|
S-SERIES TI CANN SRW 2.0 X11mm
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Aetna Commercial |
$541.50
|
| Rate for Payer: Aetna Medicare Advantage |
$427.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$363.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$363.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$363.38
|
| Rate for Payer: Cigna Commercial |
$712.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$313.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.76
|
|
|
S-SERIES TI CANN SRW 2.0 X11mm
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$285.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$313.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$213.75
|
|
|
STABILIZER G WIRE 507-114
|
Facility
|
OP
|
$407.40
|
|
| Hospital Charge Code |
270633608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Aetna Commercial |
$154.81
|
| Rate for Payer: Aetna Medicare Advantage |
$122.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$103.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$103.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$81.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$103.89
|
| Rate for Payer: Cigna Commercial |
$203.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.59
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$89.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.11
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.80
|
|
|
STABILIZER G WIRE 507-114
|
Facility
|
IP
|
$407.40
|
|
| Hospital Charge Code |
270633608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.11 |
| Max. Negotiated Rate |
$98.59 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$81.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.59
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$89.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.11
|
|
|
STABILIZER SDK DYNLOK 8430003
|
Facility
|
OP
|
$332.00
|
|
| Hospital Charge Code |
270616295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$126.16
|
| Rate for Payer: Aetna Medicare Advantage |
$99.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$84.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$84.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$84.66
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.60
|
| Rate for Payer: Oxford Commercial |
$66.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$66.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.80
|
|
|
STABILIZER SDK DYNLOK 8430003
|
Facility
|
IP
|
$332.00
|
|
| Hospital Charge Code |
270616295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.80
|
|
|
STABILIZ TIB INS TRIATHLN X3
|
Facility
|
OP
|
$23,925.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270693020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.59 |
| Max. Negotiated Rate |
$11,962.50 |
| Rate for Payer: Aetna Commercial |
$9,091.50
|
| Rate for Payer: Aetna Medicare Advantage |
$7,177.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,100.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,100.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,100.88
|
| Rate for Payer: Cigna Commercial |
$11,962.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,789.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,263.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,588.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$576.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$634.01
|
|
|
STABILIZ TIB INS TRIATHLN X3
|
Facility
|
IP
|
$23,925.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270693020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,588.75 |
| Max. Negotiated Rate |
$5,789.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,785.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,789.85
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,263.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,588.75
|
|
|
STAB PHLEB VEINS XTR 10-20
|
Facility
|
OP
|
$17,623.95
|
|
|
Service Code
|
HCPCS 37765
|
| Hospital Charge Code |
421037765
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$424.74 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$665.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$3,751.17
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,287.19
|
| Rate for Payer: Oxford Commercial |
$3,524.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,643.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,524.79
|
| Rate for Payer: UnitedHealthcare Community & State |
$424.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$467.03
|
|
|
STAB PHLEB VEINS XTR 10-20
|
Facility
|
IP
|
$17,623.95
|
|
|
Service Code
|
HCPCS 37765
|
| Hospital Charge Code |
421037765
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,643.59 |
| Max. Negotiated Rate |
$2,643.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,643.59
|
|
|
STAB PHLEB VEINS XTR 10-20
|
Facility
|
OP
|
$25,406.80
|
|
|
Service Code
|
HCPCS 37765
|
| Hospital Charge Code |
16000739
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$13,540.60 |
| Rate for Payer: Aetna Commercial |
$10,203.18
|
| Rate for Payer: Aetna Medicare Advantage |
$12,153.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13,540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3,751.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13,540.60
|
| Rate for Payer: Cigna Commercial |
$7,519.21
|
| Rate for Payer: Cigna Medicare Advantage |
$3,751.17
|
| Rate for Payer: Clover Medicare Advantage |
$3,563.61
|
| Rate for Payer: EmblemHealth Commercial |
$11,253.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,863.71
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3,751.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,622.04
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,811.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,232.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$612.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,751.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$673.28
|
|
|
STAB PHLEB VEINS XTR 10-20
|
Facility
|
IP
|
$25,406.80
|
|
|
Service Code
|
HCPCS 37765
|
| Hospital Charge Code |
16000739
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,811.02 |
| Max. Negotiated Rate |
$3,811.02 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,811.02
|
|
|
STAGRAFT DBM PUTTY
|
Facility
|
IP
|
$7,645.00
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270704573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.75 |
| Max. Negotiated Rate |
$1,850.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,529.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,850.09
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,681.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,146.75
|
|
|
STAGRAFT DBM PUTTY
|
Facility
|
OP
|
$7,645.00
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270704573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.24 |
| Max. Negotiated Rate |
$3,822.50 |
| Rate for Payer: Aetna Commercial |
$2,905.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,293.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,949.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,949.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,529.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,949.47
|
| Rate for Payer: Cigna Commercial |
$3,822.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,850.09
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,681.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,146.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$184.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$202.59
|
|
|
STAGRAFT PUTTY 2CC DBM
|
Facility
|
IP
|
$2,750.00
|
|
| Hospital Charge Code |
270703446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$665.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$665.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$605.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
|
|
STAGRAFT PUTTY 2CC DBM
|
Facility
|
OP
|
$2,750.00
|
|
| Hospital Charge Code |
270703446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.28 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$1,045.00
|
| Rate for Payer: Aetna Medicare Advantage |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$701.25
|
| Rate for Payer: Cigna Commercial |
$1,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$665.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$605.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$66.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$72.88
|
|
|
STAND ALONE ACDF 14X12X6MM
|
Facility
|
OP
|
$18,585.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.90 |
| Max. Negotiated Rate |
$9,292.50 |
| Rate for Payer: Aetna Commercial |
$7,062.30
|
| Rate for Payer: Aetna Medicare Advantage |
$5,575.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,739.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,739.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,717.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,739.18
|
| Rate for Payer: Cigna Commercial |
$9,292.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,497.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,088.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,787.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$447.90
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$492.50
|
|
|
STAND ALONE ACDF 14X12X6MM
|
Facility
|
IP
|
$18,585.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.75 |
| Max. Negotiated Rate |
$4,497.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,717.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,497.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,088.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,787.75
|
|
|
STAND ALONE ALIF CAGE 25X35MM-
|
Facility
|
OP
|
$26,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.62 |
| Max. Negotiated Rate |
$13,125.00 |
| Rate for Payer: Aetna Commercial |
$9,975.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,875.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,693.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,693.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,693.75
|
| Rate for Payer: Cigna Commercial |
$13,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,352.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,775.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,937.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$632.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$695.62
|
|
|
STAND ALONE ALIF CAGE 25X35MM-
|
Facility
|
OP
|
$26,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.62 |
| Max. Negotiated Rate |
$13,125.00 |
| Rate for Payer: Aetna Commercial |
$9,975.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,875.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,693.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,693.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,693.75
|
| Rate for Payer: Cigna Commercial |
$13,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,352.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,775.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,937.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$632.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$695.62
|
|
|
STAND ALONE ALIF CAGE 25X35MM-
|
Facility
|
IP
|
$26,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.50 |
| Max. Negotiated Rate |
$6,352.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,352.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,775.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,937.50
|
|
|
STAND ALONE ALIF CAGE 25X35MM-
|
Facility
|
IP
|
$26,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,937.50 |
| Max. Negotiated Rate |
$6,352.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,352.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,775.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,937.50
|
|
|
STAND ALONE CERVICAL 6MM
|
Facility
|
OP
|
$15,550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.75 |
| Max. Negotiated Rate |
$7,775.00 |
| Rate for Payer: Aetna Commercial |
$5,909.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,665.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,965.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,965.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,965.25
|
| Rate for Payer: Cigna Commercial |
$7,775.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,763.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,421.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,332.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$374.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$412.07
|
|
|
STAND ALONE CERVICAL 6MM
|
Facility
|
IP
|
$15,550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270706210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,332.50 |
| Max. Negotiated Rate |
$3,763.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,763.10
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,421.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,332.50
|
|
|
STAND ALONE SCREW 16MM
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$342.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$198.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.85
|
|
