|
DRILL BIT 2.0MM/MINI QC/52MM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270674782
|
|
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 2.0MM/MINI QC/52MM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270674782
|
|
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 2.0MM/MINI QC/67MM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
270674783
|
|
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 2.0MM/MINI QC/67MM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
270674783
|
|
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 2.0mm NCS-DR22
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270645464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
DRILL BIT 2.0mm NCS-DR22
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270645464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.25
|
| Rate for Payer: Oxford Commercial |
$212.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$212.50
|
|
|
DRILL BIT 2.0MM QC 140MM
|
Facility
|
IP
|
$789.60
|
|
| Hospital Charge Code |
270691895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.44
|
|
|
DRILL BIT 2.0MM QC 140MM
|
Facility
|
OP
|
$789.60
|
|
| Hospital Charge Code |
270691895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.65 |
| Max. Negotiated Rate |
$394.80 |
| Rate for Payer: Aetna Commercial |
$236.88
|
| Rate for Payer: Aetna Medicare Advantage |
$236.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.35
|
| Rate for Payer: Cigna Commercial |
$394.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.65
|
| Rate for Payer: Oxford Commercial |
$394.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$394.80
|
|
|
DRILL BIT 2.0MM QC 140MM 60MM
|
Facility
|
OP
|
$924.00
|
|
| Hospital Charge Code |
270687282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Aetna Medicare Advantage |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$235.62
|
| Rate for Payer: Cigna Commercial |
$462.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$120.12
|
| Rate for Payer: Oxford Commercial |
$462.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$462.00
|
|
|
DRILL BIT 2.0MM QC 140MM 60MM
|
Facility
|
IP
|
$924.00
|
|
| Hospital Charge Code |
270687282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.60
|
|
|
DRILLBIT 2.0 QC CANN 145MM
|
Facility
|
IP
|
$1,817.75
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.66 |
| Max. Negotiated Rate |
$272.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$272.66
|
|
|
DRILLBIT 2.0 QC CANN 145MM
|
Facility
|
OP
|
$1,817.75
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.31 |
| Max. Negotiated Rate |
$908.88 |
| Rate for Payer: Aetna Commercial |
$545.33
|
| Rate for Payer: Aetna Medicare Advantage |
$545.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$463.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$463.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$463.53
|
| Rate for Payer: Cigna Commercial |
$908.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$236.31
|
| Rate for Payer: Oxford Commercial |
$908.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$272.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$908.88
|
|
|
DRILL BIT 2.1 ASNIC MICRO
|
Facility
|
OP
|
$626.30
|
|
| Hospital Charge Code |
270704926
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$81.42 |
| Max. Negotiated Rate |
$313.15 |
| Rate for Payer: Aetna Commercial |
$187.89
|
| Rate for Payer: Aetna Medicare Advantage |
$187.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$159.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$159.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$159.71
|
| Rate for Payer: Cigna Commercial |
$313.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.42
|
| Rate for Payer: Oxford Commercial |
$313.15
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$313.15
|
|
|
DRILL BIT 2.1 ASNIC MICRO
|
Facility
|
IP
|
$626.30
|
|
| Hospital Charge Code |
270704926
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$93.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.94
|
|
|
DRILL BIT 2.2MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
270663855
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
|
|
DRILL BIT 2.2MM
|
Facility
|
IP
|
$635.00
|
|
| Hospital Charge Code |
270672338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.25 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.25
|
|
|
DRILL BIT 2.2MM
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
270663855
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| 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 |
$109.20
|
| Rate for Payer: Oxford Commercial |
$420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$420.00
|
|
|
DRILL BIT 2.2MM
|
Facility
|
OP
|
$635.00
|
|
| Hospital Charge Code |
270672338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.55 |
| Max. Negotiated Rate |
$317.50 |
| Rate for Payer: Aetna Commercial |
$190.50
|
| Rate for Payer: Aetna Medicare Advantage |
$190.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$161.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$161.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$161.93
|
| Rate for Payer: Cigna Commercial |
$317.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.55
|
| Rate for Payer: Oxford Commercial |
$317.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$317.50
|
|
|
DRILL BIT 2.2MM 8MM STP
|
Facility
|
OP
|
$1,300.00
|
|
| Hospital Charge Code |
270684919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$390.00
|
| Rate for Payer: Aetna Medicare Advantage |
$390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$331.50
|
| Rate for Payer: Cigna Commercial |
$650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.00
|
| Rate for Payer: Oxford Commercial |
$650.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$650.00
|
|
|
DRILL BIT 2.2MM 8MM STP
|
Facility
|
IP
|
$1,300.00
|
|
| Hospital Charge Code |
270684919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.00
|
|
|
DRILL BIT 2.2MM NS
|
Facility
|
IP
|
$390.00
|
|
| Hospital Charge Code |
270681161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
DRILL BIT 2.2MM NS
|
Facility
|
OP
|
$390.00
|
|
| Hospital Charge Code |
270681161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$99.45
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$195.00
|
|
|
DRILL BIT 2.2MMX60MM MICA CANN
|
Facility
|
OP
|
$2,240.50
|
|
| Hospital Charge Code |
270703024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.26 |
| Max. Negotiated Rate |
$1,120.25 |
| Rate for Payer: Aetna Commercial |
$672.15
|
| Rate for Payer: Aetna Medicare Advantage |
$672.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$571.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$571.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$571.33
|
| Rate for Payer: Cigna Commercial |
$1,120.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$291.26
|
| Rate for Payer: Oxford Commercial |
$1,120.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$336.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,120.25
|
|
|
DRILL BIT 2.2MMX60MM MICA CANN
|
Facility
|
IP
|
$2,240.50
|
|
| Hospital Charge Code |
270703024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$336.07 |
| Max. Negotiated Rate |
$336.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$336.07
|
|
|
DRILL BIT 2.35X33.5MM
|
Facility
|
IP
|
$1,535.00
|
|
| Hospital Charge Code |
270693164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.25 |
| Max. Negotiated Rate |
$230.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$230.25
|
|