|
DRILL BIT 2.35X33.5MM
|
Facility
|
OP
|
$1,535.00
|
|
| Hospital Charge Code |
270693164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.55 |
| Max. Negotiated Rate |
$767.50 |
| Rate for Payer: Aetna Commercial |
$460.50
|
| Rate for Payer: Aetna Medicare Advantage |
$460.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$391.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$391.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$391.43
|
| Rate for Payer: Cigna Commercial |
$767.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$199.55
|
| Rate for Payer: Oxford Commercial |
$767.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$230.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$767.50
|
|
|
DRILL BIT 2.3MM
|
Facility
|
IP
|
$737.00
|
|
| Hospital Charge Code |
270697901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.55 |
| Max. Negotiated Rate |
$110.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.55
|
|
|
DRILL BIT 2.3MM
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
270698463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
|
|
DRILL BIT 2.3MM
|
Facility
|
OP
|
$1,180.00
|
|
| Hospital Charge Code |
270698463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.40 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna Commercial |
$354.00
|
| Rate for Payer: Aetna Medicare Advantage |
$354.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$300.90
|
| Rate for Payer: Cigna Commercial |
$590.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$153.40
|
| Rate for Payer: Oxford Commercial |
$590.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$177.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$590.00
|
|
|
DRILL BIT 2.3MM
|
Facility
|
OP
|
$737.00
|
|
| Hospital Charge Code |
270697901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$221.10
|
| Rate for Payer: Aetna Medicare Advantage |
$221.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$187.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$187.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$187.94
|
| Rate for Payer: Cigna Commercial |
$368.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$95.81
|
| Rate for Payer: Oxford Commercial |
$368.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$110.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$368.50
|
|
|
DRILL BIT 2.4MM
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270699641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
|
|
DRILL BIT 2.4MM
|
Facility
|
IP
|
$2,625.00
|
|
| Hospital Charge Code |
270693333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.75 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.75
|
|
|
DRILL BIT 2.4MM
|
Facility
|
OP
|
$2,625.00
|
|
| Hospital Charge Code |
270693333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Aetna Medicare Advantage |
$787.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$669.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$669.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$669.38
|
| Rate for Payer: Cigna Commercial |
$1,312.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.25
|
| Rate for Payer: Oxford Commercial |
$1,312.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$393.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,312.50
|
|
|
DRILL BIT 2.4MM
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270699641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$637.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$325.00
|
| Rate for Payer: Oxford Commercial |
$1,250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$375.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,250.00
|
|
|
DRILL BIT 2.4 STP DRL AR1250LT
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
270629972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$120.00
|
| Rate for Payer: Aetna Medicare Advantage |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.00
|
| Rate for Payer: Oxford Commercial |
$200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$200.00
|
|
|
DRILL BIT 2.4 STP DRL AR1250LT
|
Facility
|
IP
|
$400.00
|
|
| Hospital Charge Code |
270629972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
DRILL BIT 2.4X140MM
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270700177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$97.50
|
| Rate for Payer: Oxford Commercial |
$375.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$375.00
|
|
|
DRILL BIT 2.4X140MM
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270700177
|
|
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 2.4X40MM
|
Facility
|
OP
|
$670.00
|
|
| Hospital Charge Code |
270684120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$201.00
|
| Rate for Payer: Aetna Medicare Advantage |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.85
|
| Rate for Payer: Cigna Commercial |
$335.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.10
|
| Rate for Payer: Oxford Commercial |
$335.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$335.00
|
|
|
DRILL BIT 2.4X40MM
|
Facility
|
IP
|
$670.00
|
|
| Hospital Charge Code |
270684120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
|
|
DRILL BIT 2.5
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
270686775
|
|
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 2.5
|
Facility
|
OP
|
$756.70
|
|
| Hospital Charge Code |
270688271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.37 |
| Max. Negotiated Rate |
$378.35 |
| Rate for Payer: Aetna Commercial |
$227.01
|
| Rate for Payer: Aetna Medicare Advantage |
$227.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$192.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$192.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$192.96
|
| Rate for Payer: Cigna Commercial |
$378.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.37
|
| Rate for Payer: Oxford Commercial |
$378.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$378.35
|
|
|
DRILL BIT 2.5
|
Facility
|
IP
|
$756.70
|
|
| Hospital Charge Code |
270688271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.50 |
| Max. Negotiated Rate |
$113.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$113.50
|
|
|
DRILL BIT 2.5
|
Facility
|
OP
|
$395.00
|
|
| Hospital Charge Code |
270677407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$118.50
|
| 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 |
$51.35
|
| Rate for Payer: Oxford Commercial |
$197.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$197.50
|
|
|
DRILL BIT 2.5
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
270686775
|
|
Hospital Revenue Code
|
272
|
| 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 2.5
|
Facility
|
IP
|
$395.00
|
|
| Hospital Charge Code |
270677407
|
|
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 2.5-3.0MMX80X170MM
|
Facility
|
OP
|
$874.50
|
|
| Hospital Charge Code |
270687284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.69 |
| Max. Negotiated Rate |
$437.25 |
| Rate for Payer: Aetna Commercial |
$262.35
|
| Rate for Payer: Aetna Medicare Advantage |
$262.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.00
|
| Rate for Payer: Cigna Commercial |
$437.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$113.69
|
| Rate for Payer: Oxford Commercial |
$437.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$437.25
|
|
|
DRILL BIT 2.5-3.0MMX80X170MM
|
Facility
|
IP
|
$874.50
|
|
| Hospital Charge Code |
270687284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.18 |
| Max. Negotiated Rate |
$131.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.18
|
|
|
DRILL BIT 2.5 3-FLTD 230/200MM
|
Facility
|
IP
|
$1,031.20
|
|
| Hospital Charge Code |
270677981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.68 |
| Max. Negotiated Rate |
$154.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$154.68
|
|
|
DRILL BIT 2.5 3-FLTD 230/200MM
|
Facility
|
OP
|
$1,031.20
|
|
| Hospital Charge Code |
270681292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.06 |
| Max. Negotiated Rate |
$515.60 |
| Rate for Payer: Aetna Commercial |
$309.36
|
| Rate for Payer: Aetna Medicare Advantage |
$309.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$262.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$262.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$262.96
|
| Rate for Payer: Cigna Commercial |
$515.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.06
|
| Rate for Payer: Oxford Commercial |
$515.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$154.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$515.60
|
|