|
CAGE CERVICAL 7X16X13MM 6D
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$3,300.00
|
| 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: Qualcare PPO/HMO/WC |
$1,650.00
|
|
|
CAGE CERVICAL CAVUX
|
Facility
|
OP
|
$23,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,450.00 |
| Max. Negotiated Rate |
$11,500.00 |
| Rate for Payer: Aetna Commercial |
$6,900.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,865.00
|
| Rate for Payer: Cigna Commercial |
$11,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,566.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,450.00
|
|
|
CAGE CERVICAL CAVUX
|
Facility
|
IP
|
$23,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,450.00 |
| Max. Negotiated Rate |
$5,566.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,566.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,450.00
|
|
|
CAGE CERVICAL CAVUX X LTX
|
Facility
|
IP
|
$9,025.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270693673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,353.75 |
| Max. Negotiated Rate |
$2,184.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,805.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,184.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,353.75
|
|
|
CAGE CERVICAL CAVUX X LTX
|
Facility
|
OP
|
$9,025.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270693673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,353.75 |
| Max. Negotiated Rate |
$4,512.50 |
| Rate for Payer: Aetna Commercial |
$2,707.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,707.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,301.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,301.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,805.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,301.38
|
| Rate for Payer: Cigna Commercial |
$4,512.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,184.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,353.75
|
|
|
CAGE CERVICAL COHERE 12X14X8MM
|
Facility
|
IP
|
$9,075.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,361.25 |
| Max. Negotiated Rate |
$2,196.15 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,815.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,196.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,361.25
|
|
|
CAGE CERVICAL COHERE 12X14X8MM
|
Facility
|
OP
|
$9,075.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,361.25 |
| Max. Negotiated Rate |
$4,537.50 |
| Rate for Payer: Aetna Commercial |
$2,722.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,722.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,314.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,314.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,815.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,314.12
|
| Rate for Payer: Cigna Commercial |
$4,537.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,196.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,361.25
|
|
|
CAGE CERVICAL PC 16X13X7MM 7D
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270693521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,100.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
CAGE CERVICAL PC 16X13X7MM 7D
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270693521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
CAGE CERV INST KIT
|
Facility
|
IP
|
$2,500.00
|
|
| Hospital Charge Code |
270701861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$605.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
|
|
CAGE CERV INST KIT
|
Facility
|
OP
|
$2,500.00
|
|
| Hospital Charge Code |
270701861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$605.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
|
|
CAGE CERV INTERBD 16X13X8MM 7D
|
Facility
|
OP
|
$5,600.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,680.00
|
| 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: Qualcare PPO/HMO/WC |
$840.00
|
|
|
CAGE CERV INTERBD 16X13X8MM 7D
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697100
|
|
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: Qualcare PPO/HMO/WC |
$840.00
|
|
|
CAGE CERV INTERBDY 9X28X9MM 5D
|
Facility
|
IP
|
$34,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270693827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,137.50 |
| Max. Negotiated Rate |
$8,288.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,850.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,288.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,137.50
|
|
|
CAGE CERV INTERBDY 9X28X9MM 5D
|
Facility
|
OP
|
$34,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270693827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,137.50 |
| Max. Negotiated Rate |
$17,125.00 |
| Rate for Payer: Aetna Commercial |
$10,275.00
|
| Rate for Payer: Aetna Medicare Advantage |
$10,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,733.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,733.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,733.75
|
| Rate for Payer: Cigna Commercial |
$17,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,288.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,137.50
|
|
|
CAGE CERV SHURF 5 DEG 6MM
|
Facility
|
IP
|
$21,097.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,164.62 |
| Max. Negotiated Rate |
$5,105.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,219.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,105.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,164.62
|
|
|
CAGE CERV SHURF 5 DEG 6MM
|
Facility
|
OP
|
$21,097.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,164.62 |
| Max. Negotiated Rate |
$10,548.75 |
| Rate for Payer: Aetna Commercial |
$6,329.25
|
| Rate for Payer: Aetna Medicare Advantage |
$6,329.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,379.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,379.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,379.86
|
| Rate for Payer: Cigna Commercial |
$10,548.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,105.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,164.62
|
|
|
CAGE CERV SPACE NANO 18X14X8MM
|
Facility
|
OP
|
$21,097.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,164.62 |
| Max. Negotiated Rate |
$10,548.75 |
| Rate for Payer: Aetna Commercial |
$6,329.25
|
| Rate for Payer: Aetna Medicare Advantage |
$6,329.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,379.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,379.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,379.86
|
| Rate for Payer: Cigna Commercial |
$10,548.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,105.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,164.62
|
|
|
CAGE CERV SPACE NANO 18X14X8MM
|
Facility
|
IP
|
$21,097.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,164.62 |
| Max. Negotiated Rate |
$5,105.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,219.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,105.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,164.62
|
|
|
CAGE CERV SPACER ACIF 18X14X7
|
Facility
|
IP
|
$21,097.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,164.62 |
| Max. Negotiated Rate |
$5,105.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,219.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,105.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,164.62
|
|
|
CAGE CERV SPACER ACIF 18X14X7
|
Facility
|
OP
|
$21,097.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,164.62 |
| Max. Negotiated Rate |
$10,548.75 |
| Rate for Payer: Aetna Commercial |
$6,329.25
|
| Rate for Payer: Aetna Medicare Advantage |
$6,329.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,379.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,379.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,379.86
|
| Rate for Payer: Cigna Commercial |
$10,548.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,105.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,164.62
|
|
|
CAGE CERV W16 MM D14MM
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270701860
|
|
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 W16 MM D14MM
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270701860
|
|
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 W16MM D14MM FIX SCRW
|
Facility
|
IP
|
$12,500.00
|
|
| Hospital Charge Code |
270701881
|
|
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 W16MM D14MM FIX SCRW
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270701881
|
|
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
|
|