|
DRILL BIT STR CANN 2.7MM
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270672350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.75
|
| Rate for Payer: Oxford Commercial |
$487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$487.50
|
|
|
DRILL BIT STR CANN 2.7MM
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270672350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
DRILL BIT TM RAIL HOLE 5MM
|
Facility
|
OP
|
$1,350.00
|
|
| Hospital Charge Code |
270697186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare Advantage |
$405.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$344.25
|
| Rate for Payer: Cigna Commercial |
$675.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.50
|
| Rate for Payer: Oxford Commercial |
$675.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$202.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$675.00
|
|
|
DRILL BIT TM RAIL HOLE 5MM
|
Facility
|
IP
|
$1,350.00
|
|
| Hospital Charge Code |
270697186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$202.50
|
|
|
DRILL BIT TORNIER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270339524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
DRILL BIT TORNIER
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270339524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
DRILL BIT TWIST CROWE POINT 4.
|
Facility
|
IP
|
$975.00
|
|
| Hospital Charge Code |
270662017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
|
|
DRILL BIT TWIST CROWE POINT 4.
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
270662017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$292.50
|
| Rate for Payer: Aetna Medicare Advantage |
$292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$248.62
|
| Rate for Payer: Cigna Commercial |
$487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$126.75
|
| Rate for Payer: Oxford Commercial |
$487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$146.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$487.50
|
|
|
DRILL BIT TWIST LAQ 2.6X61MM
|
Facility
|
OP
|
$905.45
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270699554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.71 |
| Max. Negotiated Rate |
$452.73 |
| Rate for Payer: Aetna Commercial |
$271.63
|
| Rate for Payer: Aetna Medicare Advantage |
$271.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$230.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$230.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$230.89
|
| Rate for Payer: Cigna Commercial |
$452.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.71
|
| Rate for Payer: Oxford Commercial |
$452.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$452.73
|
|
|
DRILL BIT TWIST LAQ 2.6X61MM
|
Facility
|
IP
|
$905.45
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270699554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$135.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.82
|
|
|
DRILL BIT VALOR LONG 4.3X120MM
|
Facility
|
OP
|
$2,245.00
|
|
| Hospital Charge Code |
270694900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.85 |
| Max. Negotiated Rate |
$1,122.50 |
| Rate for Payer: Aetna Commercial |
$673.50
|
| Rate for Payer: Aetna Medicare Advantage |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$572.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$572.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$572.48
|
| Rate for Payer: Cigna Commercial |
$1,122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$291.85
|
| Rate for Payer: Oxford Commercial |
$1,122.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$336.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,122.50
|
|
|
DRILL BIT VALOR LONG 4.3X120MM
|
Facility
|
IP
|
$2,245.00
|
|
| Hospital Charge Code |
270694900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$336.75 |
| Max. Negotiated Rate |
$336.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$336.75
|
|
|
DRILL BIT VALOR SHORT 4.3MM
|
Facility
|
IP
|
$2,245.00
|
|
| Hospital Charge Code |
270694901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$336.75 |
| Max. Negotiated Rate |
$336.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$336.75
|
|
|
DRILL BIT VALOR SHORT 4.3MM
|
Facility
|
OP
|
$2,245.00
|
|
| Hospital Charge Code |
270694901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.85 |
| Max. Negotiated Rate |
$1,122.50 |
| Rate for Payer: Aetna Commercial |
$673.50
|
| Rate for Payer: Aetna Medicare Advantage |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$572.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$572.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$572.48
|
| Rate for Payer: Cigna Commercial |
$1,122.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$291.85
|
| Rate for Payer: Oxford Commercial |
$1,122.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$336.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,122.50
|
|
|
DRILL BIT WITH STOP 25MM STOP
|
Facility
|
IP
|
$410.00
|
|
| Hospital Charge Code |
270656510
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.50
|
|
|
DRILL BIT WITH STOP 25MM STOP
|
Facility
|
OP
|
$410.00
|
|
| Hospital Charge Code |
270656510
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna Commercial |
$123.00
|
| Rate for Payer: Aetna Medicare Advantage |
$123.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$104.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$104.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$104.55
|
| Rate for Payer: Cigna Commercial |
$205.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.30
|
| Rate for Payer: Oxford Commercial |
$205.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$205.00
|
|
|
DRILL BIT W STOP 2.25X12MM
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270696271
|
|
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 W STOP 2.25X12MM
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270696271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
DRILL BMT 3.2 20MM 424509
|
Facility
|
IP
|
$720.00
|
|
| Hospital Charge Code |
270612168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
|
|
DRILL BMT 3.2 20MM 424509
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
270312168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
|
|
DRILL BMT 3.2 20MM 424509
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
270312168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare Advantage |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.20
|
| Rate for Payer: Oxford Commercial |
$120.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$120.00
|
|
|
DRILL BMT 3.2 20MM 424509
|
Facility
|
OP
|
$720.00
|
|
| Hospital Charge Code |
270612168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Medicare Advantage |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$183.60
|
| Rate for Payer: Cigna Commercial |
$360.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$93.60
|
| Rate for Payer: Oxford Commercial |
$360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$360.00
|
|
|
DRILL BMT 3.2 30MM 424508
|
Facility
|
IP
|
$616.00
|
|
| Hospital Charge Code |
270612166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$92.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.40
|
|
|
DRILL BMT 3.2 30MM 424508
|
Facility
|
OP
|
$616.00
|
|
| Hospital Charge Code |
270612166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Aetna Medicare Advantage |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$157.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$157.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$157.08
|
| Rate for Payer: Cigna Commercial |
$308.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.08
|
| Rate for Payer: Oxford Commercial |
$308.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$308.00
|
|
|
DRILL BMT STEP 6.2 330 471748
|
Facility
|
OP
|
$425.65
|
|
| Hospital Charge Code |
270621704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$212.82 |
| Rate for Payer: Aetna Commercial |
$127.69
|
| Rate for Payer: Aetna Medicare Advantage |
$127.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.54
|
| Rate for Payer: Cigna Commercial |
$212.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.33
|
| Rate for Payer: Oxford Commercial |
$212.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$212.82
|
|