|
CAGE LUCENT PC 18X50X12MM 12D
|
Facility
|
OP
|
$21,200.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,180.00 |
| Max. Negotiated Rate |
$10,600.00 |
| Rate for Payer: Aetna Commercial |
$6,360.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,360.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,406.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,406.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,406.00
|
| Rate for Payer: Cigna Commercial |
$10,600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,130.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,180.00
|
|
|
CAGE LUCENT PC 18X50X12MM 12D
|
Facility
|
IP
|
$21,200.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,180.00 |
| Max. Negotiated Rate |
$5,130.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,240.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,130.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,180.00
|
|
|
CAGE LUCENT PEEK 12X27X14MM5D
|
Facility
|
OP
|
$12,800.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,920.00 |
| Max. Negotiated Rate |
$6,400.00 |
| Rate for Payer: Aetna Commercial |
$3,840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,264.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,264.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,560.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,264.00
|
| Rate for Payer: Cigna Commercial |
$6,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,097.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,920.00
|
|
|
CAGE LUCENT PEEK 12X27X14MM5D
|
Facility
|
IP
|
$12,800.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,920.00 |
| Max. Negotiated Rate |
$3,097.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,097.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,920.00
|
|
|
CAGELUCENTTI-BOND12X37X13MM5D
|
Facility
|
OP
|
$12,800.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,920.00 |
| Max. Negotiated Rate |
$6,400.00 |
| Rate for Payer: Aetna Commercial |
$3,840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,264.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,264.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,560.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,264.00
|
| Rate for Payer: Cigna Commercial |
$6,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,097.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,920.00
|
|
|
CAGELUCENTTI-BOND12X37X13MM5D
|
Facility
|
IP
|
$12,800.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,920.00 |
| Max. Negotiated Rate |
$3,097.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,097.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,920.00
|
|
|
CAGE LUNA XD 14MM 12D
|
Facility
|
IP
|
$67,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,050.00 |
| Max. Negotiated Rate |
$16,214.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,214.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10,050.00
|
|
|
CAGE LUNA XD 14MM 12D
|
Facility
|
OP
|
$67,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,050.00 |
| Max. Negotiated Rate |
$33,500.00 |
| Rate for Payer: Aetna Commercial |
$20,100.00
|
| Rate for Payer: Aetna Medicare Advantage |
$20,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17,085.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17,085.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17,085.00
|
| Rate for Payer: Cigna Commercial |
$33,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,214.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10,050.00
|
|
|
CAGE MAGNUM 37X27X10MM 12D
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$4,840.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
CAGE MAGNUM 37X27X10MM 12D
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$6,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,100.00
|
| Rate for Payer: Cigna Commercial |
$10,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
CAGE MAGNUM 37X27X14MM 18D
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$6,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,100.00
|
| Rate for Payer: Cigna Commercial |
$10,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
CAGE MAGNUM 37X27X14MM 18D
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$4,840.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
CAGE MAGNUM 41MMX27MMX14MM 12D
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270693015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$12,500.00 |
| Rate for Payer: Aetna Commercial |
$7,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$7,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,375.00
|
| Rate for Payer: Cigna Commercial |
$12,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.00
|
|
|
CAGE MAGNUM 41MMX27MMX14MM 12D
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
270693015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$6,050.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,050.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,750.00
|
|
|
CAGE MAGNUM PC 37X27X12MM 12D
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$4,840.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
CAGE MAGNUM PC 37X27X12MM 12D
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270697716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$6,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,100.00
|
| Rate for Payer: Cigna Commercial |
$10,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,840.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
CAGE MATRIX CORPEC 12X14X27 6D
|
Facility
|
IP
|
$30,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,500.00
|
|
|
CAGE MATRIX CORPEC 12X14X27 6D
|
Facility
|
OP
|
$30,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$15,000.00 |
| Rate for Payer: Aetna Commercial |
$9,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,650.00
|
| Rate for Payer: Cigna Commercial |
$15,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,500.00
|
|
|
CAGE MATRIXX 12DX14WX45H 6D
|
Facility
|
OP
|
$30,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$15,000.00 |
| Rate for Payer: Aetna Commercial |
$9,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,650.00
|
| Rate for Payer: Cigna Commercial |
$15,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,500.00
|
|
|
CAGE MATRIXX 12DX14WX45H 6D
|
Facility
|
IP
|
$30,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,500.00
|
|
|
CAGE MATRIXX 12X14X24MM 6D
|
Facility
|
IP
|
$30,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,500.00
|
|
|
CAGE MATRIXX 12X14X24MM 6D
|
Facility
|
OP
|
$30,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$15,000.00 |
| Rate for Payer: Aetna Commercial |
$9,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,650.00
|
| Rate for Payer: Cigna Commercial |
$15,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,500.00
|
|
|
CAGE MATRIXX 12X14X66 6DEG
|
Facility
|
OP
|
$30,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$15,000.00 |
| Rate for Payer: Aetna Commercial |
$9,000.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,650.00
|
| Rate for Payer: Cigna Commercial |
$15,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,500.00
|
|
|
CAGE MATRIXX 12X14X66 6DEG
|
Facility
|
IP
|
$30,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,500.00
|
|
|
CAGE MODUL TLIF-O 10X10X30MM4D
|
Facility
|
IP
|
$32,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695819
|
|
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: Qualcare PPO/HMO/WC |
$4,875.00
|
|