE ZIM PRTC 4H 234700604
|
Facility
|
IP
|
$3,977.65
|
|
| Hospital Charge Code |
270615644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.65 |
| Max. Negotiated Rate |
$962.59 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$795.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$962.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$596.65
|
|
|
PLATE ZIM PRTC 4H 234700604
|
Facility
|
OP
|
$3,977.65
|
|
| Hospital Charge Code |
270615644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.65 |
| Max. Negotiated Rate |
$1,988.83 |
| Rate for Payer: Aetna Commercial |
$1,193.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,193.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,014.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,014.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$795.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,014.30
|
| Rate for Payer: Cigna Commercial |
$1,988.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$962.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$596.65
|
|
|
PLATE ZIM PRTC 6H 23470106
|
Facility
|
OP
|
$3,793.65
|
|
| Hospital Charge Code |
270611484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.05 |
| Max. Negotiated Rate |
$1,896.83 |
| Rate for Payer: Aetna Commercial |
$1,138.10
|
| Rate for Payer: Aetna Medicare Advantage |
$1,138.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$967.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$967.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$758.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$967.38
|
| Rate for Payer: Cigna Commercial |
$1,896.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$918.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$569.05
|
|
|
PLATE ZIM PRTC 6H 23470106
|
Facility
|
IP
|
$3,793.65
|
|
| Hospital Charge Code |
270611484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.05 |
| Max. Negotiated Rate |
$918.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$758.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$918.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$569.05
|
|
|
PLATE ZIM RECON 10H 1179-05-10
|
Facility
|
OP
|
$950.45
|
|
| Hospital Charge Code |
270613676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.57 |
| Max. Negotiated Rate |
$475.23 |
| Rate for Payer: Aetna Commercial |
$285.13
|
| Rate for Payer: Aetna Medicare Advantage |
$285.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$242.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$242.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$242.36
|
| Rate for Payer: Cigna Commercial |
$475.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.57
|
|
|
PLATE ZIM RECON 10H 1179-05-10
|
Facility
|
IP
|
$950.45
|
|
| Hospital Charge Code |
270613676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.57 |
| Max. Negotiated Rate |
$230.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.57
|
|
|
PLATE ZIM SELF CMP 145MM 12H
|
Facility
|
OP
|
$553.65
|
|
| Hospital Charge Code |
270607165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$276.82 |
| Rate for Payer: Aetna Commercial |
$166.09
|
| Rate for Payer: Aetna Medicare Advantage |
$166.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$141.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$141.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$141.18
|
| Rate for Payer: Cigna Commercial |
$276.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.05
|
|
|
PLATE ZIM SELF CMP 145MM 12H
|
Facility
|
IP
|
$553.65
|
|
| Hospital Charge Code |
270607165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$133.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.05
|
|
|
PLATE ZIM SELF CMP BD 140MM 8H
|
Facility
|
OP
|
$704.00
|
|
| Hospital Charge Code |
270605557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$211.20
|
| Rate for Payer: Aetna Medicare Advantage |
$211.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$179.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$179.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$179.52
|
| Rate for Payer: Cigna Commercial |
$352.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.60
|
|
|
PLATE ZIM SELF CMP BD 140MM 8H
|
Facility
|
IP
|
$704.00
|
|
| Hospital Charge Code |
270605557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$170.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.60
|
|
|
PLATE ZIM SELF CMP BD 156MM 9H
|
Facility
|
OP
|
$766.45
|
|
| Hospital Charge Code |
270608108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.97 |
| Max. Negotiated Rate |
$383.23 |
| Rate for Payer: Aetna Commercial |
$229.94
|
| Rate for Payer: Aetna Medicare Advantage |
$229.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$195.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$195.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$153.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$195.44
|
| Rate for Payer: Cigna Commercial |
$383.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$185.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.97
|
|
|
PLATE ZIM SELF CMP BD 156MM 9H
|
Facility
|
IP
|
$766.45
|
|
| Hospital Charge Code |
270608108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.97 |
| Max. Negotiated Rate |
$185.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$153.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$185.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.97
|
|
|
PLATE ZIM SELF CMP NR 124MM 7H
|
Facility
|
OP
|
$466.45
|
|
| Hospital Charge Code |
270605555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$233.22 |
| Rate for Payer: Aetna Commercial |
$139.94
|
| Rate for Payer: Aetna Medicare Advantage |
$139.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$118.94
|
| Rate for Payer: Cigna Commercial |
$233.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.97
|
|
|
PLATE ZIM SELF CMP NR 124MM 7H
|
Facility
|
IP
|
$466.45
|
|
| Hospital Charge Code |
270605555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$112.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.97
|
|
|
PLATE ZIM SELF CMP NR 140MM 8H
|
Facility
|
OP
|
$466.45
|
|
| Hospital Charge Code |
270605556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$233.22 |
| Rate for Payer: Aetna Commercial |
$139.94
|
| Rate for Payer: Aetna Medicare Advantage |
$139.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$118.94
|
| Rate for Payer: Cigna Commercial |
$233.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.97
|
|
|
PLATE ZIM SELF CMP NR 140MM 8H
|
Facility
|
IP
|
$466.45
|
|
| Hospital Charge Code |
270605556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$112.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$93.29
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.97
|
|
|
PLATE ZIM SELF COMP BRD 8-10HL
|
Facility
|
OP
|
$403.00
|
|
| Hospital Charge Code |
1602564
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$201.50 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: Aetna Medicare Advantage |
$120.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.77
|
| Rate for Payer: Cigna Commercial |
$201.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.45
|
|
|
PLATE ZIM SELF COMP BRD 8-10HL
|
Facility
|
IP
|
$403.00
|
|
| Hospital Charge Code |
1602564
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$97.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$80.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.45
|
|
|
PLATE ZIM TIB 40 5790-45-12
|
Facility
|
OP
|
$4,131.25
|
|
| Hospital Charge Code |
270626740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.69 |
| Max. Negotiated Rate |
$2,065.62 |
| Rate for Payer: Aetna Commercial |
$1,239.38
|
| Rate for Payer: Aetna Medicare Advantage |
$1,239.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,053.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,053.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$826.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,053.47
|
| Rate for Payer: Cigna Commercial |
$2,065.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$999.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$619.69
|
|
|
PLATE ZIM TIB 40 5790-45-12
|
Facility
|
IP
|
$4,131.25
|
|
| Hospital Charge Code |
270626740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.69 |
| Max. Negotiated Rate |
$999.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$826.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$999.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$619.69
|
|
|
PLATE ZIM TIB 8H L 2347-008-8
|
Facility
|
OP
|
$4,137.65
|
|
| Hospital Charge Code |
270620801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.65 |
| Max. Negotiated Rate |
$2,068.82 |
| Rate for Payer: Aetna Commercial |
$1,241.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,241.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,055.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,055.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$827.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,055.10
|
| Rate for Payer: Cigna Commercial |
$2,068.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,001.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$620.65
|
|
|
PLATE ZIM TIB 8H L 2347-008-8
|
Facility
|
IP
|
$4,137.65
|
|
| Hospital Charge Code |
270620801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.65 |
| Max. Negotiated Rate |
$1,001.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$827.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,001.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$620.65
|
|
|
PLAT FL COMP 2H 135D 118113502
|
Facility
|
IP
|
$1,403.70
|
|
| Hospital Charge Code |
270639016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.56 |
| Max. Negotiated Rate |
$339.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.74
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$339.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.56
|
|