|
DRILL BIT CARBHU4MM SINGLE USE
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270695328
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
DRILL BIT CARBHU4MM SINGLE USE
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270695328
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$375.00
|
| Rate for Payer: Oxford Commercial |
$250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.12
|
|
|
DRILL BIT CARBHU5MM SINGLE USE
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270695329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$375.00
|
| Rate for Payer: Oxford Commercial |
$250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.12
|
|
|
DRILL BIT CARBHU5MM SINGLE USE
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270695329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
DRILL BIT CARBHU6MM SINGLE USE
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270695330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
DRILL BIT CARBHU6MM SINGLE USE
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270695330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$375.00
|
| Rate for Payer: Oxford Commercial |
$250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.12
|
|
|
DRILL BIT CARTIVA MTP COUNTER
|
Facility
|
IP
|
$1,062.45
|
|
| Hospital Charge Code |
270679216
|
|
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 CARTIVA MTP COUNTER
|
Facility
|
OP
|
$1,062.45
|
|
| Hospital Charge Code |
270679216
|
|
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 CENTRAL 3.2MM
|
Facility
|
IP
|
$660.00
|
|
| Hospital Charge Code |
270669246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
DRILL BIT CENTRAL 3.2MM
|
Facility
|
OP
|
$660.00
|
|
| Hospital Charge Code |
270669246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$250.80
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$198.00
|
| Rate for Payer: Oxford Commercial |
$132.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$132.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.49
|
|
|
DRILL BIT CERES 12MM
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270692544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
DRILL BIT CERES 12MM
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270692544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Oxford Commercial |
$150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
DRILL BIT CERES 14MM
|
Facility
|
IP
|
$1,375.00
|
|
| Hospital Charge Code |
270692488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.25 |
| Max. Negotiated Rate |
$206.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
|
|
DRILL BIT CERES 14MM
|
Facility
|
OP
|
$1,375.00
|
|
| Hospital Charge Code |
270692488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Aetna Commercial |
$522.50
|
| Rate for Payer: Aetna Medicare Advantage |
$412.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$350.62
|
| Rate for Payer: Cigna Commercial |
$687.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$412.50
|
| Rate for Payer: Oxford Commercial |
$275.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$275.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.44
|
|
|
DRILL BIT CERVICAL 14MM
|
Facility
|
OP
|
$2,750.00
|
|
| Hospital Charge Code |
270697546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.28 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$1,045.00
|
| Rate for Payer: Aetna Medicare Advantage |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$701.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$701.25
|
| Rate for Payer: Cigna Commercial |
$1,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$825.00
|
| Rate for Payer: Oxford Commercial |
$550.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$66.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$72.88
|
|
|
DRILL BIT CERVICAL 14MM
|
Facility
|
IP
|
$2,750.00
|
|
| Hospital Charge Code |
270697546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$412.50
|
|
|
DRILL BIT CINCHLOCK FLEX
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270677419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$375.00
|
| Rate for Payer: Oxford Commercial |
$250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.12
|
|
|
DRILL BIT CINCHLOCK FLEX
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270677419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
DRILL BIT CINCHLOCK SS
|
Facility
|
IP
|
$945.00
|
|
| Hospital Charge Code |
270670493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.75
|
|
|
DRILL BIT CINCHLOCK SS
|
Facility
|
OP
|
$945.00
|
|
| Hospital Charge Code |
270670493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.77 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Aetna Medicare Advantage |
$283.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$240.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$240.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$240.97
|
| Rate for Payer: Cigna Commercial |
$472.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$283.50
|
| Rate for Payer: Oxford Commercial |
$189.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$141.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$189.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.04
|
|
|
DRILL BIT CMPR FT 7.0MM
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
270693860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
DRILL BIT CMPR FT 7.0MM
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
270693860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$380.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Oxford Commercial |
$200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$200.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
DRILL BIT COMP FT 2.2MM
|
Facility
|
OP
|
$1,056.25
|
|
| Hospital Charge Code |
270699861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$528.12 |
| Rate for Payer: Aetna Commercial |
$401.38
|
| Rate for Payer: Aetna Medicare Advantage |
$316.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$269.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$269.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$269.34
|
| Rate for Payer: Cigna Commercial |
$528.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$316.88
|
| Rate for Payer: Oxford Commercial |
$211.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$158.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.99
|
|
|
DRILL BIT COMP FT 2.2MM
|
Facility
|
IP
|
$1,056.25
|
|
| Hospital Charge Code |
270699861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.44 |
| Max. Negotiated Rate |
$158.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$158.44
|
|
|
DRILL BIT DARCO 2.8MM
|
Facility
|
IP
|
$695.00
|
|
| Hospital Charge Code |
270686744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.25
|
|