|
CAGE PROLINK 16X13X8MM 7D
|
Facility
|
OP
|
$17,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,625.00 |
| Max. Negotiated Rate |
$8,750.00 |
| Rate for Payer: Aetna Commercial |
$5,250.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,462.50
|
| Rate for Payer: Cigna Commercial |
$8,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,235.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,625.00
|
|
|
CAGE PROLINK TI 16X13X6MM 7D
|
Facility
|
OP
|
$17,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,625.00 |
| Max. Negotiated Rate |
$8,750.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,625.00
|
| Rate for Payer: Aetna Commercial |
$5,250.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,462.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,462.50
|
| Rate for Payer: Cigna Commercial |
$8,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,235.00
|
|
|
CAGE PROLINK TI 16X13X6MM 7D
|
Facility
|
IP
|
$17,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,625.00 |
| Max. Negotiated Rate |
$4,235.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,235.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,625.00
|
|
|
CAGE PSR
|
Facility
|
IP
|
$8,225.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270691792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$1,990.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|
|
CAGE PSR
|
Facility
|
OP
|
$8,225.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270691792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.75 |
| Max. Negotiated Rate |
$4,112.50 |
| Rate for Payer: Aetna Commercial |
$2,467.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,467.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,097.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,645.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,097.38
|
| Rate for Payer: Cigna Commercial |
$4,112.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,990.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,233.75
|
|
|
CAGE PSX EXPAND 7X10X25MM 20D
|
Facility
|
OP
|
$35,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270699536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,287.50 |
| Max. Negotiated Rate |
$17,625.00 |
| Rate for Payer: Aetna Commercial |
$10,575.00
|
| Rate for Payer: Aetna Medicare Advantage |
$10,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,988.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,988.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,988.75
|
| Rate for Payer: Cigna Commercial |
$17,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,530.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,287.50
|
|
|
CAGE PSX EXPAND 7X10X25MM 20D
|
Facility
|
IP
|
$35,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270699536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,287.50 |
| Max. Negotiated Rate |
$8,530.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,530.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,287.50
|
|
|
CAGEPSXLORDOTEXP10X10X25MM20D
|
Facility
|
OP
|
$35,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,287.50 |
| Max. Negotiated Rate |
$17,625.00 |
| Rate for Payer: Aetna Commercial |
$10,575.00
|
| Rate for Payer: Aetna Medicare Advantage |
$10,575.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,988.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,988.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,988.75
|
| Rate for Payer: Cigna Commercial |
$17,625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,530.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,287.50
|
|
|
CAGEPSXLORDOTEXP10X10X25MM20D
|
Facility
|
IP
|
$35,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,287.50 |
| Max. Negotiated Rate |
$8,530.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,050.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,530.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,287.50
|
|
|
CAGE REG 8MM
|
Facility
|
IP
|
$16,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,471.25 |
| Max. Negotiated Rate |
$3,986.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,986.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,471.25
|
|
|
CAGE REG 8MM
|
Facility
|
OP
|
$16,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,471.25 |
| Max. Negotiated Rate |
$8,237.50 |
| Rate for Payer: Aetna Commercial |
$4,942.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4,942.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,201.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,201.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,201.12
|
| Rate for Payer: Cigna Commercial |
$8,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,986.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,471.25
|
|
|
CAGE RISE-L 22X60MM 10D
|
Facility
|
IP
|
$39,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,925.00 |
| Max. Negotiated Rate |
$9,559.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,925.00
|
|
|
CAGE RISE-L 22X60MM 10D
|
Facility
|
OP
|
$39,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,925.00 |
| Max. Negotiated Rate |
$19,750.00 |
| Rate for Payer: Aetna Commercial |
$11,850.00
|
| Rate for Payer: Aetna Medicare Advantage |
$11,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10,072.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10,072.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10,072.50
|
| Rate for Payer: Cigna Commercial |
$19,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9,559.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5,925.00
|
|
|
CAGE ROI-C 12X14X9 H9
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692184
|
|
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 ROI-C 12X14X9 H9
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692184
|
|
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 ROI-C LOR CERV 12x 14H5mm
|
Facility
|
IP
|
$11,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678599
|
|
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 ROI-C LOR CERV 12x 14H5mm
|
Facility
|
OP
|
$11,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678599
|
|
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 ROI-C LORDOTIC 12X14MM10D
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270699663
|
|
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 ROI-C LORDOTIC 12X14MM10D
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270699663
|
|
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 ROI-C LORDOTIC H8 12X14MM
|
Facility
|
IP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270691758
|
|
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 ROI-C LORDOTIC H8 12X14MM
|
Facility
|
OP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270691758
|
|
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 ROI-C PEEK TI 12X14 H8
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692001
|
|
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 ROI-C PEEK TI 12X14 H8
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270692001
|
|
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 ROI-C TI 14x15.5Hmm
|
Facility
|
IP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678600
|
|
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 ROI-C TI 14x15.5Hmm
|
Facility
|
OP
|
$11,666.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678600
|
|
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
|
|