|
DRILL BIT CANN 15x280mm QC
|
Facility
|
IP
|
$2,119.75
|
|
| Hospital Charge Code |
270645689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.96 |
| Max. Negotiated Rate |
$317.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$317.96
|
|
|
DRILL BIT CANN 15x280mm QC
|
Facility
|
OP
|
$2,119.75
|
|
| Hospital Charge Code |
270645689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.57 |
| Max. Negotiated Rate |
$1,059.88 |
| Rate for Payer: Aetna Commercial |
$635.92
|
| Rate for Payer: Aetna Medicare Advantage |
$635.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$540.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$540.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$540.54
|
| Rate for Payer: Cigna Commercial |
$1,059.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.57
|
| Rate for Payer: Oxford Commercial |
$1,059.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$317.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,059.88
|
|
|
DRILL BIT CANN 1.7x100MM
|
Facility
|
IP
|
$1,928.15
|
|
| Hospital Charge Code |
270634211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.22 |
| Max. Negotiated Rate |
$289.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.22
|
|
|
DRILL BIT CANN 1.7x100MM
|
Facility
|
OP
|
$1,928.15
|
|
| Hospital Charge Code |
270634211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.66 |
| Max. Negotiated Rate |
$964.08 |
| Rate for Payer: Aetna Commercial |
$578.45
|
| Rate for Payer: Aetna Medicare Advantage |
$578.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$491.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$491.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$491.68
|
| Rate for Payer: Cigna Commercial |
$964.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$250.66
|
| Rate for Payer: Oxford Commercial |
$964.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$964.08
|
|
|
DRILL BIT CANN 2.0
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270683395
|
|
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 CANN 2.0
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270683395
|
|
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 CANN 3.0MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270685917
|
|
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 CANN 3.0MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270685917
|
|
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 CANN 3.5x160MM
|
Facility
|
OP
|
$1,944.65
|
|
| Hospital Charge Code |
270646925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$972.33 |
| Rate for Payer: Aetna Commercial |
$583.39
|
| Rate for Payer: Aetna Medicare Advantage |
$583.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$495.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$495.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$495.89
|
| Rate for Payer: Cigna Commercial |
$972.33
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$252.80
|
| Rate for Payer: Oxford Commercial |
$972.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$291.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$972.33
|
|
|
DRILL BIT CANN 3.5x160MM
|
Facility
|
IP
|
$1,944.65
|
|
| Hospital Charge Code |
270646925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.70 |
| Max. Negotiated Rate |
$291.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$291.70
|
|
|
DRILL BIT CANN 4.3 MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270685918
|
|
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 CANN 4.3 MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270685918
|
|
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 CANN 4.5x170MM
|
Facility
|
OP
|
$1,854.00
|
|
| Hospital Charge Code |
270604931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.02 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna Commercial |
$556.20
|
| Rate for Payer: Aetna Medicare Advantage |
$556.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$472.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$472.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$472.77
|
| Rate for Payer: Cigna Commercial |
$927.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$241.02
|
| Rate for Payer: Oxford Commercial |
$927.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$278.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$927.00
|
|
|
DRILL BIT CANN 4.5x170MM
|
Facility
|
IP
|
$1,854.00
|
|
| Hospital Charge Code |
270604931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.10 |
| Max. Negotiated Rate |
$278.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$278.10
|
|
|
DRILL BIT CANN 4.5x233MM
|
Facility
|
OP
|
$1,909.60
|
|
| Hospital Charge Code |
270605008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.25 |
| Max. Negotiated Rate |
$954.80 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Aetna Medicare Advantage |
$572.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$486.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$486.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$486.95
|
| Rate for Payer: Cigna Commercial |
$954.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$248.25
|
| Rate for Payer: Oxford Commercial |
$954.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$286.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$954.80
|
|
|
DRILL BIT CANN 4.5x233MM
|
Facility
|
IP
|
$1,909.60
|
|
| Hospital Charge Code |
270605008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.44 |
| Max. Negotiated Rate |
$286.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$286.44
|
|
|
DRILL BIT CANN 7.3X300MM
|
Facility
|
OP
|
$1,836.00
|
|
| Hospital Charge Code |
270670831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.68 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Medicare Advantage |
$550.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$468.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$468.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$468.18
|
| Rate for Payer: Cigna Commercial |
$918.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$238.68
|
| Rate for Payer: Oxford Commercial |
$918.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$275.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$918.00
|
|
|
DRILL BIT CANN 7.3X300MM
|
Facility
|
IP
|
$1,836.00
|
|
| Hospital Charge Code |
270670831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$275.40
|
|
|
DRILL BIT CANN AO 2.0X65MM
|
Facility
|
IP
|
$600.00
|
|
| Hospital Charge Code |
270692685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
|
|
DRILL BIT CANN AO 2.0X65MM
|
Facility
|
OP
|
$600.00
|
|
| Hospital Charge Code |
270692685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Medicare Advantage |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$153.00
|
| Rate for Payer: Cigna Commercial |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$145.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.00
|
|
|
DRILLBIT CANN AO COUP 2.1MM
|
Facility
|
OP
|
$2,020.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270673480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.60 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: Aetna Commercial |
$606.00
|
| Rate for Payer: Aetna Medicare Advantage |
$606.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$515.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$515.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$515.10
|
| Rate for Payer: Cigna Commercial |
$1,010.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$262.60
|
| Rate for Payer: Oxford Commercial |
$1,010.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$303.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,010.00
|
|
|
DRILLBIT CANN AO COUP 2.1MM
|
Facility
|
IP
|
$2,020.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270673480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.00 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$303.00
|
|
|
DRILL BIT CANN LG QC 12.8MM
|
Facility
|
IP
|
$3,132.55
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270692420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.88 |
| Max. Negotiated Rate |
$469.88 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$469.88
|
|
|
DRILL BIT CANN LG QC 12.8MM
|
Facility
|
OP
|
$3,132.55
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270692420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.23 |
| Max. Negotiated Rate |
$1,566.28 |
| Rate for Payer: Aetna Commercial |
$939.76
|
| Rate for Payer: Aetna Medicare Advantage |
$939.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$798.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$798.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$798.80
|
| Rate for Payer: Cigna Commercial |
$1,566.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$407.23
|
| Rate for Payer: Oxford Commercial |
$1,566.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$469.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,566.28
|
|
|
DRILL BIT CANN LG QC 12x190MM
|
Facility
|
OP
|
$2,175.00
|
|
| Hospital Charge Code |
270674887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.75 |
| Max. Negotiated Rate |
$1,087.50 |
| Rate for Payer: Aetna Commercial |
$652.50
|
| Rate for Payer: Aetna Medicare Advantage |
$652.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$554.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$554.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$554.62
|
| Rate for Payer: Cigna Commercial |
$1,087.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$282.75
|
| Rate for Payer: Oxford Commercial |
$1,087.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$326.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,087.50
|
|