|
CAGE BENGAL STD 6MM 7DEG
|
Facility
|
OP
|
$6,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$3,250.00 |
| Rate for Payer: Aetna Commercial |
$2,470.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,657.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,657.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,657.50
|
| Rate for Payer: Cigna Commercial |
$3,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,573.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$975.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$205.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$184.60
|
|
|
CAGE BENGAL STD 6MM 7DEG
|
Facility
|
IP
|
$6,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$1,573.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,573.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$975.00
|
|
|
CAGE BLACKHAWK TI 16X16X6 6 H
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.50 |
| Max. Negotiated Rate |
$11,875.00 |
| Rate for Payer: Aetna Commercial |
$9,025.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$750.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$674.50
|
|
|
CAGE BLACKHAWK TI 16X16X6 6 H
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270695158
|
|
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
|
|
|
CAGE BNGEL 30MM
|
Facility
|
OP
|
$22,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.00 |
| Max. Negotiated Rate |
$11,250.00 |
| Rate for Payer: Aetna Commercial |
$8,550.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,737.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,737.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,737.50
|
| Rate for Payer: Cigna Commercial |
$11,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,445.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,375.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$711.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$639.00
|
|
|
CAGE BNGEL 30MM
|
Facility
|
IP
|
$22,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$5,445.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,445.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,375.00
|
|
|
CAGE BNGEL 32MM
|
Facility
|
IP
|
$22,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$5,445.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,445.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,375.00
|
|
|
CAGE BNGEL 32MM
|
Facility
|
OP
|
$22,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.00 |
| Max. Negotiated Rate |
$11,250.00 |
| Rate for Payer: Aetna Commercial |
$8,550.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,737.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,737.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,737.50
|
| Rate for Payer: Cigna Commercial |
$11,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,445.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,375.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$711.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$639.00
|
|
|
CAGE CERES-C 15X12X8MM 10D
|
Facility
|
IP
|
$6,200.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696388
|
|
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
|
|
|
CAGE CERES-C 15X12X8MM 10D
|
Facility
|
OP
|
$6,200.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.08 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna Commercial |
$2,356.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$195.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$176.08
|
|
|
CAGE CERV 14.5X12MM 7D
|
Facility
|
IP
|
$42,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698160
|
|
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 CERV 14.5X12MM 7D
|
Facility
|
OP
|
$42,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270698160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Aetna Commercial |
$16,150.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,343.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,207.00
|
|
|
CAGE CERV DISC PRESTIGE 7X18MM
|
Facility
|
IP
|
$44,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$10,769.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,769.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,675.00
|
|
|
CAGE CERV DISC PRESTIGE 7X18MM
|
Facility
|
OP
|
$44,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270694698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.80 |
| Max. Negotiated Rate |
$22,250.00 |
| Rate for Payer: Aetna Commercial |
$16,910.00
|
| Rate for Payer: Aetna Medicare Advantage |
$13,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,347.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,347.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11,347.50
|
| Rate for Payer: Cigna Commercial |
$22,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,769.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,675.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,406.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,263.80
|
|
|
CAGE CERV F3D 14.5X12X9MM 7D
|
Facility
|
OP
|
$34,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.70 |
| Max. Negotiated Rate |
$17,125.00 |
| Rate for Payer: Aetna Commercial |
$13,015.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,082.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$972.70
|
|
|
CAGE CERV F3D 14.5X12X9MM 7D
|
Facility
|
IP
|
$34,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270696269
|
|
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 H06 MM W14.5MM D12MM
|
Facility
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270701865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$4,750.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$395.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$355.00
|
|
|
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
|
OP
|
$12,500.00
|
|
| Hospital Charge Code |
270701862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Aetna Commercial |
$4,750.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$395.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$355.00
|
|
|
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
|
|
|
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 |
$1,207.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Aetna Commercial |
$16,150.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,343.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,207.00
|
|
|
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
|
|
|
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 |
$255.60 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$3,420.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$284.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$255.60
|
|
|
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
|
|