|
DRILL BIT 3.0MM CANN QC 215MM
|
Facility
|
IP
|
$2,103.40
|
|
| Hospital Charge Code |
270693425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.51 |
| Max. Negotiated Rate |
$315.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$315.51
|
|
|
DRILL BIT 3.0MM CANN QC 215MM
|
Facility
|
OP
|
$2,103.40
|
|
| Hospital Charge Code |
270693425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.44 |
| Max. Negotiated Rate |
$1,051.70 |
| Rate for Payer: Aetna Commercial |
$631.02
|
| Rate for Payer: Aetna Medicare Advantage |
$631.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$536.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$536.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$536.37
|
| Rate for Payer: Cigna Commercial |
$1,051.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$273.44
|
| Rate for Payer: Oxford Commercial |
$1,051.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$315.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,051.70
|
|
|
DRILL BIT 3.0 MM CANNULATED
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270682619
|
|
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 MM CANNULATED
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270682619
|
|
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 3.1MM
|
Facility
|
OP
|
$351.00
|
|
| Hospital Charge Code |
270676247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.63 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$105.30
|
| Rate for Payer: Aetna Medicare Advantage |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$89.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$89.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$89.50
|
| Rate for Payer: Cigna Commercial |
$175.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.63
|
| Rate for Payer: Oxford Commercial |
$175.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.50
|
|
|
DRILL BIT 3.1MM
|
Facility
|
IP
|
$351.00
|
|
| Hospital Charge Code |
270676247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$52.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.65
|
|
|
DRILL BIT 3.1MM
|
Facility
|
OP
|
$961.40
|
|
| Hospital Charge Code |
270673955
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.98 |
| Max. Negotiated Rate |
$480.70 |
| Rate for Payer: Aetna Commercial |
$288.42
|
| Rate for Payer: Aetna Medicare Advantage |
$288.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$245.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$245.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$245.16
|
| Rate for Payer: Cigna Commercial |
$480.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$124.98
|
| Rate for Payer: Oxford Commercial |
$480.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$480.70
|
|
|
DRILL BIT 3.1MM
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270671575
|
|
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 3.1MM
|
Facility
|
IP
|
$961.40
|
|
| Hospital Charge Code |
270673955
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$144.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.21
|
|
|
DRILL BIT 3.1MM
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270671575
|
|
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 3.2
|
Facility
|
OP
|
$1,659.00
|
|
| Hospital Charge Code |
270663861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.67 |
| Max. Negotiated Rate |
$829.50 |
| Rate for Payer: Aetna Commercial |
$497.70
|
| Rate for Payer: Aetna Medicare Advantage |
$497.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.05
|
| Rate for Payer: Cigna Commercial |
$829.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$215.67
|
| Rate for Payer: Oxford Commercial |
$829.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$829.50
|
|
|
DRILL BIT 3.2
|
Facility
|
IP
|
$1,659.00
|
|
| Hospital Charge Code |
270663861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.85 |
| Max. Negotiated Rate |
$248.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.85
|
|
|
DRILL BIT 3.2 3FLTD 230/200MM
|
Facility
|
IP
|
$1,225.35
|
|
| Hospital Charge Code |
270684302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.80 |
| Max. Negotiated Rate |
$183.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.80
|
|
|
DRILL BIT 3.2 3FLTD 230/200MM
|
Facility
|
OP
|
$1,225.35
|
|
| Hospital Charge Code |
270684302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$612.67 |
| Rate for Payer: Aetna Commercial |
$367.61
|
| Rate for Payer: Aetna Medicare Advantage |
$367.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$312.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$312.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$312.46
|
| Rate for Payer: Cigna Commercial |
$612.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.30
|
| Rate for Payer: Oxford Commercial |
$612.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$183.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$612.67
|
|
|
DRILL BIT 3.2mm
|
Facility
|
IP
|
$1,450.00
|
|
| Hospital Charge Code |
270663306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$217.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.50
|
|
|
DRILL BIT 3.2mm
|
Facility
|
OP
|
$1,450.00
|
|
| Hospital Charge Code |
270663306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna Commercial |
$435.00
|
| Rate for Payer: Aetna Medicare Advantage |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$369.75
|
| Rate for Payer: Cigna Commercial |
$725.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$188.50
|
| Rate for Payer: Oxford Commercial |
$725.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$725.00
|
|
|
DRILL BIT 3.2MM
|
Facility
|
OP
|
$1,370.00
|
|
| Hospital Charge Code |
270668341
|
|
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 3.2MM
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
270668586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.45 |
| Max. Negotiated Rate |
$482.50 |
| Rate for Payer: Aetna Commercial |
$289.50
|
| Rate for Payer: Aetna Medicare Advantage |
$289.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$246.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$246.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$246.07
|
| Rate for Payer: Cigna Commercial |
$482.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.45
|
| Rate for Payer: Oxford Commercial |
$482.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$482.50
|
|
|
DRILL BIT 3.2MM
|
Facility
|
OP
|
$1,370.00
|
|
| Hospital Charge Code |
270671568
|
|
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 3.2MM
|
Facility
|
IP
|
$1,370.00
|
|
| Hospital Charge Code |
270671568
|
|
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 3.2MM
|
Facility
|
IP
|
$1,370.00
|
|
| Hospital Charge Code |
270668341
|
|
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 3.2MM
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
270668586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$144.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.75
|
|
|
DRILL BIT 3.2 MM CANN
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270690985
|
|
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 3.2 MM CANN
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270690985
|
|
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 3.2 MM CANN LONG
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270691765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|