|
DRILL BIT CANNULATED 1.7
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270656508
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$112.50
|
| Rate for Payer: Oxford Commercial |
$75.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.94
|
|
|
DRILL BIT CANNULATED 1.7
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270656508
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
DRILL BIT CANNULATED 1.7 MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270683591
|
|
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 CANNULATED 1.7 MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270683591
|
|
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 CANNULATED 1.7MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
270667126
|
|
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 CANNULATED 1.7MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270670930
|
|
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 CANNULATED 1.7MM
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
270667126
|
|
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 CANNULATED 1.7MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270670930
|
|
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, CANNULATED 1.7MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270671792
|
|
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, CANNULATED 1.7MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270671792
|
|
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 CANNULATED 2.0 MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270683589
|
|
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 CANNULATED 2.0 MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270683589
|
|
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 CANNULATED 2.0X130MM
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698260
|
|
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 CANNULATED 2.0X130MM
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698260
|
|
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 CANNULATED 2.1MM
|
Facility
|
OP
|
$1,893.75
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$946.88 |
| Rate for Payer: Aetna Commercial |
$719.62
|
| Rate for Payer: Aetna Medicare Advantage |
$568.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$482.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$482.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$482.91
|
| Rate for Payer: Cigna Commercial |
$946.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$568.12
|
| Rate for Payer: Oxford Commercial |
$378.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$378.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$50.18
|
|
|
DRILL BIT CANNULATED 2.1MM
|
Facility
|
IP
|
$1,893.75
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.06 |
| Max. Negotiated Rate |
$284.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.06
|
|
|
DRILL BIT CANNULATED 2.2MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
270667125
|
|
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 CANNULATED 2.2MM
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
270667125
|
|
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 CANNULATED 2.4MM
|
Facility
|
IP
|
$2,375.00
|
|
| Hospital Charge Code |
270669224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$356.25 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
|
|
DRILL BIT CANNULATED 2.4MM
|
Facility
|
OP
|
$1,965.00
|
|
| Hospital Charge Code |
270674572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.36 |
| Max. Negotiated Rate |
$982.50 |
| Rate for Payer: Aetna Commercial |
$746.70
|
| Rate for Payer: Aetna Medicare Advantage |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$501.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$501.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$501.07
|
| Rate for Payer: Cigna Commercial |
$982.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$589.50
|
| Rate for Payer: Oxford Commercial |
$393.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$294.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$393.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.07
|
|
|
DRILL BIT CANNULATED 2.4MM
|
Facility
|
OP
|
$2,375.00
|
|
| Hospital Charge Code |
270669224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$1,187.50 |
| Rate for Payer: Aetna Commercial |
$902.50
|
| Rate for Payer: Aetna Medicare Advantage |
$712.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$605.62
|
| Rate for Payer: Cigna Commercial |
$1,187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$712.50
|
| Rate for Payer: Oxford Commercial |
$475.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$475.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$57.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$62.94
|
|
|
DRILL BIT CANNULATED 2.4MM
|
Facility
|
IP
|
$1,965.00
|
|
| Hospital Charge Code |
270674572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.75 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$294.75
|
|
|
DRILL BIT CANNULATED 2.5MM
|
Facility
|
IP
|
$1,100.00
|
|
| Hospital Charge Code |
270698540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
|
|
DRILL BIT CANNULATED 2.5MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
270675124
|
|
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 CANNULATED 2.5MM
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
270675124
|
|
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
|
|