|
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
|
|
|
DRILL BIT 3.2mm X 200mm 03030
|
Facility
|
IP
|
$694.45
|
|
| Hospital Charge Code |
270634729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.17 |
| Max. Negotiated Rate |
$104.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.17
|
|
|
DRILL BIT 3.2mm X 200mm 03030
|
Facility
|
OP
|
$694.45
|
|
| Hospital Charge Code |
270634729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.28 |
| Max. Negotiated Rate |
$347.23 |
| Rate for Payer: Aetna Commercial |
$208.34
|
| Rate for Payer: Aetna Medicare Advantage |
$208.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$177.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$177.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$177.08
|
| Rate for Payer: Cigna Commercial |
$347.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.28
|
| Rate for Payer: Oxford Commercial |
$347.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$104.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$347.23
|
|
|
DRILL BIT 3.2x170mm STERILE
|
Facility
|
OP
|
$2,122.90
|
|
| Hospital Charge Code |
270678422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.98 |
| Max. Negotiated Rate |
$1,061.45 |
| Rate for Payer: Aetna Commercial |
$636.87
|
| Rate for Payer: Aetna Medicare Advantage |
$636.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$541.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$541.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$541.34
|
| Rate for Payer: Cigna Commercial |
$1,061.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.98
|
| Rate for Payer: Oxford Commercial |
$1,061.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,061.45
|
|
|
DRILL BIT 3.2x170mm STERILE
|
Facility
|
IP
|
$2,122.90
|
|
| Hospital Charge Code |
270678422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.44 |
| Max. Negotiated Rate |
$318.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$318.44
|
|
|
DRILL BIT 3.2X200MM 4MM PINS
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
270669475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
DRILL BIT 3.2X200MM 4MM PINS
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
270669475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$240.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.00
|
| Rate for Payer: Oxford Commercial |
$400.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$400.00
|
|
|
DRILL BIT 3.2x240MM
|
Facility
|
OP
|
$715.00
|
|
| Hospital Charge Code |
270656622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$357.50 |
| Rate for Payer: Aetna Commercial |
$214.50
|
| Rate for Payer: Aetna Medicare Advantage |
$214.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$182.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$182.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$182.32
|
| Rate for Payer: Cigna Commercial |
$357.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$92.95
|
| Rate for Payer: Oxford Commercial |
$357.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$357.50
|
|
|
DRILL BIT 3.2x240MM
|
Facility
|
IP
|
$715.00
|
|
| Hospital Charge Code |
270656622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$107.25
|
|
|
DRILL BIT 3.5
|
Facility
|
OP
|
$378.33
|
|
| Hospital Charge Code |
270657772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.18 |
| Max. Negotiated Rate |
$189.16 |
| Rate for Payer: Aetna Commercial |
$113.50
|
| Rate for Payer: Aetna Medicare Advantage |
$113.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$96.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$96.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$96.47
|
| Rate for Payer: Cigna Commercial |
$189.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.18
|
| Rate for Payer: Oxford Commercial |
$189.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$189.16
|
|
|
DRILL BIT 3.5
|
Facility
|
IP
|
$378.33
|
|
| Hospital Charge Code |
270657772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$56.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.75
|
|
|
DRILL BIT 3.5 MM
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270662028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Medicare Advantage |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.88
|
| Rate for Payer: Cigna Commercial |
$562.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$146.25
|
| Rate for Payer: Oxford Commercial |
$562.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$562.50
|
|
|
DRILL BIT 3.5 MM
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270662028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.75
|
|
|
DRILL BIT 3.5MM
|
Facility
|
IP
|
$1,062.00
|
|
| Hospital Charge Code |
270686435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.30
|
|
|
DRILL BIT 3.5MM
|
Facility
|
OP
|
$2,540.65
|
|
| Hospital Charge Code |
270704457
|
|
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 3.5MM
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270699245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
DRILL BIT 3.5MM
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270699245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.00
|
| Rate for Payer: Oxford Commercial |
$250.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.00
|
|
|
DRILL BIT 3.5MM
|
Facility
|
IP
|
$465.00
|
|
| Hospital Charge Code |
270698550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.75
|
|
|
DRILL BIT 3.5MM
|
Facility
|
OP
|
$465.00
|
|
| Hospital Charge Code |
270698550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$139.50
|
| Rate for Payer: Aetna Medicare Advantage |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$118.58
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.45
|
| Rate for Payer: Oxford Commercial |
$232.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$232.50
|
|
|
DRILL BIT 3.5MM
|
Facility
|
OP
|
$1,062.00
|
|
| Hospital Charge Code |
270686435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Medicare Advantage |
$318.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$270.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$270.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$270.81
|
| Rate for Payer: Cigna Commercial |
$531.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$138.06
|
| Rate for Payer: Oxford Commercial |
$531.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$159.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$531.00
|
|
|
DRILL BIT 3.5MM
|
Facility
|
IP
|
$2,540.65
|
|
| Hospital Charge Code |
270704457
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$381.10 |
| Max. Negotiated Rate |
$381.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$381.10
|
|
|
DRILL BIT 3.5MM 195MM
|
Facility
|
IP
|
$643.45
|
|
| Hospital Charge Code |
270681645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.52 |
| Max. Negotiated Rate |
$96.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.52
|
|
|
DRILL BIT 3.5MM 195MM
|
Facility
|
OP
|
$643.45
|
|
| Hospital Charge Code |
270681645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.65 |
| Max. Negotiated Rate |
$321.73 |
| Rate for Payer: Aetna Commercial |
$193.03
|
| Rate for Payer: Aetna Medicare Advantage |
$193.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$164.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$164.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$164.08
|
| Rate for Payer: Cigna Commercial |
$321.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$83.65
|
| Rate for Payer: Oxford Commercial |
$321.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$321.73
|
|
|
DRILL BIT 3.5MM LINEUM
|
Facility
|
OP
|
$1,785.00
|
|
| Hospital Charge Code |
270693062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna Medicare Advantage |
$535.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$455.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$455.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$455.18
|
| Rate for Payer: Cigna Commercial |
$892.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$232.05
|
| Rate for Payer: Oxford Commercial |
$892.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$892.50
|
|
|
DRILL BIT 3.5MM LINEUM
|
Facility
|
IP
|
$1,785.00
|
|
| Hospital Charge Code |
270693062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$267.75
|
|