|
CAGE SYSTEM BENGAL 6mm
|
Facility
|
IP
|
$6,500.00
|
|
| Hospital Charge Code |
270671113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$1,573.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,573.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,430.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$975.00
|
|
|
CAGE TAPERED STALIF 14MMX5.
|
Facility
|
IP
|
$20,100.00
|
|
| Hospital Charge Code |
270667980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.00 |
| Max. Negotiated Rate |
$4,864.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,864.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,422.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,015.00
|
|
|
CAGE TAPERED STALIF 14MMX5.
|
Facility
|
OP
|
$20,100.00
|
|
| Hospital Charge Code |
270667980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.41 |
| Max. Negotiated Rate |
$10,050.00 |
| Rate for Payer: Aetna Commercial |
$7,638.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,030.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,125.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,125.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,125.50
|
| Rate for Payer: Cigna Commercial |
$10,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,864.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,422.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,015.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$484.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$532.65
|
|
|
CAGE TAPERED STALIF 14MMX6.
|
Facility
|
IP
|
$20,100.00
|
|
| Hospital Charge Code |
270667979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.00 |
| Max. Negotiated Rate |
$4,864.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,864.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,422.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,015.00
|
|
|
CAGE TAPERED STALIF 14MMX6.
|
Facility
|
OP
|
$20,100.00
|
|
| Hospital Charge Code |
270667979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.41 |
| Max. Negotiated Rate |
$10,050.00 |
| Rate for Payer: Aetna Commercial |
$7,638.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,030.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,125.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,125.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,125.50
|
| Rate for Payer: Cigna Commercial |
$10,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,864.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,422.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,015.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$484.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$532.65
|
|
|
CAGE TETRA 14X22MM 6D
|
Facility
|
IP
|
$21,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,225.00 |
| Max. Negotiated Rate |
$5,203.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,203.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,730.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,225.00
|
|
|
CAGE TETRA 14X22MM 6D
|
Facility
|
OP
|
$21,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.15 |
| Max. Negotiated Rate |
$10,750.00 |
| Rate for Payer: Aetna Commercial |
$8,170.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,482.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,482.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$10,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,203.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,730.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,225.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$518.15
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$569.75
|
|
|
CAGE TI 8MM XWIDE
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270699692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$275.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
CAGE TI 8MM XWIDE
|
Facility
|
OP
|
$9,150.00
|
|
| Hospital Charge Code |
270698204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.51 |
| Max. Negotiated Rate |
$4,575.00 |
| Rate for Payer: Aetna Commercial |
$3,477.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,745.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,333.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,333.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,830.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,333.25
|
| Rate for Payer: Cigna Commercial |
$4,575.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,214.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,013.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,372.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$220.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$242.47
|
|
|
CAGE TI 8MM XWIDE
|
Facility
|
IP
|
$9,150.00
|
|
| Hospital Charge Code |
270698204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,372.50 |
| Max. Negotiated Rate |
$2,214.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,830.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,214.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,013.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,372.50
|
|
|
CAGE TI 8MM XWIDE
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270699692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$275.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.12
|
|
|
CAGE TIGER LAT 45X17X12D 11H
|
Facility
|
OP
|
$37,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.73 |
| Max. Negotiated Rate |
$18,625.00 |
| Rate for Payer: Aetna Commercial |
$14,155.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,498.75
|
| Rate for Payer: Cigna Commercial |
$18,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,014.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,587.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$897.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$987.12
|
|
|
CAGE TIGER LAT 45X17X12D 11H
|
Facility
|
IP
|
$37,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,587.50 |
| Max. Negotiated Rate |
$9,014.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,014.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,587.50
|
|
|
CAGE TIGER LAT 50X17X12D 11H
|
Facility
|
OP
|
$37,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.73 |
| Max. Negotiated Rate |
$18,625.00 |
| Rate for Payer: Aetna Commercial |
$14,155.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,498.75
|
| Rate for Payer: Cigna Commercial |
$18,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,014.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,587.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$897.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$987.12
|
|
|
CAGE TIGER LAT 50X17X12D 11H
|
Facility
|
IP
|
$37,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,587.50 |
| Max. Negotiated Rate |
$9,014.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,014.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,587.50
|
|
|
CAGE TIGER LAT 50X22X12D 11H
|
Facility
|
OP
|
$37,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.73 |
| Max. Negotiated Rate |
$18,625.00 |
| Rate for Payer: Aetna Commercial |
$14,155.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,498.75
|
| Rate for Payer: Cigna Commercial |
$18,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,014.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,587.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$897.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$987.12
|
|
|
CAGE TIGER LAT 50X22X12D 11H
|
Facility
|
IP
|
$37,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,587.50 |
| Max. Negotiated Rate |
$9,014.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,014.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,587.50
|
|
|
CAGETIGERSHARKLAT50X22X1312D
|
Facility
|
IP
|
$37,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,587.50 |
| Max. Negotiated Rate |
$9,014.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,014.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,587.50
|
|
|
CAGETIGERSHARKLAT50X22X1312D
|
Facility
|
OP
|
$37,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.73 |
| Max. Negotiated Rate |
$18,625.00 |
| Rate for Payer: Aetna Commercial |
$14,155.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,498.75
|
| Rate for Payer: Cigna Commercial |
$18,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,014.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,587.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$897.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$987.12
|
|
|
CAGETIGERSHARKLAT50X22X1512D
|
Facility
|
OP
|
$37,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.73 |
| Max. Negotiated Rate |
$18,625.00 |
| Rate for Payer: Aetna Commercial |
$14,155.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,498.75
|
| Rate for Payer: Cigna Commercial |
$18,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,014.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,587.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$897.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$987.12
|
|
|
CAGETIGERSHARKLAT50X22X1512D
|
Facility
|
IP
|
$37,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,587.50 |
| Max. Negotiated Rate |
$9,014.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,014.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$8,195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,587.50
|
|
|
CAGE TILIF-O 8X10X30MM 4D
|
Facility
|
OP
|
$32,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$783.25 |
| Max. Negotiated Rate |
$16,250.00 |
| Rate for Payer: Aetna Commercial |
$12,350.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,287.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,287.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,287.50
|
| Rate for Payer: Cigna Commercial |
$16,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,865.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,875.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$783.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$861.25
|
|
|
CAGE TILIF-O 8X10X30MM 4D
|
Facility
|
IP
|
$32,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,875.00 |
| Max. Negotiated Rate |
$7,865.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,865.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$7,150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,875.00
|
|
|
CAGE TI STALIF-C 6.5X12MM 6D
|
Facility
|
IP
|
$22,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270693735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,300.00 |
| Max. Negotiated Rate |
$5,324.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,324.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,300.00
|
|
|
CAGE TI STALIF-C 6.5X12MM 6D
|
Facility
|
OP
|
$22,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270693735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.20 |
| Max. Negotiated Rate |
$11,000.00 |
| Rate for Payer: Aetna Commercial |
$8,360.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,610.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,610.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,610.00
|
| Rate for Payer: Cigna Commercial |
$11,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,324.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$530.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$583.00
|
|