|
DRILL BIT CANNULATED 1.7
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270656508
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$48.75
|
| Rate for Payer: Oxford Commercial |
$187.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$187.50
|
|
|
DRILL BIT CANNULATED 1.7
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270656508
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
DRILL BIT CANNULATED 1.7 MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270683591
|
|
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 CANNULATED 1.7 MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270683591
|
|
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 CANNULATED 1.7MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270670930
|
|
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 CANNULATED 1.7MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270670930
|
|
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 CANNULATED 1.7MM
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
270667126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Medicare Advantage |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$214.20
|
| Rate for Payer: Cigna Commercial |
$420.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$109.20
|
| Rate for Payer: Oxford Commercial |
$420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$420.00
|
|
|
DRILL BIT CANNULATED 1.7MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
270667126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
|
|
DRILL BIT, CANNULATED 1.7MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270671792
|
|
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, CANNULATED 1.7MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270671792
|
|
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 CANNULATED 2.0 MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270683589
|
|
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 CANNULATED 2.0 MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270683589
|
|
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 CANNULATED 2.0X130MM
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
|
|
DRILL BIT CANNULATED 2.0X130MM
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Medicare Advantage |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$214.20
|
| Rate for Payer: Cigna Commercial |
$420.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$109.20
|
| Rate for Payer: Oxford Commercial |
$420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$420.00
|
|
|
DRILL BIT CANNULATED 2.1MM
|
Facility
|
OP
|
$1,893.75
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.19 |
| Max. Negotiated Rate |
$946.88 |
| Rate for Payer: Aetna Commercial |
$568.12
|
| Rate for Payer: Aetna Medicare Advantage |
$568.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$482.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$482.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$482.91
|
| Rate for Payer: Cigna Commercial |
$946.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.19
|
| Rate for Payer: Oxford Commercial |
$946.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$946.88
|
|
|
DRILL BIT CANNULATED 2.1MM
|
Facility
|
IP
|
$1,893.75
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.06 |
| Max. Negotiated Rate |
$284.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$284.06
|
|
|
DRILL BIT CANNULATED 2.2MM
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
270667125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Medicare Advantage |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$214.20
|
| Rate for Payer: Cigna Commercial |
$420.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$109.20
|
| Rate for Payer: Oxford Commercial |
$420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$420.00
|
|
|
DRILL BIT CANNULATED 2.2MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
270667125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
|
|
DRILL BIT CANNULATED 2.4MM
|
Facility
|
OP
|
$1,965.00
|
|
| Hospital Charge Code |
270674572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.45 |
| Max. Negotiated Rate |
$982.50 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Medicare Advantage |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$501.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$501.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$501.07
|
| Rate for Payer: Cigna Commercial |
$982.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$255.45
|
| Rate for Payer: Oxford Commercial |
$982.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$294.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$982.50
|
|
|
DRILL BIT CANNULATED 2.4MM
|
Facility
|
IP
|
$1,965.00
|
|
| Hospital Charge Code |
270674572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.75 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$294.75
|
|
|
DRILL BIT CANNULATED 2.4MM
|
Facility
|
IP
|
$2,375.00
|
|
| Hospital Charge Code |
270669224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$356.25 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
|
|
DRILL BIT CANNULATED 2.4MM
|
Facility
|
OP
|
$2,375.00
|
|
| Hospital Charge Code |
270669224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$1,187.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Medicare Advantage |
$712.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$605.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$605.62
|
| Rate for Payer: Cigna Commercial |
$1,187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$308.75
|
| Rate for Payer: Oxford Commercial |
$1,187.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$356.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,187.50
|
|
|
DRILL BIT CANNULATED 2.5MM
|
Facility
|
IP
|
$1,100.00
|
|
| Hospital Charge Code |
270698540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
|
|
DRILL BIT CANNULATED 2.5MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
270675124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
|
|
DRILL BIT CANNULATED 2.5MM
|
Facility
|
OP
|
$1,100.00
|
|
| Hospital Charge Code |
270698540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$330.00
|
| Rate for Payer: Aetna Medicare Advantage |
$330.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$280.50
|
| Rate for Payer: Cigna Commercial |
$550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.00
|
| Rate for Payer: Oxford Commercial |
$550.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$550.00
|
|