|
STEM ZIM FEM 16 145 7853-1601
|
Facility
|
OP
|
$13,664.25
|
|
| Hospital Charge Code |
270616306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.64 |
| Max. Negotiated Rate |
$6,832.12 |
| Rate for Payer: Aetna Commercial |
$4,099.27
|
| Rate for Payer: Aetna Medicare Advantage |
$4,099.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,484.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,484.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,732.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,484.38
|
| Rate for Payer: Cigna Commercial |
$6,832.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,306.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,049.64
|
|
|
STEM ZIM FEM 16 145MM 7852-16
|
Facility
|
OP
|
$12,250.00
|
|
| Hospital Charge Code |
270612220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,837.50 |
| Max. Negotiated Rate |
$6,125.00 |
| Rate for Payer: Aetna Commercial |
$3,675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,123.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,123.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,123.75
|
| Rate for Payer: Cigna Commercial |
$6,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,964.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,837.50
|
|
|
STEM ZIM FEM 16 145MM 7852-16
|
Facility
|
IP
|
$12,250.00
|
|
| Hospital Charge Code |
270612220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,837.50 |
| Max. Negotiated Rate |
$2,964.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,964.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,837.50
|
|
|
STEM ZIM FEM 16 160MM 7841-16
|
Facility
|
OP
|
$15,272.00
|
|
| Hospital Charge Code |
270616189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,290.80 |
| Max. Negotiated Rate |
$7,636.00 |
| Rate for Payer: Aetna Commercial |
$4,581.60
|
| Rate for Payer: Aetna Medicare Advantage |
$4,581.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,894.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,894.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,054.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,894.36
|
| Rate for Payer: Cigna Commercial |
$7,636.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,695.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,290.80
|
|
|
STEM ZIM FEM 16 160MM 7841-16
|
Facility
|
IP
|
$15,272.00
|
|
| Hospital Charge Code |
270616189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,290.80 |
| Max. Negotiated Rate |
$3,695.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,054.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,695.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,290.80
|
|
|
STEM ZIM FEM 17 150MM 7853-17
|
Facility
|
IP
|
$12,338.00
|
|
| Hospital Charge Code |
270619568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.70 |
| Max. Negotiated Rate |
$2,985.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,467.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,985.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,850.70
|
|
|
STEM ZIM FEM 17 150MM 7853-17
|
Facility
|
OP
|
$12,338.00
|
|
| Hospital Charge Code |
270619568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.70 |
| Max. Negotiated Rate |
$6,169.00 |
| Rate for Payer: Aetna Commercial |
$3,701.40
|
| Rate for Payer: Aetna Medicare Advantage |
$3,701.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,146.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,146.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,467.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,146.19
|
| Rate for Payer: Cigna Commercial |
$6,169.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,985.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,850.70
|
|
|
STEM ZIM FEM 17 160MM 7841-17
|
Facility
|
IP
|
$13,882.45
|
|
| Hospital Charge Code |
270616381
|
|
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 17 160MM 7841-17
|
Facility
|
OP
|
$13,882.45
|
|
| Hospital Charge Code |
270616381
|
|
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 18 160MM 7841-18
|
Facility
|
OP
|
$16,717.50
|
|
| Hospital Charge Code |
270616167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.62 |
| Max. Negotiated Rate |
$8,358.75 |
| Rate for Payer: Aetna Commercial |
$5,015.25
|
| Rate for Payer: Aetna Medicare Advantage |
$5,015.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,262.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,262.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,343.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,262.96
|
| Rate for Payer: Cigna Commercial |
$8,358.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,045.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,507.62
|
|
|
STEM ZIM FEM 18 160MM 7841-18
|
Facility
|
IP
|
$16,717.50
|
|
| Hospital Charge Code |
270616167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.62 |
| Max. Negotiated Rate |
$4,045.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,343.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,045.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,507.62
|
|
|
STEM ZIM FEM 9028-20
|
Facility
|
OP
|
$6,371.25
|
|
| Hospital Charge Code |
270607082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.69 |
| Max. Negotiated Rate |
$3,185.62 |
| Rate for Payer: Aetna Commercial |
$1,911.38
|
| Rate for Payer: Aetna Medicare Advantage |
$1,911.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,624.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,624.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,274.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,624.67
|
| Rate for Payer: Cigna Commercial |
$3,185.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,541.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$955.69
|
|
|
STEM ZIM FEM 9028-20
|
Facility
|
IP
|
$11,025.00
|
|
| Hospital Charge Code |
270605481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,653.75 |
| Max. Negotiated Rate |
$2,668.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,668.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,653.75
|
|
|
STEM ZIM FEM 9028-20
|
Facility
|
OP
|
$11,025.00
|
|
| Hospital Charge Code |
270605481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,653.75 |
| Max. Negotiated Rate |
$5,512.50 |
| Rate for Payer: Aetna Commercial |
$3,307.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,811.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,811.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,811.38
|
| Rate for Payer: Cigna Commercial |
$5,512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,668.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,653.75
|
|
|
STEM ZIM FEM 9028-20
|
Facility
|
IP
|
$6,371.25
|
|
| Hospital Charge Code |
270607082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.69 |
| Max. Negotiated Rate |
$1,541.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,274.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,541.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$955.69
|
|
|
STEM ZIM FEM LG 140MM 9028-30
|
Facility
|
IP
|
$11,025.00
|
|
| Hospital Charge Code |
270606986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,653.75 |
| Max. Negotiated Rate |
$2,668.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,668.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,653.75
|
|
|
STEM ZIM FEM LG 140MM 9028-30
|
Facility
|
OP
|
$11,025.00
|
|
| Hospital Charge Code |
270606986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,653.75 |
| Max. Negotiated Rate |
$5,512.50 |
| Rate for Payer: Aetna Commercial |
$3,307.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,811.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,811.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,811.38
|
| Rate for Payer: Cigna Commercial |
$5,512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,668.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,653.75
|
|
|
STEM ZIM FEM LG 155MM 9028-35
|
Facility
|
IP
|
$11,025.00
|
|
| Hospital Charge Code |
270608150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,653.75 |
| Max. Negotiated Rate |
$2,668.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,668.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,653.75
|
|
|
STEM ZIM FEM LG 155MM 9028-35
|
Facility
|
OP
|
$11,025.00
|
|
| Hospital Charge Code |
270608150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,653.75 |
| Max. Negotiated Rate |
$5,512.50 |
| Rate for Payer: Aetna Commercial |
$3,307.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,811.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,811.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,205.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,811.38
|
| Rate for Payer: Cigna Commercial |
$5,512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,668.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,653.75
|
|
|
STEM ZIM FEM SM 9028-10
|
Facility
|
OP
|
$11,850.00
|
|
| Hospital Charge Code |
270605860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,777.50 |
| Max. Negotiated Rate |
$5,925.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,777.50
|
| Rate for Payer: Aetna Commercial |
$3,555.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,555.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,021.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,021.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,370.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,021.75
|
| Rate for Payer: Cigna Commercial |
$5,925.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,867.70
|
|
|
STEM ZIM FEM SM 9028-10
|
Facility
|
IP
|
$11,850.00
|
|
| Hospital Charge Code |
270605860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,777.50 |
| Max. Negotiated Rate |
$2,867.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,867.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,777.50
|
|
|
STEM ZIM HUM 11 130 43001113
|
Facility
|
IP
|
$14,620.00
|
|
| Hospital Charge Code |
270629064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,193.00 |
| Max. Negotiated Rate |
$3,538.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,924.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,538.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,193.00
|
|
|
STEM ZIM HUM 11 130 43001113
|
Facility
|
OP
|
$14,620.00
|
|
| Hospital Charge Code |
270629064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,193.00 |
| Max. Negotiated Rate |
$7,310.00 |
| Rate for Payer: Aetna Commercial |
$4,386.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,728.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,728.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,924.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,728.10
|
| Rate for Payer: Cigna Commercial |
$7,310.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,538.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,193.00
|
|
|
STEM ZIM HUMERAL 7 130 4065-42
|
Facility
|
OP
|
$8,675.00
|
|
| Hospital Charge Code |
270611155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.25 |
| Max. Negotiated Rate |
$4,337.50 |
| Rate for Payer: Aetna Commercial |
$2,602.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,602.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,212.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,212.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,735.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,212.12
|
| Rate for Payer: Cigna Commercial |
$4,337.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,099.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,301.25
|
|
|
STEM ZIM HUMERAL 7 130 4065-42
|
Facility
|
IP
|
$8,675.00
|
|
| Hospital Charge Code |
270611155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.25 |
| Max. Negotiated Rate |
$2,099.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,735.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,099.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,301.25
|
|