|
SPACER BLACKHAWK TI 14X12X6MM
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270693531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,562.50 |
| Max. Negotiated Rate |
$11,875.00 |
| Rate for Payer: Aetna Commercial |
$7,125.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,056.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,056.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,056.25
|
| Rate for Payer: Cigna Commercial |
$11,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,747.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,562.50
|
|
|
SPACER BLACKHAWK TI 14X12X7D
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270699091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,562.50 |
| Max. Negotiated Rate |
$11,875.00 |
| Rate for Payer: Aetna Commercial |
$7,125.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,125.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,056.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,056.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,056.25
|
| Rate for Payer: Cigna Commercial |
$11,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,747.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,562.50
|
|
|
SPACER BLACKHAWK TI 14X12X7D
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270699091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,562.50 |
| Max. Negotiated Rate |
$5,747.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,747.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,562.50
|
|
|
SPACER, CALIBRATE LTX 6X18X50M
|
Facility
|
OP
|
$47,734.40
|
|
| Hospital Charge Code |
270702577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,160.16 |
| Max. Negotiated Rate |
$23,867.20 |
| Rate for Payer: Aetna Commercial |
$14,320.32
|
| Rate for Payer: Aetna Medicare Advantage |
$14,320.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,172.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,172.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9,546.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,172.27
|
| Rate for Payer: Cigna Commercial |
$23,867.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,551.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,160.16
|
|
|
SPACER, CALIBRATE LTX 6X18X50M
|
Facility
|
IP
|
$47,734.40
|
|
| Hospital Charge Code |
270702577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,160.16 |
| Max. Negotiated Rate |
$11,551.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9,546.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11,551.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,160.16
|
|
|
SPACER CAPSTONE 22X10MM
|
Facility
|
IP
|
$26,030.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,904.50 |
| Max. Negotiated Rate |
$6,299.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,206.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,299.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,904.50
|
|
|
SPACER CAPSTONE 22X10MM
|
Facility
|
OP
|
$26,030.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,904.50 |
| Max. Negotiated Rate |
$13,015.00 |
| Rate for Payer: Aetna Commercial |
$7,809.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,809.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,637.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,637.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,206.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,637.65
|
| Rate for Payer: Cigna Commercial |
$13,015.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,299.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,904.50
|
|
|
SPACER CAPSTONE 26X10MM
|
Facility
|
OP
|
$26,030.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,904.50 |
| Max. Negotiated Rate |
$13,015.00 |
| Rate for Payer: Aetna Commercial |
$7,809.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,809.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,637.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,637.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,206.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,637.65
|
| Rate for Payer: Cigna Commercial |
$13,015.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,299.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,904.50
|
|
|
SPACER CAPSTONE 26X10MM
|
Facility
|
IP
|
$26,030.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,904.50 |
| Max. Negotiated Rate |
$6,299.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,206.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,299.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,904.50
|
|
|
SPACER CAPSTONE 26X9MM
|
Facility
|
OP
|
$35,190.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,278.50 |
| Max. Negotiated Rate |
$17,595.00 |
| Rate for Payer: Aetna Commercial |
$10,557.00
|
| Rate for Payer: Aetna Medicare Advantage |
$10,557.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,973.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,973.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,038.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,973.45
|
| Rate for Payer: Cigna Commercial |
$17,595.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,515.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,278.50
|
|
|
SPACER CAPSTONE 26X9MM
|
Facility
|
IP
|
$35,190.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,278.50 |
| Max. Negotiated Rate |
$8,515.98 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,038.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,515.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,278.50
|
|
|
SPACER CATALYFT PL LONG 9MM
|
Facility
|
IP
|
$31,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$7,502.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,502.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,650.00
|
|
|
SPACER CATALYFT PL LONG 9MM
|
Facility
|
OP
|
$31,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$15,500.00 |
| Rate for Payer: Aetna Commercial |
$9,300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,905.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,905.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,905.00
|
| Rate for Payer: Cigna Commercial |
$15,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,502.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,650.00
|
|
|
SPACER CERES 12X15X7 6DEG
|
Facility
|
OP
|
$7,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,875.00 |
| Rate for Payer: Aetna Commercial |
$2,325.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,325.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,976.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,976.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,976.25
|
| Rate for Payer: Cigna Commercial |
$3,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,875.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,162.50
|
|
|
SPACER CERES 12X15X7 6DEG
|
Facility
|
IP
|
$7,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$1,875.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,875.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,162.50
|
|
|
SPACER CERES 12X15X8 6DEG
|
Facility
|
IP
|
$7,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$1,875.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,875.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,162.50
|
|
|
SPACER CERES 12X15X8 6DEG
|
Facility
|
OP
|
$7,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,875.00 |
| Rate for Payer: Aetna Commercial |
$2,325.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,325.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,976.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,976.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,976.25
|
| Rate for Payer: Cigna Commercial |
$3,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,875.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,162.50
|
|
|
SPACER CERES 12X15X9
|
Facility
|
IP
|
$7,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$1,875.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,875.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,162.50
|
|
|
SPACER CERES 12X15X9
|
Facility
|
OP
|
$7,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,875.00 |
| Rate for Payer: Aetna Commercial |
$2,325.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,325.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,976.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,976.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,976.25
|
| Rate for Payer: Cigna Commercial |
$3,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,875.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,162.50
|
|
|
SPACER CERES-C 12X15X6MM 10D
|
Facility
|
OP
|
$6,200.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$930.00 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna Commercial |
$1,860.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,860.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,581.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,581.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$3,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,500.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.00
|
|
|
SPACER CERES-C 12X15X6MM 10D
|
Facility
|
IP
|
$6,200.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$930.00 |
| Max. Negotiated Rate |
$1,500.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,240.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,500.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.00
|
|
|
SPACER CERES-C 12X15X7MM 10D
|
Facility
|
IP
|
$6,200.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$930.00 |
| Max. Negotiated Rate |
$1,500.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,240.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,500.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.00
|
|
|
SPACER CERES-C 12X15X7MM 10D
|
Facility
|
OP
|
$6,200.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$930.00 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna Commercial |
$1,860.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,860.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,581.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,581.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$3,100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,500.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$930.00
|
|
|
SPACER CERES-C 12X15X8 6DEG
|
Facility
|
IP
|
$7,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270682520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$1,875.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,875.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,162.50
|
|
|
SPACER CERES-C 12X15X8 6DEG
|
Facility
|
OP
|
$7,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270682520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,875.00 |
| Rate for Payer: Aetna Commercial |
$2,325.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,325.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,976.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,976.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,976.25
|
| Rate for Payer: Cigna Commercial |
$3,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,875.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,162.50
|
|