|
CAGE MODULUS XL 8X18X50MM 10D
|
Facility
|
OP
|
$37,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.75 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Aetna Commercial |
$14,250.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,562.50
|
| Rate for Payer: Cigna Commercial |
$18,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,075.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,625.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$903.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$993.75
|
|
|
CAGE MODULUS XL 8X18X55MM 10D
|
Facility
|
OP
|
$37,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.75 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Aetna Commercial |
$14,250.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,562.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,562.50
|
| Rate for Payer: Cigna Commercial |
$18,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,075.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,625.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$903.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$993.75
|
|
|
CAGE MODULUS XL 8X18X55MM 10D
|
Facility
|
IP
|
$37,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,625.00 |
| Max. Negotiated Rate |
$9,075.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,075.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,625.00
|
|
|
CAGE MONET ACIF X WIDE 8MM
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270700104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.10 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$4,180.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,805.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,805.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,805.00
|
| Rate for Payer: Cigna Commercial |
$5,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,662.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$291.50
|
|
|
CAGE MONET ACIF X WIDE 8MM
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270700104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$2,662.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,662.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
CAGE MONET WIDE EXTRA 7MM$$N/C
|
Facility
|
IP
|
$9,450.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,286.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,890.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,286.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,079.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,417.50
|
|
|
CAGE MONET WIDE EXTRA 7MM$$N/C
|
Facility
|
OP
|
$9,450.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.75 |
| Max. Negotiated Rate |
$4,725.00 |
| Rate for Payer: Aetna Commercial |
$3,591.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,835.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,409.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,409.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,890.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,409.75
|
| Rate for Payer: Cigna Commercial |
$4,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,286.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,079.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,417.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$227.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$250.43
|
|
|
CAGE MONET XWIDE 8MM
|
Facility
|
OP
|
$9,450.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.75 |
| Max. Negotiated Rate |
$4,725.00 |
| Rate for Payer: Aetna Commercial |
$3,591.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,835.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,409.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,409.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,890.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,409.75
|
| Rate for Payer: Cigna Commercial |
$4,725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,286.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,079.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,417.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$227.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$250.43
|
|
|
CAGE MONET XWIDE 8MM
|
Facility
|
IP
|
$9,450.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,286.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,890.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,286.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,079.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,417.50
|
|
|
CAGE MONTECEY 14X28X36 MM
|
Facility
|
IP
|
$44,975.00
|
|
|
Service Code
|
HCPCS C1716
|
| Hospital Charge Code |
270701765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,746.25 |
| Max. Negotiated Rate |
$10,883.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,883.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,894.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,746.25
|
|
|
CAGE MONTECEY 14X28X36 MM
|
Facility
|
OP
|
$44,975.00
|
|
|
Service Code
|
HCPCS C1716
|
| Hospital Charge Code |
270701765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.34 |
| Max. Negotiated Rate |
$10,883.95 |
| Rate for Payer: Aetna Commercial |
$1,624.38
|
| Rate for Payer: Aetna Medicare Advantage |
$1,934.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,155.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,155.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,995.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,155.71
|
| Rate for Payer: Cigna Commercial |
$1,197.08
|
| Rate for Payer: Cigna Medicare Advantage |
$597.20
|
| Rate for Payer: Clover Medicare Advantage |
$567.34
|
| Rate for Payer: EmblemHealth Commercial |
$1,791.60
|
| Rate for Payer: Humana Medicare Advantage |
$615.12
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$597.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,883.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,894.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,746.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,083.90
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$597.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$597.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,191.84
|
|
|
CAGE PARALLEL 9X11X27 MM
|
Facility
|
IP
|
$24,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.50 |
| Max. Negotiated Rate |
$5,868.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,868.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,335.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,637.50
|
|
|
CAGE PARALLEL 9X11X27 MM
|
Facility
|
OP
|
$24,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.42 |
| Max. Negotiated Rate |
$12,125.00 |
| Rate for Payer: Aetna Commercial |
$9,215.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,183.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,183.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,183.75
|
| Rate for Payer: Cigna Commercial |
$12,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,868.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,335.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,637.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$584.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$642.62
|
|
|
CAGE PC 10X22X10MM 5D
|
Facility
|
IP
|
$6,400.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$1,548.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,548.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,408.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.00
|
|
|
CAGE PC 10X22X10MM 5D
|
Facility
|
OP
|
$6,400.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.24 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,432.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,920.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,632.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,632.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$3,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,548.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,408.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$960.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$154.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$169.60
|
|
|
CAGE PC T1 BOND 14X11X6MM 7D
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$1,355.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,355.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,232.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$840.00
|
|
|
CAGE PC T1 BOND 14X11X6MM 7D
|
Facility
|
OP
|
$5,600.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.96 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$2,128.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,680.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,428.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,428.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,428.00
|
| Rate for Payer: Cigna Commercial |
$2,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,355.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,232.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$840.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$134.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$148.40
|
|
|
CAGE PEEK 12MM X 10MM
|
Facility
|
OP
|
$29,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270691714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.95 |
| Max. Negotiated Rate |
$14,750.00 |
| Rate for Payer: Aetna Commercial |
$11,210.00
|
| Rate for Payer: Aetna Medicare Advantage |
$8,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,522.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,522.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,522.50
|
| Rate for Payer: Cigna Commercial |
$14,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,139.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,490.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,425.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$710.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$781.75
|
|
|
CAGE PEEK 12MM X 10MM
|
Facility
|
IP
|
$29,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270691714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,425.00 |
| Max. Negotiated Rate |
$7,139.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,139.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$6,490.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,425.00
|
|
|
CAGE PEEK 20 X 16MM
|
Facility
|
IP
|
$16,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,471.25 |
| Max. Negotiated Rate |
$3,986.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,986.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,624.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,471.25
|
|
|
CAGE PEEK 20 X 16MM
|
Facility
|
OP
|
$16,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$397.05 |
| Max. Negotiated Rate |
$8,237.50 |
| Rate for Payer: Aetna Commercial |
$6,260.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,942.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,201.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,201.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,201.12
|
| Rate for Payer: Cigna Commercial |
$8,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,986.95
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,624.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,471.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$397.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$436.59
|
|
|
CAGE PEEK 2C TPLIF 10X29MM
|
Facility
|
IP
|
$36,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,400.00 |
| Max. Negotiated Rate |
$8,712.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,712.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,920.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,400.00
|
|
|
CAGE PEEK 2C TPLIF 10X29MM
|
Facility
|
OP
|
$36,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$867.60 |
| Max. Negotiated Rate |
$18,000.00 |
| Rate for Payer: Aetna Commercial |
$13,680.00
|
| Rate for Payer: Aetna Medicare Advantage |
$10,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,180.00
|
| Rate for Payer: Cigna Commercial |
$18,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,712.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,920.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,400.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$867.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$954.00
|
|
|
CAGE PEEK 2C TPLIF 11X29MM
|
Facility
|
IP
|
$36,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,400.00 |
| Max. Negotiated Rate |
$8,712.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,712.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,920.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,400.00
|
|
|
CAGE PEEK 2C TPLIF 11X29MM
|
Facility
|
OP
|
$36,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$867.60 |
| Max. Negotiated Rate |
$18,000.00 |
| Rate for Payer: Aetna Commercial |
$13,680.00
|
| Rate for Payer: Aetna Medicare Advantage |
$10,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,180.00
|
| Rate for Payer: Cigna Commercial |
$18,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,712.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,920.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,400.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$867.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$954.00
|
|