|
CAGE CERV H06 MM W14.5MM D12MM
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270701865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$3,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CAGE CERV H06 MM W14.5MM D12MM
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270701865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CAGE CERV H0 MMW14.5MM D12MM
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270701862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CAGE CERV H0 MMW14.5MM D12MM
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270701862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$3,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,187.50
|
| Rate for Payer: Cigna Commercial |
$6,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,025.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,875.00
|
|
|
CAGECERV IBPEEK 7D 14.5X12X6MM
|
Facility
|
IP
|
$42,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,375.00 |
| Max. Negotiated Rate |
$10,285.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,285.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,375.00
|
|
|
CAGECERV IBPEEK 7D 14.5X12X6MM
|
Facility
|
OP
|
$42,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,375.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Aetna Commercial |
$12,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,837.50
|
| Rate for Payer: Cigna Commercial |
$21,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,285.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,375.00
|
|
|
CAGE CERVICAL 10MM 10 DEG
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270691985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$2,700.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,295.00
|
| Rate for Payer: Cigna Commercial |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
|
|
CAGE CERVICAL 10MM 10 DEG
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270691985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,178.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,350.00
|
|
|
CAGE CERVICAL 14.5X12X7MM7D
|
Facility
|
IP
|
$42,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,375.00 |
| Max. Negotiated Rate |
$10,285.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,285.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,375.00
|
|
|
CAGE CERVICAL 14.5X12X7MM7D
|
Facility
|
OP
|
$42,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,375.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Aetna Commercial |
$12,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$12,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,837.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,837.50
|
| Rate for Payer: Cigna Commercial |
$21,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,285.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,375.00
|
|
|
CAGE CERVICAL 14mm x 15.5 mm H
|
Facility
|
IP
|
$11,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.75 |
| Max. Negotiated Rate |
$2,822.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,822.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,749.75
|
|
|
CAGE CERVICAL 14mm x 15.5 mm H
|
Facility
|
OP
|
$11,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.75 |
| Max. Negotiated Rate |
$5,832.50 |
| Rate for Payer: Aetna Commercial |
$3,499.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,499.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,974.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,974.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,974.57
|
| Rate for Payer: Cigna Commercial |
$5,832.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,822.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,749.75
|
|
|
CAGE CERVICAL 14mm X 17mm
|
Facility
|
IP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$2,823.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,823.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,750.00
|
|
|
CAGE CERVICAL 14mm X 17mm
|
Facility
|
OP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$5,833.32 |
| Rate for Payer: Aetna Commercial |
$3,499.99
|
| Rate for Payer: Aetna Medicare Advantage |
$3,499.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,975.00
|
| Rate for Payer: Cigna Commercial |
$5,833.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,823.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,750.00
|
|
|
CAGE CERVICAL 14MM X 17MM H6
|
Facility
|
IP
|
$11,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.75 |
| Max. Negotiated Rate |
$2,822.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,822.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,749.75
|
|
|
CAGE CERVICAL 14MM X 17MM H6
|
Facility
|
OP
|
$11,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,749.75 |
| Max. Negotiated Rate |
$5,832.50 |
| Rate for Payer: Aetna Commercial |
$3,499.50
|
| Rate for Payer: Aetna Medicare Advantage |
$3,499.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,974.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,974.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,974.57
|
| Rate for Payer: Cigna Commercial |
$5,832.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,822.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,749.75
|
|
|
CAGE CERVICAL 14mmx17mm H7
|
Facility
|
IP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$2,823.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,823.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,750.00
|
|
|
CAGE CERVICAL 14mmx17mm H7
|
Facility
|
OP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$5,833.32 |
| Rate for Payer: Aetna Commercial |
$3,499.99
|
| Rate for Payer: Aetna Medicare Advantage |
$3,499.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,975.00
|
| Rate for Payer: Cigna Commercial |
$5,833.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,823.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,750.00
|
|
|
CAGE CERVICAL 14mmx17mm H8
|
Facility
|
IP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$2,823.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,823.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,750.00
|
|
|
CAGE CERVICAL 14mmx17mm H8
|
Facility
|
OP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270680520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$5,833.32 |
| Rate for Payer: Aetna Commercial |
$3,499.99
|
| Rate for Payer: Aetna Medicare Advantage |
$3,499.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,975.00
|
| Rate for Payer: Cigna Commercial |
$5,833.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,823.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,750.00
|
|
|
CAGE CERVICAL 14mm X 17mm H8
|
Facility
|
OP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$5,833.32 |
| Rate for Payer: Aetna Commercial |
$3,499.99
|
| Rate for Payer: Aetna Medicare Advantage |
$3,499.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,975.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,975.00
|
| Rate for Payer: Cigna Commercial |
$5,833.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,823.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,750.00
|
|
|
CAGE CERVICAL 14mm X 17mm H8
|
Facility
|
IP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$2,823.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,333.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,823.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,750.00
|
|
|
CAGE CERVICAL 14X11X7MM 7D
|
Facility
|
IP
|
$7,300.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$1,766.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,460.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,766.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,095.00
|
|
|
CAGE CERVICAL 14X11X7MM 7D
|
Facility
|
OP
|
$7,300.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$3,650.00 |
| Rate for Payer: Aetna Commercial |
$2,190.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,190.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,861.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,861.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,460.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,861.50
|
| Rate for Payer: Cigna Commercial |
$3,650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,766.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,095.00
|
|
|
CAGE CERVICAL 7X16X13MM 6D
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694339
|
|
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: Qualcare PPO/HMO/WC |
$1,650.00
|
|