|
DRILL BMT STEP 6.2 330 471748
|
Facility
|
IP
|
$425.65
|
|
| Hospital Charge Code |
270621704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.85 |
| Max. Negotiated Rate |
$63.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.85
|
|
|
DRILL BMT TWIST 3.2 180 472060
|
Facility
|
IP
|
$555.60
|
|
| Hospital Charge Code |
270613719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.34 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.34
|
|
|
DRILL BMT TWIST 3.2 180 472060
|
Facility
|
OP
|
$555.60
|
|
| Hospital Charge Code |
270613719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.23 |
| Max. Negotiated Rate |
$277.80 |
| Rate for Payer: Aetna Commercial |
$166.68
|
| Rate for Payer: Aetna Medicare Advantage |
$166.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$141.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$141.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$141.68
|
| Rate for Payer: Cigna Commercial |
$277.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.23
|
| Rate for Payer: Oxford Commercial |
$277.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$83.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$277.80
|
|
|
DRILL BMT TWIST 3.6 180 472064
|
Facility
|
OP
|
$383.25
|
|
| Hospital Charge Code |
270621705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$191.62 |
| Rate for Payer: Aetna Commercial |
$114.97
|
| Rate for Payer: Aetna Medicare Advantage |
$114.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.73
|
| Rate for Payer: Cigna Commercial |
$191.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.82
|
| Rate for Payer: Oxford Commercial |
$191.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$191.62
|
|
|
DRILL BMT TWIST 3.6 180 472064
|
Facility
|
IP
|
$383.25
|
|
| Hospital Charge Code |
270621705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$57.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.49
|
|
|
DRILL BMT TWIST 4.0 471841
|
Facility
|
OP
|
$775.25
|
|
| Hospital Charge Code |
270618657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.78 |
| Max. Negotiated Rate |
$387.62 |
| Rate for Payer: Aetna Commercial |
$232.57
|
| Rate for Payer: Aetna Medicare Advantage |
$232.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$197.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$197.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$197.69
|
| Rate for Payer: Cigna Commercial |
$387.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$100.78
|
| Rate for Payer: Oxford Commercial |
$387.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$387.62
|
|
|
DRILL BMT TWIST 4.0 471841
|
Facility
|
IP
|
$775.25
|
|
| Hospital Charge Code |
270618657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.29 |
| Max. Negotiated Rate |
$116.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$116.29
|
|
|
DRILL BMT TWIST 4.3 203 471655
|
Facility
|
OP
|
$544.85
|
|
| Hospital Charge Code |
270612313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$272.43 |
| Rate for Payer: Aetna Commercial |
$163.46
|
| Rate for Payer: Aetna Medicare Advantage |
$163.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$138.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$138.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$138.94
|
| Rate for Payer: Cigna Commercial |
$272.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.83
|
| Rate for Payer: Oxford Commercial |
$272.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$272.43
|
|
|
DRILL BMT TWIST 4.3 203 471655
|
Facility
|
IP
|
$544.85
|
|
| Hospital Charge Code |
270612313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.73 |
| Max. Negotiated Rate |
$81.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$81.73
|
|
|
DRILL BMT TWIST 4.3 254 471656
|
Facility
|
OP
|
$530.00
|
|
| Hospital Charge Code |
270606460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna Commercial |
$159.00
|
| Rate for Payer: Aetna Medicare Advantage |
$159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$135.15
|
| Rate for Payer: Cigna Commercial |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.90
|
| Rate for Payer: Oxford Commercial |
$265.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$265.00
|
|
|
DRILL BMT TWIST 4.3 254 471656
|
Facility
|
IP
|
$530.00
|
|
| Hospital Charge Code |
270606460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.50
|
|
|
DRILL BMT TWIST 4.3 471845
|
Facility
|
OP
|
$763.25
|
|
| Hospital Charge Code |
270614629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.22 |
| Max. Negotiated Rate |
$381.62 |
| Rate for Payer: Aetna Commercial |
$228.97
|
| Rate for Payer: Aetna Medicare Advantage |
$228.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$194.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$194.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$194.63
|
| Rate for Payer: Cigna Commercial |
$381.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.22
|
| Rate for Payer: Oxford Commercial |
$381.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$381.62
|
|
|
DRILL BMT TWIST 4.3 471845
|
Facility
|
IP
|
$763.25
|
|
| Hospital Charge Code |
270614629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.49 |
| Max. Negotiated Rate |
$114.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.49
|
|
|
DRILL BMT TWIST 5.0 254 471786
|
Facility
|
IP
|
$460.85
|
|
| Hospital Charge Code |
270618213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.13 |
| Max. Negotiated Rate |
$69.13 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.13
|
|
|
DRILL BMT TWIST 5.0 254 471786
|
Facility
|
OP
|
$310.45
|
|
| Hospital Charge Code |
270621866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$155.22 |
| Rate for Payer: Aetna Commercial |
$93.14
|
| Rate for Payer: Aetna Medicare Advantage |
$93.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.16
|
| Rate for Payer: Cigna Commercial |
$155.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.36
|
| Rate for Payer: Oxford Commercial |
$155.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$155.22
|
|
|
DRILL BMT TWIST 5.0 254 471786
|
Facility
|
IP
|
$310.45
|
|
| Hospital Charge Code |
270621866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$46.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.57
|
|
|
DRILL BMT TWIST 5.0 254 471786
|
Facility
|
OP
|
$460.85
|
|
| Hospital Charge Code |
270618213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$230.43 |
| Rate for Payer: Aetna Commercial |
$138.25
|
| Rate for Payer: Aetna Medicare Advantage |
$138.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$117.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$117.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$117.52
|
| Rate for Payer: Cigna Commercial |
$230.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.91
|
| Rate for Payer: Oxford Commercial |
$230.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$230.43
|
|
|
DRILL BMT TWIST CANN 7 471140
|
Facility
|
IP
|
$2,386.45
|
|
| Hospital Charge Code |
270624244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.97 |
| Max. Negotiated Rate |
$357.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$357.97
|
|
|
DRILL BMT TWIST CANN 7 471140
|
Facility
|
OP
|
$2,386.45
|
|
| Hospital Charge Code |
270624244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,193.22 |
| Rate for Payer: Aetna Commercial |
$715.93
|
| Rate for Payer: Aetna Medicare Advantage |
$715.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$608.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$608.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$608.54
|
| Rate for Payer: Cigna Commercial |
$1,193.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$310.24
|
| Rate for Payer: Oxford Commercial |
$1,193.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$357.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,193.22
|
|
|
DRILL BMT TWIST CRW 3.6 471868
|
Facility
|
OP
|
$964.85
|
|
| Hospital Charge Code |
270609864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.43 |
| Max. Negotiated Rate |
$482.43 |
| Rate for Payer: Aetna Commercial |
$289.45
|
| Rate for Payer: Aetna Medicare Advantage |
$289.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$246.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$246.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$246.04
|
| Rate for Payer: Cigna Commercial |
$482.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.43
|
| Rate for Payer: Oxford Commercial |
$482.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$482.43
|
|
|
DRILL BMT TWIST CRW 3.6 471868
|
Facility
|
IP
|
$964.85
|
|
| Hospital Charge Code |
270609864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.73 |
| Max. Negotiated Rate |
$144.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.73
|
|
|
DRILL BMT TWIST CRW 4.3 156072
|
Facility
|
OP
|
$763.25
|
|
| Hospital Charge Code |
270612856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.22 |
| Max. Negotiated Rate |
$381.62 |
| Rate for Payer: Aetna Commercial |
$228.97
|
| Rate for Payer: Aetna Medicare Advantage |
$228.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$194.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$194.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$194.63
|
| Rate for Payer: Cigna Commercial |
$381.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.22
|
| Rate for Payer: Oxford Commercial |
$381.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$381.62
|
|
|
DRILL BMT TWIST CRW 4.3 156072
|
Facility
|
IP
|
$763.25
|
|
| Hospital Charge Code |
270612856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.49 |
| Max. Negotiated Rate |
$114.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.49
|
|
|
DRILL BMT TWIST CRW 471873
|
Facility
|
IP
|
$964.85
|
|
| Hospital Charge Code |
270606461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.73 |
| Max. Negotiated Rate |
$144.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.73
|
|
|
DRILL BMT TWIST CRW 471873
|
Facility
|
OP
|
$964.85
|
|
| Hospital Charge Code |
270606461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.43 |
| Max. Negotiated Rate |
$482.43 |
| Rate for Payer: Aetna Commercial |
$289.45
|
| Rate for Payer: Aetna Medicare Advantage |
$289.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$246.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$246.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$246.04
|
| Rate for Payer: Cigna Commercial |
$482.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.43
|
| Rate for Payer: Oxford Commercial |
$482.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$482.43
|
|