|
SCREW ZIM CORT 4.5 48 231949
|
Facility
|
OP
|
$65.65
|
|
| Hospital Charge Code |
270605552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna Medicare Advantage |
$19.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.74
|
| Rate for Payer: Cigna Commercial |
$32.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
SCREW ZIM CORT 4.5 50 230651
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270610343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
SCREW ZIM CORT 4.5 50 230651
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270610343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
SCREW ZIM CORT 4.5 50 231951
|
Facility
|
IP
|
$65.65
|
|
| Hospital Charge Code |
270613660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
SCREW ZIM CORT 4.5 50 231951
|
Facility
|
OP
|
$65.65
|
|
| Hospital Charge Code |
270613660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna Medicare Advantage |
$19.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.74
|
| Rate for Payer: Cigna Commercial |
$32.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
SCREW ZIM CORT 4.5 52 230653
|
Facility
|
OP
|
$33.65
|
|
| Hospital Charge Code |
270610344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$16.82 |
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna Medicare Advantage |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.58
|
| Rate for Payer: Cigna Commercial |
$16.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.05
|
|
|
SCREW ZIM CORT 4.5 52 230653
|
Facility
|
IP
|
$33.65
|
|
| Hospital Charge Code |
270610344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.05
|
|
|
SCREW ZIM CORT 4.5 52 231953
|
Facility
|
IP
|
$63.25
|
|
| Hospital Charge Code |
270613661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
|
|
SCREW ZIM CORT 4.5 52 231953
|
Facility
|
OP
|
$63.25
|
|
| Hospital Charge Code |
270613661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$18.98
|
| Rate for Payer: Aetna Medicare Advantage |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.13
|
| Rate for Payer: Cigna Commercial |
$31.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
|
|
SCREW ZIM CORT 4.5 54 231955
|
Facility
|
OP
|
$63.25
|
|
| Hospital Charge Code |
270613662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$18.98
|
| Rate for Payer: Aetna Medicare Advantage |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.13
|
| Rate for Payer: Cigna Commercial |
$31.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
|
|
SCREW ZIM CORT 4.5 54 231955
|
Facility
|
IP
|
$63.25
|
|
| Hospital Charge Code |
270613662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.31
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.49
|
|
|
SCREW ZIM CORT 4.5 55 22455545
|
Facility
|
OP
|
$664.85
|
|
| Hospital Charge Code |
270610834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$332.43 |
| Rate for Payer: Aetna Commercial |
$199.46
|
| Rate for Payer: Aetna Medicare Advantage |
$199.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.54
|
| Rate for Payer: Cigna Commercial |
$332.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.73
|
|
|
SCREW ZIM CORT 4.5 55 22455545
|
Facility
|
IP
|
$664.85
|
|
| Hospital Charge Code |
270610834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$160.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.97
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.73
|
|
|
SCREW ZIM CORT 4.5 56 230657
|
Facility
|
OP
|
$50.45
|
|
| Hospital Charge Code |
270601999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$15.13
|
| Rate for Payer: Aetna Medicare Advantage |
$15.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.86
|
| Rate for Payer: Cigna Commercial |
$25.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.57
|
|
|
SCREW ZIM CORT 4.5 56 230657
|
Facility
|
IP
|
$50.45
|
|
| Hospital Charge Code |
270601999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.57
|
|
|
SCREW ZIM CORT 4.5 58 2306-159
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
270610346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.40
|
|
|
SCREW ZIM CORT 4.5 58 2306-159
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
270610346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Medicare Advantage |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.18
|
| Rate for Payer: Cigna Commercial |
$18.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.40
|
|
|
SCREW ZIM CORT 4.5 58 231959
|
Facility
|
OP
|
$65.65
|
|
| Hospital Charge Code |
270613664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna Medicare Advantage |
$19.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.74
|
| Rate for Payer: Cigna Commercial |
$32.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
SCREW ZIM CORT 4.5 58 231959
|
Facility
|
IP
|
$65.65
|
|
| Hospital Charge Code |
270613664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
SCREW ZIM CORT 4.5 60 230661
|
Facility
|
IP
|
$43.25
|
|
| Hospital Charge Code |
270610348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.49
|
|
|
SCREW ZIM CORT 4.5 60 230661
|
Facility
|
OP
|
$43.25
|
|
| Hospital Charge Code |
270610348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$21.62 |
| Rate for Payer: Aetna Commercial |
$12.97
|
| Rate for Payer: Aetna Medicare Advantage |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.03
|
| Rate for Payer: Cigna Commercial |
$21.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.49
|
|
|
SCREW ZIM CORT 4.5 61 231961
|
Facility
|
OP
|
$65.65
|
|
| Hospital Charge Code |
270613665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Aetna Commercial |
$19.70
|
| Rate for Payer: Aetna Medicare Advantage |
$19.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.74
|
| Rate for Payer: Cigna Commercial |
$32.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
SCREW ZIM CORT 4.5 61 231961
|
Facility
|
IP
|
$65.65
|
|
| Hospital Charge Code |
270613665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.85
|
|
|
SCREW ZIM CORT 4.5 64 230665
|
Facility
|
IP
|
$25.65
|
|
| Hospital Charge Code |
270610349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.85
|
|
|
SCREW ZIM CORT 4.5 64 230665
|
Facility
|
OP
|
$25.65
|
|
| Hospital Charge Code |
270610349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Aetna Medicare Advantage |
$7.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.54
|
| Rate for Payer: Cigna Commercial |
$12.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.85
|
|