|
PLATE PYRENEES LVL 3 75MM
|
Facility
|
IP
|
$7,845.00
|
|
| Hospital Charge Code |
270670313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.75 |
| Max. Negotiated Rate |
$1,898.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,569.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,898.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,176.75
|
|
|
PLATE PYRENEES LVL 3 78MM
|
Facility
|
OP
|
$7,845.00
|
|
| Hospital Charge Code |
270670314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.80 |
| Max. Negotiated Rate |
$3,922.50 |
| Rate for Payer: Aetna Commercial |
$2,981.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,353.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,000.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,000.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,569.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,000.47
|
| Rate for Payer: Cigna Commercial |
$3,922.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,898.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,176.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$247.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$222.80
|
|
|
PLATE PYRENEES LVL 3 78MM
|
Facility
|
IP
|
$7,845.00
|
|
| Hospital Charge Code |
270670314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.75 |
| Max. Negotiated Rate |
$1,898.49 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,569.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,898.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,176.75
|
|
|
PLATE PYRENEES LVL 4 101MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|
|
PLATE PYRENEES LVL 4 101MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 61MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 61MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|
|
PLATE PYRENEES LVL 4 65MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 65MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|
|
PLATE PYRENEES LVL 4 69MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 69MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|
|
PLATE PYRENEES LVL 4 73MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|
|
PLATE PYRENEES LVL 4 73MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 77MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|
|
PLATE PYRENEES LVL 4 77MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 81MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|
|
PLATE PYRENEES LVL 4 81MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 85MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 85MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|
|
PLATE PYRENEES LVL 4 89MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 89MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|
|
PLATE PYRENEES LVL 4 93MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|
|
PLATE PYRENEES LVL 4 93MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 97MM
|
Facility
|
OP
|
$8,545.00
|
|
| Hospital Charge Code |
270670326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.68 |
| Max. Negotiated Rate |
$4,272.50 |
| Rate for Payer: Aetna Commercial |
$3,247.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,178.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,178.97
|
| Rate for Payer: Cigna Commercial |
$4,272.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$270.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.68
|
|
|
PLATE PYRENEES LVL 4 97MM
|
Facility
|
IP
|
$8,545.00
|
|
| Hospital Charge Code |
270670326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,067.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,709.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,067.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,281.75
|
|