|
DRILL BIT 2.5MM
|
Facility
|
IP
|
$408.00
|
|
| Hospital Charge Code |
270682615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.20
|
|
|
DRILL BIT 2.5MM
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270661597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
|
|
DRILL BIT 2.5MM
|
Facility
|
OP
|
$2,540.65
|
|
| Hospital Charge Code |
270704456
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$330.28 |
| Max. Negotiated Rate |
$1,270.33 |
| Rate for Payer: Aetna Commercial |
$762.20
|
| Rate for Payer: Aetna Medicare Advantage |
$762.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$647.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$647.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$647.87
|
| Rate for Payer: Cigna Commercial |
$1,270.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$330.28
|
| Rate for Payer: Oxford Commercial |
$1,270.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$381.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,270.33
|
|
|
DRILL BIT 2.5MM
|
Facility
|
OP
|
$670.00
|
|
| Hospital Charge Code |
270638285
|
|
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 2.5MM
|
Facility
|
IP
|
$181.95
|
|
| Hospital Charge Code |
270664049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$27.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.29
|
|
|
DRILL BIT 2.5MM
|
Facility
|
OP
|
$467.50
|
|
| Hospital Charge Code |
270648250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.77 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: Aetna Medicare Advantage |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$119.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$119.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$119.21
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.77
|
| Rate for Payer: Oxford Commercial |
$233.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$233.75
|
|
|
DRILL BIT 2.5MM
|
Facility
|
IP
|
$461.50
|
|
| Hospital Charge Code |
270664485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.22 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.22
|
|
|
DRILL BIT 2.5MM 135MM 45MM
|
Facility
|
OP
|
$580.45
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270691083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$290.23 |
| Rate for Payer: Aetna Commercial |
$174.13
|
| Rate for Payer: Aetna Medicare Advantage |
$174.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$148.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$148.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$148.01
|
| Rate for Payer: Cigna Commercial |
$290.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.46
|
| Rate for Payer: Oxford Commercial |
$290.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$290.23
|
|
|
DRILL BIT 2.5MM 135MM 45MM
|
Facility
|
IP
|
$580.45
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270691083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.07 |
| Max. Negotiated Rate |
$87.07 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.07
|
|
|
DRILL BIT 2.5MM FLUTED
|
Facility
|
IP
|
$516.75
|
|
| Hospital Charge Code |
270698393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.51 |
| Max. Negotiated Rate |
$77.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.51
|
|
|
DRILL BIT 2.5MM FLUTED
|
Facility
|
OP
|
$516.75
|
|
| Hospital Charge Code |
270698393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.18 |
| Max. Negotiated Rate |
$258.38 |
| Rate for Payer: Aetna Commercial |
$155.03
|
| Rate for Payer: Aetna Medicare Advantage |
$155.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$131.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$131.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$131.77
|
| Rate for Payer: Cigna Commercial |
$258.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.18
|
| Rate for Payer: Oxford Commercial |
$258.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$258.38
|
|
|
DRILL BIT 2.5MM/L110MM
|
Facility
|
IP
|
$1,370.00
|
|
| Hospital Charge Code |
270667535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.50 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.50
|
|
|
DRILL BIT 2.5MM/L110MM
|
Facility
|
OP
|
$1,370.00
|
|
| Hospital Charge Code |
270667535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Aetna Commercial |
$411.00
|
| Rate for Payer: Aetna Medicare Advantage |
$411.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$349.35
|
| Rate for Payer: Cigna Commercial |
$685.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$178.10
|
| Rate for Payer: Oxford Commercial |
$685.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$685.00
|
|
|
DRILL BIT 2.5MM QC 135MM 45CAL
|
Facility
|
IP
|
$639.20
|
|
| Hospital Charge Code |
270691203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.88 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.88
|
|
|
DRILL BIT 2.5MM QC 135MM 45CAL
|
Facility
|
OP
|
$639.20
|
|
| Hospital Charge Code |
270691203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.10 |
| Max. Negotiated Rate |
$319.60 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna Medicare Advantage |
$191.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$163.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$163.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$163.00
|
| Rate for Payer: Cigna Commercial |
$319.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$83.10
|
| Rate for Payer: Oxford Commercial |
$319.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$319.60
|
|
|
DRILL BIT 2.5X
|
Facility
|
OP
|
$1,900.00
|
|
| Hospital Charge Code |
270704202
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$570.00
|
| Rate for Payer: Aetna Medicare Advantage |
$570.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$484.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$484.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$484.50
|
| Rate for Payer: Cigna Commercial |
$950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$247.00
|
| Rate for Payer: Oxford Commercial |
$950.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$950.00
|
|
|
DRILL BIT 2.5X
|
Facility
|
IP
|
$1,900.00
|
|
| Hospital Charge Code |
270704202
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$285.00
|
|
|
DRILL BIT 2.5x60MM
|
Facility
|
IP
|
$615.00
|
|
| Hospital Charge Code |
270667124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$92.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.25
|
|
|
DRILL BIT 2.5x60MM
|
Facility
|
OP
|
$615.00
|
|
| Hospital Charge Code |
270667124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$307.50 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Medicare Advantage |
$184.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$156.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$156.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$156.82
|
| Rate for Payer: Cigna Commercial |
$307.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.95
|
| Rate for Payer: Oxford Commercial |
$307.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$307.50
|
|
|
DRILL BIT 2.6
|
Facility
|
IP
|
$650.65
|
|
| Hospital Charge Code |
270660361
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$97.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.60
|
|
|
DRILL BIT 2.6
|
Facility
|
OP
|
$650.65
|
|
| Hospital Charge Code |
270660361
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.58 |
| Max. Negotiated Rate |
$325.32 |
| Rate for Payer: Aetna Commercial |
$195.19
|
| Rate for Payer: Aetna Medicare Advantage |
$195.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$165.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$165.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$165.92
|
| Rate for Payer: Cigna Commercial |
$325.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.58
|
| Rate for Payer: Oxford Commercial |
$325.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.32
|
|
|
DRILL BIT 2.6 MM
|
Facility
|
OP
|
$1,300.00
|
|
| Hospital Charge Code |
270667385
|
|
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 2.6 MM
|
Facility
|
IP
|
$1,300.00
|
|
| Hospital Charge Code |
270667385
|
|
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 2.7
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
270686220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.15 |
| Max. Negotiated Rate |
$727.50 |
| Rate for Payer: Aetna Commercial |
$436.50
|
| Rate for Payer: Aetna Medicare Advantage |
$436.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$371.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$371.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$371.02
|
| Rate for Payer: Cigna Commercial |
$727.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$189.15
|
| Rate for Payer: Oxford Commercial |
$727.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$218.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$727.50
|
|
|
DRILL BIT 2.7
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
270686220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.25 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$218.25
|
|