|
DRILL CANULATED 4.4
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
270683637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.15 |
| Max. Negotiated Rate |
$727.50 |
| Rate for Payer: Aetna Commercial |
$436.50
|
| Rate for Payer: Aetna Medicare Advantage |
$436.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$371.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$371.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$371.02
|
| Rate for Payer: Cigna Commercial |
$727.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$189.15
|
| Rate for Payer: Oxford Commercial |
$727.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$218.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$727.50
|
|
|
DRILL CODMAN WIRE PASS 26-1247
|
Facility
|
OP
|
$412.85
|
|
| Hospital Charge Code |
270600324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.67 |
| Max. Negotiated Rate |
$206.43 |
| Rate for Payer: Aetna Commercial |
$123.86
|
| Rate for Payer: Aetna Medicare Advantage |
$123.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$105.28
|
| Rate for Payer: Cigna Commercial |
$206.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.67
|
| Rate for Payer: Oxford Commercial |
$206.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$206.43
|
|
|
DRILL CODMAN WIRE PASS 26-1247
|
Facility
|
IP
|
$412.85
|
|
| Hospital Charge Code |
270600324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
DRILL COUPLING ADAPTER
|
Facility
|
IP
|
$4,850.00
|
|
| Hospital Charge Code |
270700468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$727.50 |
| Max. Negotiated Rate |
$727.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$727.50
|
|
|
DRILL COUPLING ADAPTER
|
Facility
|
OP
|
$4,850.00
|
|
| Hospital Charge Code |
270700468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.50 |
| Max. Negotiated Rate |
$2,425.00 |
| Rate for Payer: Aetna Commercial |
$1,455.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,455.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,236.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,236.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,236.75
|
| Rate for Payer: Cigna Commercial |
$2,425.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$630.50
|
| Rate for Payer: Oxford Commercial |
$2,425.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$727.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,425.00
|
|
|
DRILL D2.8
|
Facility
|
OP
|
$2,400.00
|
|
| Hospital Charge Code |
270680909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Medicare Advantage |
$720.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$312.00
|
| Rate for Payer: Oxford Commercial |
$1,200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$360.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,200.00
|
|
|
DRILL D2.8
|
Facility
|
IP
|
$2,400.00
|
|
| Hospital Charge Code |
270680909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$360.00
|
|
|
DRILL DEPTH GAUGE FOR LG SCREW
|
Facility
|
OP
|
$2,382.00
|
|
| Hospital Charge Code |
270668379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.66 |
| Max. Negotiated Rate |
$1,191.00 |
| Rate for Payer: Aetna Commercial |
$714.60
|
| Rate for Payer: Aetna Medicare Advantage |
$714.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$607.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$607.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$607.41
|
| Rate for Payer: Cigna Commercial |
$1,191.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$309.66
|
| Rate for Payer: Oxford Commercial |
$1,191.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$357.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,191.00
|
|
|
DRILL DEPTH GAUGE FOR LG SCREW
|
Facility
|
IP
|
$2,382.00
|
|
| Hospital Charge Code |
270668379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.30 |
| Max. Negotiated Rate |
$357.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$357.30
|
|
|
DRILL DEPTH MARK MINI 1.5x96MM
|
Facility
|
IP
|
$652.45
|
|
| Hospital Charge Code |
270666015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.87 |
| Max. Negotiated Rate |
$97.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.87
|
|
|
DRILL DEPTH MARK MINI 1.5x96MM
|
Facility
|
OP
|
$652.45
|
|
| Hospital Charge Code |
270666015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$326.23 |
| Rate for Payer: Aetna Commercial |
$195.74
|
| Rate for Payer: Aetna Medicare Advantage |
$195.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$166.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$166.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$166.37
|
| Rate for Payer: Cigna Commercial |
$326.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.82
|
| Rate for Payer: Oxford Commercial |
$326.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$97.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$326.23
|
|
|
DRILL DIAMOND 10MM
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270676993
|
|
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 DIAMOND 10MM
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270676993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
DRILL DIAMOND 12MM
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
270657678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$402.50 |
| Rate for Payer: Aetna Commercial |
$241.50
|
| Rate for Payer: Aetna Medicare Advantage |
$241.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$205.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$205.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$205.28
|
| Rate for Payer: Cigna Commercial |
$402.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.65
|
| Rate for Payer: Oxford Commercial |
$402.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$402.50
|
|
|
DRILL DIAMOND 12MM
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
270657678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.75
|
|
|
DRILL DIAMOND 14MM
|
Facility
|
OP
|
$1,475.00
|
|
| Hospital Charge Code |
270657683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.75 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$442.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$191.75
|
| Rate for Payer: Oxford Commercial |
$737.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$737.50
|
|
|
DRILL DIAMOND 14MM
|
Facility
|
IP
|
$1,475.00
|
|
| Hospital Charge Code |
270657683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$221.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
DRILL DISP QFIX 1.9MM
|
Facility
|
IP
|
$2,430.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270687541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$364.50 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$364.50
|
|
|
DRILL DISP QFIX 1.9MM
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270687541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.90 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$729.00
|
| Rate for Payer: Aetna Medicare Advantage |
$729.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$619.65
|
| Rate for Payer: Cigna Commercial |
$1,215.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$315.90
|
| Rate for Payer: Oxford Commercial |
$1,215.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$364.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,215.00
|
|
|
DRILL DISTAL GRADUATED LG 4.3M
|
Facility
|
OP
|
$1,080.00
|
|
| Hospital Charge Code |
270650501
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Medicare Advantage |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$275.40
|
| Rate for Payer: Cigna Commercial |
$540.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$140.40
|
| Rate for Payer: Oxford Commercial |
$540.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$540.00
|
|
|
DRILL DISTAL GRADUATED LG 4.3M
|
Facility
|
IP
|
$1,080.00
|
|
| Hospital Charge Code |
270650501
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.00
|
|
|
DRILL FEM CALBRTD 5mm 22553550
|
Facility
|
OP
|
$917.65
|
|
| Hospital Charge Code |
270628517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.29 |
| Max. Negotiated Rate |
$458.82 |
| Rate for Payer: Aetna Commercial |
$275.30
|
| Rate for Payer: Aetna Medicare Advantage |
$275.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$234.00
|
| Rate for Payer: Cigna Commercial |
$458.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$119.29
|
| Rate for Payer: Oxford Commercial |
$458.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$137.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$458.82
|
|
|
DRILL FEM CALBRTD 5mm 22553550
|
Facility
|
IP
|
$917.65
|
|
| Hospital Charge Code |
270628517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.65 |
| Max. Negotiated Rate |
$137.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$137.65
|
|
|
DRILL FENESTRATING
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
270698470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$887.50 |
| Rate for Payer: Aetna Commercial |
$532.50
|
| Rate for Payer: Aetna Medicare Advantage |
$532.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$452.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$452.62
|
| Rate for Payer: Cigna Commercial |
$887.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$230.75
|
| Rate for Payer: Oxford Commercial |
$887.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$887.50
|
|
|
DRILL FENESTRATING
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
270698470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.25 |
| Max. Negotiated Rate |
$266.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$266.25
|
|