|
DRILL BIT 2.8MM
|
Facility
|
OP
|
$531.55
|
|
| Hospital Charge Code |
270664458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.10 |
| Max. Negotiated Rate |
$265.77 |
| Rate for Payer: Aetna Commercial |
$159.47
|
| Rate for Payer: Aetna Medicare Advantage |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$135.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$135.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$135.55
|
| Rate for Payer: Cigna Commercial |
$265.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$69.10
|
| Rate for Payer: Oxford Commercial |
$265.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$265.77
|
|
|
DRILL BIT 2.8MM
|
Facility
|
OP
|
$1,315.00
|
|
| Hospital Charge Code |
270704459
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$170.95 |
| Max. Negotiated Rate |
$657.50 |
| Rate for Payer: Aetna Commercial |
$394.50
|
| Rate for Payer: Aetna Medicare Advantage |
$394.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$335.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$335.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$335.32
|
| Rate for Payer: Cigna Commercial |
$657.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.95
|
| Rate for Payer: Oxford Commercial |
$657.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$657.50
|
|
|
DRILL BIT 2.8MM
|
Facility
|
IP
|
$1,315.00
|
|
| Hospital Charge Code |
270704459
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$197.25 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.25
|
|
|
DRILL BIT 2.8MM 200MM ST 110MM
|
Facility
|
OP
|
$799.00
|
|
| Hospital Charge Code |
270688094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare Advantage |
$239.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$203.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$203.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$203.75
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$103.87
|
| Rate for Payer: Oxford Commercial |
$399.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$119.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$399.50
|
|
|
DRILL BIT 2.8MM 200MM ST 110MM
|
Facility
|
IP
|
$799.00
|
|
| Hospital Charge Code |
270688094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$119.85
|
|
|
DRILL BIT 2.8 MM CAN AO
|
Facility
|
OP
|
$852.50
|
|
| Hospital Charge Code |
270700704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.83 |
| Max. Negotiated Rate |
$426.25 |
| Rate for Payer: Aetna Commercial |
$255.75
|
| Rate for Payer: Aetna Medicare Advantage |
$255.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$217.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$217.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$217.39
|
| Rate for Payer: Cigna Commercial |
$426.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.83
|
| Rate for Payer: Oxford Commercial |
$426.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$426.25
|
|
|
DRILL BIT 2.8 MM CAN AO
|
Facility
|
IP
|
$852.50
|
|
| Hospital Charge Code |
270700704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.88 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$127.88
|
|
|
DRILL BIT 2.8MM QC 135MM 45CAL
|
Facility
|
IP
|
$627.45
|
|
| Hospital Charge Code |
270691896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.12 |
| Max. Negotiated Rate |
$94.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.12
|
|
|
DRILL BIT 2.8MM QC 135MM 45CAL
|
Facility
|
OP
|
$627.45
|
|
| Hospital Charge Code |
270691896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$313.73 |
| Rate for Payer: Aetna Commercial |
$188.24
|
| Rate for Payer: Aetna Medicare Advantage |
$188.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.00
|
| Rate for Payer: Cigna Commercial |
$313.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.57
|
| Rate for Payer: Oxford Commercial |
$313.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$313.73
|
|
|
DRILL BIT 2.8MM QC 200MM
|
Facility
|
OP
|
$726.15
|
|
| Hospital Charge Code |
270693045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$363.07 |
| Rate for Payer: Aetna Commercial |
$217.84
|
| Rate for Payer: Aetna Medicare Advantage |
$217.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$185.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$185.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$185.17
|
| Rate for Payer: Cigna Commercial |
$363.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.40
|
| Rate for Payer: Oxford Commercial |
$363.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$363.07
|
|
|
DRILL BIT 2.8MM QC 200MM
|
Facility
|
IP
|
$726.15
|
|
| Hospital Charge Code |
270693045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$108.92 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.92
|
|
|
DRILL BIT 2.8x60MM
|
Facility
|
IP
|
$615.00
|
|
| Hospital Charge Code |
270667123
|
|
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 2.8x60MM
|
Facility
|
OP
|
$615.00
|
|
| Hospital Charge Code |
270667123
|
|
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 2.9MM
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
270632517
|
|
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 2.9MM
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
270632517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$362.50 |
| Rate for Payer: Aetna Commercial |
$217.50
|
| Rate for Payer: Aetna Medicare Advantage |
$217.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$184.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$184.88
|
| Rate for Payer: Cigna Commercial |
$362.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$94.25
|
| Rate for Payer: Oxford Commercial |
$362.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$362.50
|
|
|
DRILL BIT 2MM
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270666079
|
|
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 2MM
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270666079
|
|
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 2MMX30MM
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270662862
|
|
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 2MMX30MM
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270662862
|
|
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 2x24MM
|
Facility
|
IP
|
$615.00
|
|
| Hospital Charge Code |
270662458
|
|
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 2x24MM
|
Facility
|
OP
|
$615.00
|
|
| Hospital Charge Code |
270662458
|
|
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 3.0/4.0MM CANNULA
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270666768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
DRILL BIT 3.0/4.0MM CANNULA
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270666768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$262.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$113.75
|
| Rate for Payer: Oxford Commercial |
$437.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$437.50
|
|
|
DRILL BIT 3.0MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270688368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$262.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$113.75
|
| Rate for Payer: Oxford Commercial |
$437.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$437.50
|
|
|
DRILL BIT 3.0MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270688368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|