|
STEM ZIM FEM 13 130MM 7852-13
|
Facility
|
OP
|
$11,520.00
|
|
| Hospital Charge Code |
270609816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.00 |
| Max. Negotiated Rate |
$5,760.00 |
| Rate for Payer: Aetna Commercial |
$3,456.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,456.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,937.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,937.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,304.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,937.60
|
| Rate for Payer: Cigna Commercial |
$5,760.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,787.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,728.00
|
|
|
STEM ZIM FEM 13 130MM 7852-13
|
Facility
|
IP
|
$11,520.00
|
|
| Hospital Charge Code |
270609816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.00 |
| Max. Negotiated Rate |
$2,787.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,304.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,787.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,728.00
|
|
|
STEM ZIM FEM 13 130MM 7853-13
|
Facility
|
OP
|
$11,864.25
|
|
| Hospital Charge Code |
270616264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,779.64 |
| Max. Negotiated Rate |
$5,932.12 |
| Rate for Payer: Aetna Commercial |
$3,559.28
|
| Rate for Payer: Aetna Medicare Advantage |
$3,559.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,025.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,025.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,372.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,025.38
|
| Rate for Payer: Cigna Commercial |
$5,932.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,871.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,779.64
|
|
|
STEM ZIM FEM 13 130MM 7853-13
|
Facility
|
OP
|
$9,396.00
|
|
| Hospital Charge Code |
270621223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.40 |
| Max. Negotiated Rate |
$4,698.00 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Medicare Advantage |
$2,818.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,395.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,395.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,879.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,395.98
|
| Rate for Payer: Cigna Commercial |
$4,698.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,273.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,409.40
|
|
|
STEM ZIM FEM 13 130MM 7853-13
|
Facility
|
IP
|
$9,396.00
|
|
| Hospital Charge Code |
270621223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.40 |
| Max. Negotiated Rate |
$2,273.83 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,879.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,273.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,409.40
|
|
|
STEM ZIM FEM 13 130MM 7853-13
|
Facility
|
IP
|
$11,864.25
|
|
| Hospital Charge Code |
270616264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,779.64 |
| Max. Negotiated Rate |
$2,871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,372.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,871.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,779.64
|
|
|
STEM ZIM FEM 13 140MM 7841-13
|
Facility
|
OP
|
$13,882.45
|
|
| Hospital Charge Code |
270619084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.37 |
| Max. Negotiated Rate |
$6,941.23 |
| Rate for Payer: Aetna Commercial |
$4,164.73
|
| Rate for Payer: Aetna Medicare Advantage |
$4,164.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,540.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,540.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,776.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,540.02
|
| Rate for Payer: Cigna Commercial |
$6,941.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,359.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,082.37
|
|
|
STEM ZIM FEM 13 140MM 7841-13
|
Facility
|
IP
|
$13,882.45
|
|
| Hospital Charge Code |
270619084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.37 |
| Max. Negotiated Rate |
$3,359.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,776.49
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,359.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,082.37
|
|
|
STEM ZIM FEM 13 170MM 7871-13
|
Facility
|
OP
|
$23,298.20
|
|
| Hospital Charge Code |
270622361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,494.73 |
| Max. Negotiated Rate |
$11,649.10 |
| Rate for Payer: Aetna Commercial |
$6,989.46
|
| Rate for Payer: Aetna Medicare Advantage |
$6,989.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,941.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,941.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,659.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,941.04
|
| Rate for Payer: Cigna Commercial |
$11,649.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,638.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,494.73
|
|
|
STEM ZIM FEM 13 170MM 7871-13
|
Facility
|
IP
|
$23,298.20
|
|
| Hospital Charge Code |
270622361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,494.73 |
| Max. Negotiated Rate |
$5,638.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,659.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,638.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,494.73
|
|
|
STEM ZIM FEM 14 135MM 7833-14
|
Facility
|
IP
|
$3,579.25
|
|
| Hospital Charge Code |
270624976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.89 |
| Max. Negotiated Rate |
$866.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$715.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$866.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$536.89
|
|
|
STEM ZIM FEM 14 135MM 7833-14
|
Facility
|
OP
|
$3,579.25
|
|
| Hospital Charge Code |
270624976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.89 |
| Max. Negotiated Rate |
$1,789.62 |
| Rate for Payer: Aetna Commercial |
$1,073.78
|
| Rate for Payer: Aetna Medicare Advantage |
$1,073.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$715.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.71
|
| Rate for Payer: Cigna Commercial |
$1,789.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$866.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$536.89
|
|
|
STEM ZIM FEM 14 135MM 7852-14
|
Facility
|
IP
|
$11,520.00
|
|
| Hospital Charge Code |
270606001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.00 |
| Max. Negotiated Rate |
$2,787.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,304.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,787.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,728.00
|
|
|
STEM ZIM FEM 14 135MM 7852-14
|
Facility
|
OP
|
$11,520.00
|
|
| Hospital Charge Code |
270606001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.00 |
| Max. Negotiated Rate |
$5,760.00 |
| Rate for Payer: Aetna Commercial |
$3,456.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,456.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,937.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,937.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,304.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,937.60
|
| Rate for Payer: Cigna Commercial |
$5,760.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,787.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,728.00
|
|
|
STEM ZIM FEM 14 140MM 7841-14
|
Facility
|
OP
|
$20,300.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270613461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.03 |
| Max. Negotiated Rate |
$10,150.10 |
| Rate for Payer: Aetna Commercial |
$6,090.06
|
| Rate for Payer: Aetna Medicare Advantage |
$6,090.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,176.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,176.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,060.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,176.55
|
| Rate for Payer: Cigna Commercial |
$10,150.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,912.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,045.03
|
|
|
STEM ZIM FEM 14 140MM 7841-14
|
Facility
|
IP
|
$20,300.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270613461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.03 |
| Max. Negotiated Rate |
$4,912.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,060.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,912.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,045.03
|
|
|
STEM ZIM FEM 14X135MM 78531401
|
Facility
|
IP
|
$14,830.35
|
|
| Hospital Charge Code |
270616875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.55 |
| Max. Negotiated Rate |
$3,588.94 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,966.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,588.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,224.55
|
|
|
STEM ZIM FEM 14X135MM 78531401
|
Facility
|
OP
|
$14,830.35
|
|
| Hospital Charge Code |
270616875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.55 |
| Max. Negotiated Rate |
$7,415.18 |
| Rate for Payer: Aetna Commercial |
$4,449.10
|
| Rate for Payer: Aetna Medicare Advantage |
$4,449.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,781.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,781.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,966.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,781.74
|
| Rate for Payer: Cigna Commercial |
$7,415.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,588.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,224.55
|
|
|
STEM ZIM FEM 15 140MM 7852-15
|
Facility
|
OP
|
$11,520.00
|
|
| Hospital Charge Code |
270608927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.00 |
| Max. Negotiated Rate |
$5,760.00 |
| Rate for Payer: Aetna Commercial |
$3,456.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,456.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,937.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,937.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,304.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,937.60
|
| Rate for Payer: Cigna Commercial |
$5,760.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,787.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,728.00
|
|
|
STEM ZIM FEM 15 140MM 7852-15
|
Facility
|
IP
|
$11,520.00
|
|
| Hospital Charge Code |
270608927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.00 |
| Max. Negotiated Rate |
$2,787.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,304.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,787.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,728.00
|
|
|
STEM ZIM FEM 15 140MM 7853-15
|
Facility
|
OP
|
$11,864.25
|
|
| Hospital Charge Code |
270619925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,779.64 |
| Max. Negotiated Rate |
$5,932.12 |
| Rate for Payer: Aetna Commercial |
$3,559.28
|
| Rate for Payer: Aetna Medicare Advantage |
$3,559.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,025.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,025.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,372.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,025.38
|
| Rate for Payer: Cigna Commercial |
$5,932.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,871.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,779.64
|
|
|
STEM ZIM FEM 15 140MM 7853-15
|
Facility
|
IP
|
$11,864.25
|
|
| Hospital Charge Code |
270619925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,779.64 |
| Max. Negotiated Rate |
$2,871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,372.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,871.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,779.64
|
|
|
STEM ZIM FEM 15 160MM 7841-15
|
Facility
|
IP
|
$18,618.45
|
|
| Hospital Charge Code |
270605653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.77 |
| Max. Negotiated Rate |
$4,505.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,723.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,505.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,792.77
|
|
|
STEM ZIM FEM 15 160MM 7841-15
|
Facility
|
OP
|
$18,618.45
|
|
| Hospital Charge Code |
270605653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.77 |
| Max. Negotiated Rate |
$9,309.23 |
| Rate for Payer: Aetna Commercial |
$5,585.53
|
| Rate for Payer: Aetna Medicare Advantage |
$5,585.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,747.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,747.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,723.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,747.70
|
| Rate for Payer: Cigna Commercial |
$9,309.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,505.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,792.77
|
|
|
STEM ZIM FEM 16 145 7853-1601
|
Facility
|
IP
|
$13,664.25
|
|
| Hospital Charge Code |
270616306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.64 |
| Max. Negotiated Rate |
$3,306.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,732.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,306.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,049.64
|
|