|
DRILL BIT 1.1MM
|
Facility
|
IP
|
$107.80
|
|
| Hospital Charge Code |
270664050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.17
|
|
|
DRILL BIT 1.1MM/MINI QC/28MM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270674777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
DRILL BIT 1.1MM/MINI QC/28MM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270674777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.50
|
| Rate for Payer: Oxford Commercial |
$175.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
|
|
DRILL BIT 1.1MM/MINI QC/45MM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270674778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.50
|
| Rate for Payer: Oxford Commercial |
$175.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
|
|
DRILL BIT 1.1MM/MINI QC/45MM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270674778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
DRILL BIT 12.0MM 03.010.036
|
Facility
|
OP
|
$2,508.75
|
|
| Hospital Charge Code |
270647426
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$326.14 |
| Max. Negotiated Rate |
$1,254.38 |
| Rate for Payer: Aetna Commercial |
$752.62
|
| Rate for Payer: Aetna Medicare Advantage |
$752.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$639.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$639.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$639.73
|
| Rate for Payer: Cigna Commercial |
$1,254.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$326.14
|
| Rate for Payer: Oxford Commercial |
$1,254.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$376.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,254.38
|
|
|
DRILL BIT 12.0MM 03.010.036
|
Facility
|
IP
|
$2,508.75
|
|
| Hospital Charge Code |
270647426
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$376.31 |
| Max. Negotiated Rate |
$376.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$376.31
|
|
|
DRILL BIT 12 MM
|
Facility
|
OP
|
$1,250.00
|
|
| Hospital Charge Code |
270691931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| 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 |
$162.50
|
| Rate for Payer: Oxford Commercial |
$625.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$625.00
|
|
|
DRILL BIT 12 MM
|
Facility
|
IP
|
$1,250.00
|
|
| Hospital Charge Code |
270691931
|
|
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 12MM
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
270667753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
DRILL BIT 12MM
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270687814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.75 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$352.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.75
|
| Rate for Payer: Oxford Commercial |
$587.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$587.50
|
|
|
DRILL BIT 12MM
|
Facility
|
OP
|
$1,737.50
|
|
| Hospital Charge Code |
270693818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.88 |
| Max. Negotiated Rate |
$868.75 |
| Rate for Payer: Aetna Commercial |
$521.25
|
| Rate for Payer: Aetna Medicare Advantage |
$521.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$443.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$443.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$443.06
|
| Rate for Payer: Cigna Commercial |
$868.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.88
|
| Rate for Payer: Oxford Commercial |
$868.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$260.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$868.75
|
|
|
DRILL BIT 12MM
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270687814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
DRILL BIT 12MM
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
270667753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Oxford Commercial |
$750.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$750.00
|
|
|
DRILL BIT 12MM
|
Facility
|
IP
|
$1,737.50
|
|
| Hospital Charge Code |
270693818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.62 |
| Max. Negotiated Rate |
$260.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$260.62
|
|
|
DRILL BIT 1.30
|
Facility
|
OP
|
$2,798.10
|
|
| Hospital Charge Code |
270693268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.75 |
| Max. Negotiated Rate |
$1,399.05 |
| Rate for Payer: Aetna Commercial |
$839.43
|
| Rate for Payer: Aetna Medicare Advantage |
$839.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$713.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$713.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$713.52
|
| Rate for Payer: Cigna Commercial |
$1,399.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.75
|
| Rate for Payer: Oxford Commercial |
$1,399.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$419.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,399.05
|
|
|
DRILL BIT 1.30
|
Facility
|
IP
|
$2,798.10
|
|
| Hospital Charge Code |
270693268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.71 |
| Max. Negotiated Rate |
$419.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$419.71
|
|
|
DRILL BIT 1.3B MM
|
Facility
|
IP
|
$366.00
|
|
| Hospital Charge Code |
270681690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.90
|
|
|
DRILL BIT 1.3B MM
|
Facility
|
OP
|
$366.00
|
|
| Hospital Charge Code |
270681690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna Commercial |
$109.80
|
| Rate for Payer: Aetna Medicare Advantage |
$109.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.33
|
| Rate for Payer: Cigna Commercial |
$183.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.58
|
| Rate for Payer: Oxford Commercial |
$183.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$183.00
|
|
|
DRILL BIT 14MM
|
Facility
|
OP
|
$1,375.00
|
|
| Hospital Charge Code |
270692537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Aetna Commercial |
$412.50
|
| 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 |
$178.75
|
| Rate for Payer: Oxford Commercial |
$687.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$687.50
|
|
|
DRILL BIT 14MM
|
Facility
|
IP
|
$1,375.00
|
|
| Hospital Charge Code |
270692537
|
|
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 1.5 MM
|
Facility
|
IP
|
$366.00
|
|
| Hospital Charge Code |
270686488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.90
|
|
|
DRILL BIT 1.5 MM
|
Facility
|
OP
|
$366.00
|
|
| Hospital Charge Code |
270686488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna Commercial |
$109.80
|
| Rate for Payer: Aetna Medicare Advantage |
$109.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$93.33
|
| Rate for Payer: Cigna Commercial |
$183.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.58
|
| Rate for Payer: Oxford Commercial |
$183.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$183.00
|
|
|
DRILL BIT 1.5MM/MINI QC/28MM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270674779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
|
|
DRILL BIT 1.5MM/MINI QC/28MM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270674779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.25
|
| Rate for Payer: Cigna Commercial |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.50
|
| Rate for Payer: Oxford Commercial |
$175.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
|