|
DRILL BIT 4.8MM X 300MM
|
Facility
|
OP
|
$1,800.00
|
|
| Hospital Charge Code |
270680280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Medicare Advantage |
$540.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$459.00
|
| Rate for Payer: Cigna Commercial |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$540.00
|
| Rate for Payer: Oxford Commercial |
$360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$360.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$47.70
|
|
|
DRILL BIT 4.8x240MM
|
Facility
|
IP
|
$747.50
|
|
| Hospital Charge Code |
270656629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.12 |
| Max. Negotiated Rate |
$112.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.12
|
|
|
DRILL BIT 4.8x240MM
|
Facility
|
OP
|
$747.50
|
|
| Hospital Charge Code |
270656629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$373.75 |
| Rate for Payer: Aetna Commercial |
$284.05
|
| Rate for Payer: Aetna Medicare Advantage |
$224.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$190.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$190.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$190.61
|
| Rate for Payer: Cigna Commercial |
$373.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$224.25
|
| Rate for Payer: Oxford Commercial |
$149.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$149.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.81
|
|
|
DRILL BIT 4MM 3 FLUTD 65X260MM
|
Facility
|
OP
|
$859.00
|
|
| Hospital Charge Code |
270633853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$429.50 |
| Rate for Payer: Aetna Commercial |
$326.42
|
| Rate for Payer: Aetna Medicare Advantage |
$257.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.04
|
| Rate for Payer: Cigna Commercial |
$429.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$257.70
|
| Rate for Payer: Oxford Commercial |
$171.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$171.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.76
|
|
|
DRILL BIT 4MM 3 FLUTD 65X260MM
|
Facility
|
IP
|
$859.00
|
|
| Hospital Charge Code |
270633853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.85 |
| Max. Negotiated Rate |
$128.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.85
|
|
|
DRILL BIT 5.0
|
Facility
|
IP
|
$10,900.00
|
|
| Hospital Charge Code |
270704742
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,635.00 |
| Max. Negotiated Rate |
$1,635.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,635.00
|
|
|
DRILL BIT 5.0
|
Facility
|
OP
|
$10,900.00
|
|
| Hospital Charge Code |
270704742
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$262.69 |
| Max. Negotiated Rate |
$5,450.00 |
| Rate for Payer: Aetna Commercial |
$4,142.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,779.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,779.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,779.50
|
| Rate for Payer: Cigna Commercial |
$5,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,270.00
|
| Rate for Payer: Oxford Commercial |
$2,180.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,635.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,180.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$262.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$288.85
|
|
|
DRILL BIT 5.0MM
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
270665922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$319.20
|
| Rate for Payer: Aetna Medicare Advantage |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$214.20
|
| Rate for Payer: Cigna Commercial |
$420.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$252.00
|
| Rate for Payer: Oxford Commercial |
$168.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.26
|
|
|
DRILL BIT 5.0MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
270665922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
|
|
DRILL BIT 5.0 MM CANNULATED
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270691359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
DRILL BIT 5.0 MM CANNULATED
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270691359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$262.50
|
| Rate for Payer: Oxford Commercial |
$175.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.19
|
|
|
DRILL BIT 5X230MM
|
Facility
|
IP
|
$3,455.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270669249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$518.25 |
| Max. Negotiated Rate |
$518.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$518.25
|
|
|
DRILL BIT 5X230MM
|
Facility
|
OP
|
$3,455.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270669249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$1,727.50 |
| Rate for Payer: Aetna Commercial |
$1,312.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,036.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$881.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$881.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$881.02
|
| Rate for Payer: Cigna Commercial |
$1,727.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,036.50
|
| Rate for Payer: Oxford Commercial |
$691.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$518.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$691.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$83.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$91.56
|
|
|
DRILL BIT 6.0
|
Facility
|
OP
|
$2,307.00
|
|
| Hospital Charge Code |
270660403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$1,153.50 |
| Rate for Payer: Aetna Commercial |
$876.66
|
| Rate for Payer: Aetna Medicare Advantage |
$692.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$588.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$588.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$588.28
|
| Rate for Payer: Cigna Commercial |
$1,153.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$692.10
|
| Rate for Payer: Oxford Commercial |
$461.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$346.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$461.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$61.14
|
|
|
DRILL BIT 6.0
|
Facility
|
IP
|
$2,307.00
|
|
| Hospital Charge Code |
270660403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.05 |
| Max. Negotiated Rate |
$346.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$346.05
|
|
|
DRILL BIT 6.1 mm
|
Facility
|
OP
|
$2,550.00
|
|
| Hospital Charge Code |
270681079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna Commercial |
$969.00
|
| Rate for Payer: Aetna Medicare Advantage |
$765.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$650.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$650.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$650.25
|
| Rate for Payer: Cigna Commercial |
$1,275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$765.00
|
| Rate for Payer: Oxford Commercial |
$510.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$382.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$510.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$61.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$67.58
|
|
|
DRILL BIT 6.1 mm
|
Facility
|
IP
|
$2,550.00
|
|
| Hospital Charge Code |
270681079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$382.50
|
|
|
DRILL BIT 6.5 MM CONICAL
|
Facility
|
OP
|
$1,710.80
|
|
| Hospital Charge Code |
270688999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.23 |
| Max. Negotiated Rate |
$855.40 |
| Rate for Payer: Aetna Commercial |
$650.10
|
| Rate for Payer: Aetna Medicare Advantage |
$513.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$436.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$436.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$436.25
|
| Rate for Payer: Cigna Commercial |
$855.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$513.24
|
| Rate for Payer: Oxford Commercial |
$342.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$342.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$41.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$45.34
|
|
|
DRILL BIT 6.5 MM CONICAL
|
Facility
|
IP
|
$1,710.80
|
|
| Hospital Charge Code |
270688999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.62 |
| Max. Negotiated Rate |
$256.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$256.62
|
|
|
DRILL BIT 6MM CANNUL 25MM
|
Facility
|
OP
|
$997.50
|
|
| Hospital Charge Code |
270696098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$379.05
|
| Rate for Payer: Aetna Medicare Advantage |
$299.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$254.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$254.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$254.36
|
| Rate for Payer: Cigna Commercial |
$498.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$299.25
|
| Rate for Payer: Oxford Commercial |
$199.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$199.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.43
|
|
|
DRILL BIT 6MM CANNUL 25MM
|
Facility
|
IP
|
$997.50
|
|
| Hospital Charge Code |
270696098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.62 |
| Max. Negotiated Rate |
$149.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.62
|
|
|
DRILL BIT 8mm
|
Facility
|
IP
|
$1,062.45
|
|
| Hospital Charge Code |
270679220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.37 |
| Max. Negotiated Rate |
$159.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.37
|
|
|
DRILL BIT 8mm
|
Facility
|
OP
|
$1,062.45
|
|
| Hospital Charge Code |
270679220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$531.23 |
| Rate for Payer: Aetna Commercial |
$403.73
|
| Rate for Payer: Aetna Medicare Advantage |
$318.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$270.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$270.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$270.92
|
| Rate for Payer: Cigna Commercial |
$531.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$318.74
|
| Rate for Payer: Oxford Commercial |
$212.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$212.49
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.15
|
|
|
DRILL BIT-ABBOTT SPINE
|
Facility
|
IP
|
$395.00
|
|
| Hospital Charge Code |
270339027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.25
|
|
|
DRILL BIT-ABBOTT SPINE
|
Facility
|
OP
|
$395.00
|
|
| Hospital Charge Code |
270339027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$150.10
|
| Rate for Payer: Aetna Medicare Advantage |
$118.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$100.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$100.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$100.72
|
| Rate for Payer: Cigna Commercial |
$197.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.50
|
| Rate for Payer: Oxford Commercial |
$79.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$79.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.47
|
|