|
DRILL BIT ASNIS 2.1MM
|
Facility
|
IP
|
$2,135.85
|
|
| Hospital Charge Code |
270704925
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$320.38 |
| Max. Negotiated Rate |
$320.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$320.38
|
|
|
DRILL BIT BUD 11MM
|
Facility
|
IP
|
$1,650.00
|
|
| Hospital Charge Code |
270671063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$247.50
|
|
|
DRILL BIT BUD 11MM
|
Facility
|
OP
|
$1,650.00
|
|
| Hospital Charge Code |
270671063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$495.00
|
| Rate for Payer: Aetna Medicare Advantage |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$420.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$420.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$420.75
|
| Rate for Payer: Cigna Commercial |
$825.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.50
|
| Rate for Payer: Oxford Commercial |
$825.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$247.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$825.00
|
|
|
DRILL BIT BUSHING 4.3MM
|
Facility
|
OP
|
$1,675.00
|
|
| Hospital Charge Code |
270700120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$837.50 |
| Rate for Payer: Aetna Commercial |
$502.50
|
| Rate for Payer: Aetna Medicare Advantage |
$502.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$427.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$427.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$427.12
|
| Rate for Payer: Cigna Commercial |
$837.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.75
|
| Rate for Payer: Oxford Commercial |
$837.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$837.50
|
|
|
DRILL BIT BUSHING 4.3MM
|
Facility
|
IP
|
$1,675.00
|
|
| Hospital Charge Code |
270700120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.25 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$251.25
|
|
|
DRILL BIT CALI 4.2 EXTRA LONG
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270692384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
DRILL BIT CALI 4.2 EXTRA LONG
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270692384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.75 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$352.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.75
|
| Rate for Payer: Oxford Commercial |
$587.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$587.50
|
|
|
DRILL BIT CALIB 2.0X110MM
|
Facility
|
OP
|
$646.25
|
|
| Hospital Charge Code |
270691082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.01 |
| Max. Negotiated Rate |
$323.12 |
| Rate for Payer: Aetna Commercial |
$193.88
|
| Rate for Payer: Aetna Medicare Advantage |
$193.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$164.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$164.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$164.79
|
| Rate for Payer: Cigna Commercial |
$323.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.01
|
| Rate for Payer: Oxford Commercial |
$323.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$323.12
|
|
|
DRILL BIT CALIB 2.0X110MM
|
Facility
|
IP
|
$646.25
|
|
| Hospital Charge Code |
270691082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.94 |
| Max. Negotiated Rate |
$96.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.94
|
|
|
DRILL BIT CALIB 4.2MM XL
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270697681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.25 |
| Max. Negotiated Rate |
$1,812.50 |
| Rate for Payer: Aetna Commercial |
$1,087.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,087.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$924.38
|
| Rate for Payer: Cigna Commercial |
$1,812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$471.25
|
| Rate for Payer: Oxford Commercial |
$1,812.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,812.50
|
|
|
DRILL BIT CALIB 4.2MM XL
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270697681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$543.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$543.75
|
|
|
DRILL BIT CALIBERAT 3.2m 27565
|
Facility
|
OP
|
$1,040.00
|
|
| Hospital Charge Code |
270640160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna Commercial |
$312.00
|
| Rate for Payer: Aetna Medicare Advantage |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$265.20
|
| Rate for Payer: Cigna Commercial |
$520.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.20
|
| Rate for Payer: Oxford Commercial |
$520.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$156.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$520.00
|
|
|
DRILL BIT CALIBERAT 3.2m 27565
|
Facility
|
IP
|
$1,040.00
|
|
| Hospital Charge Code |
270640160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$156.00
|
|
|
DRILL BIT CALIBERAT 4.5m 27555
|
Facility
|
OP
|
$1,040.00
|
|
| Hospital Charge Code |
270640161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna Commercial |
$312.00
|
| Rate for Payer: Aetna Medicare Advantage |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$265.20
|
| Rate for Payer: Cigna Commercial |
$520.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.20
|
| Rate for Payer: Oxford Commercial |
$520.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$156.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$520.00
|
|
|
DRILL BIT CALIBERAT 4.5m 27555
|
Facility
|
IP
|
$1,040.00
|
|
| Hospital Charge Code |
270640161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$156.00
|
|
|
DRILL BIT CALIBRATED 2.5MM
|
Facility
|
OP
|
$501.00
|
|
| Hospital Charge Code |
270671106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$250.50 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Medicare Advantage |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.75
|
| Rate for Payer: Cigna Commercial |
$250.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$65.13
|
| Rate for Payer: Oxford Commercial |
$250.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.50
|
|
|
DRILL BIT CALIBRATED 2.5MM
|
Facility
|
IP
|
$501.00
|
|
| Hospital Charge Code |
270671106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.15 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.15
|
|
|
DRILL BIT CALIBRATED 2.9MM
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
270661695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare Advantage |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$238.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$238.43
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.55
|
| Rate for Payer: Oxford Commercial |
$467.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$467.50
|
|
|
DRILL BIT CALIBRATED 2.9MM
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
270661695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$140.25
|
|
|
DRILL BIT CALIBRTD 4.8mm 27550
|
Facility
|
OP
|
$1,380.00
|
|
| Hospital Charge Code |
270648677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Medicare Advantage |
$414.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$351.90
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.40
|
| Rate for Payer: Oxford Commercial |
$690.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$690.00
|
|
|
DRILL BIT CALIBRTD 4.8mm 27550
|
Facility
|
IP
|
$1,380.00
|
|
| Hospital Charge Code |
270648677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$207.00
|
|
|
DRILL BIT CAN AO/QC 3.0MM
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
270697017
|
|
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 CAN AO/QC 3.0MM
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
270697017
|
|
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 CANN 11.0mm X 280mm
|
Facility
|
OP
|
$2,095.00
|
|
| Hospital Charge Code |
270633852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.35 |
| Max. Negotiated Rate |
$1,047.50 |
| Rate for Payer: Aetna Commercial |
$628.50
|
| Rate for Payer: Aetna Medicare Advantage |
$628.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$534.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$534.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$534.23
|
| Rate for Payer: Cigna Commercial |
$1,047.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.35
|
| Rate for Payer: Oxford Commercial |
$1,047.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$314.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,047.50
|
|
|
DRILL BIT CANN 11.0mm X 280mm
|
Facility
|
IP
|
$2,095.00
|
|
| Hospital Charge Code |
270633852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$314.25 |
| Max. Negotiated Rate |
$314.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$314.25
|
|