|
DRILL SUBCHONDRAL 1.5mm
|
Facility
|
IP
|
$190.00
|
|
| Hospital Charge Code |
270621558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.50
|
|
|
DRILL SURG 4.5MM OD ST 3.0MM
|
Facility
|
IP
|
$741.30
|
|
| Hospital Charge Code |
270697894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.19 |
| Max. Negotiated Rate |
$111.19 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.19
|
|
|
DRILL SURG 4.5MM OD ST 3.0MM
|
Facility
|
OP
|
$741.30
|
|
| Hospital Charge Code |
270697894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.37 |
| Max. Negotiated Rate |
$370.65 |
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna Medicare Advantage |
$222.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.03
|
| Rate for Payer: Cigna Commercial |
$370.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$96.37
|
| Rate for Payer: Oxford Commercial |
$370.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$370.65
|
|
|
DRILL SYN 14MM 324.14
|
Facility
|
IP
|
$1,503.25
|
|
| Hospital Charge Code |
270609419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.49 |
| Max. Negotiated Rate |
$225.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.49
|
|
|
DRILL SYN 14MM 324.14
|
Facility
|
OP
|
$1,503.25
|
|
| Hospital Charge Code |
270609419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.42 |
| Max. Negotiated Rate |
$751.62 |
| Rate for Payer: Aetna Commercial |
$450.98
|
| Rate for Payer: Aetna Medicare Advantage |
$450.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$383.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$383.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$383.33
|
| Rate for Payer: Cigna Commercial |
$751.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.42
|
| Rate for Payer: Oxford Commercial |
$751.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$751.62
|
|
|
DRILL SYN 8 1.0 316443
|
Facility
|
IP
|
$644.00
|
|
| Hospital Charge Code |
270626840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.60
|
|
|
DRILL SYN 8 1.0 316443
|
Facility
|
OP
|
$644.00
|
|
| Hospital Charge Code |
270626840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.72 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$193.20
|
| Rate for Payer: Aetna Medicare Advantage |
$193.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$164.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$164.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$164.22
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$83.72
|
| Rate for Payer: Oxford Commercial |
$322.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$322.00
|
|
|
DRILL TIBIAL 4.8MM
|
Facility
|
IP
|
$1,170.00
|
|
| Hospital Charge Code |
270676977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.50
|
|
|
DRILL TIBIAL 4.8MM
|
Facility
|
OP
|
$1,170.00
|
|
| Hospital Charge Code |
270676977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Medicare Advantage |
$351.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$298.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$298.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$298.35
|
| Rate for Payer: Cigna Commercial |
$585.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.10
|
| Rate for Payer: Oxford Commercial |
$585.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$175.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$585.00
|
|
|
DRILL TIP 2.5 GUIDEWIRE 12mm
|
Facility
|
IP
|
$308.75
|
|
| Hospital Charge Code |
270685404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.31 |
| Max. Negotiated Rate |
$46.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.31
|
|
|
DRILL TIP 2.5 GUIDEWIRE 12mm
|
Facility
|
OP
|
$308.75
|
|
| Hospital Charge Code |
270685404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$154.38 |
| Rate for Payer: Aetna Commercial |
$92.62
|
| Rate for Payer: Aetna Medicare Advantage |
$92.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.73
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$40.14
|
| Rate for Payer: Oxford Commercial |
$154.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$154.38
|
|
|
DRILL TIP SPADE 3.9MM
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
270687860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Medicare Advantage |
$157.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.88
|
| Rate for Payer: Cigna Commercial |
$262.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$68.25
|
| Rate for Payer: Oxford Commercial |
$262.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$262.50
|
|
|
DRILL TIP SPADE 3.9MM
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
270687860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
|
|
DRILL TRI FLAT
|
Facility
|
IP
|
$1,030.00
|
|
| Hospital Charge Code |
270670470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.50 |
| Max. Negotiated Rate |
$154.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$154.50
|
|
|
DRILL TRI FLAT
|
Facility
|
OP
|
$1,030.00
|
|
| Hospital Charge Code |
270670470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna Commercial |
$309.00
|
| Rate for Payer: Aetna Medicare Advantage |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$262.65
|
| Rate for Payer: Cigna Commercial |
$515.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.90
|
| Rate for Payer: Oxford Commercial |
$515.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$154.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$515.00
|
|
|
DRILL TRIM 2 MM X100 MM
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
DRILL TRIM 2 MM X100 MM
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$242.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
DRILL TWIST 1/4 18 ga 4044-16
|
Facility
|
IP
|
$84.85
|
|
| Hospital Charge Code |
270601289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.73
|
|
|
DRILL TWIST 1/4 18 ga 4044-16
|
Facility
|
OP
|
$84.85
|
|
| Hospital Charge Code |
270601289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$42.42 |
| Rate for Payer: Aetna Commercial |
$25.45
|
| Rate for Payer: Aetna Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.64
|
| Rate for Payer: Cigna Commercial |
$42.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.03
|
| Rate for Payer: Oxford Commercial |
$42.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.42
|
|
|
DRILL TWIST 1.5 105 01-9198
|
Facility
|
IP
|
$561.65
|
|
| Hospital Charge Code |
270610975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.25 |
| Max. Negotiated Rate |
$84.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.25
|
|
|
DRILL TWIST 1.5 105 01-9198
|
Facility
|
OP
|
$561.65
|
|
| Hospital Charge Code |
270610975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$280.82 |
| Rate for Payer: Aetna Commercial |
$168.50
|
| Rate for Payer: Aetna Medicare Advantage |
$168.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$143.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$143.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$143.22
|
| Rate for Payer: Cigna Commercial |
$280.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$73.01
|
| Rate for Payer: Oxford Commercial |
$280.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$84.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$280.82
|
|
|
DRILL TWIST 1/8
|
Facility
|
OP
|
$207.00
|
|
| Hospital Charge Code |
270335218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Medicare Advantage |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$52.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$52.78
|
| Rate for Payer: Cigna Commercial |
$103.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.91
|
| Rate for Payer: Oxford Commercial |
$103.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.50
|
|
|
DRILL TWIST 1/8
|
Facility
|
IP
|
$207.00
|
|
| Hospital Charge Code |
270335218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.05
|
|
|
DRILL TWIST 3.6x180 472064
|
Facility
|
OP
|
$605.00
|
|
| Hospital Charge Code |
270632875
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Aetna Commercial |
$181.50
|
| Rate for Payer: Aetna Medicare Advantage |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.28
|
| Rate for Payer: Cigna Commercial |
$302.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$78.65
|
| Rate for Payer: Oxford Commercial |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$302.50
|
|
|
DRILL TWIST 3.6x180 472064
|
Facility
|
IP
|
$605.00
|
|
| Hospital Charge Code |
270632875
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.75 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$90.75
|
|