|
2.6 CANN DRILL BIT
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
270663089
|
|
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
|
|
|
26MM 2 LEVEL PLATE
|
Facility
|
OP
|
$2,685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.75 |
| Max. Negotiated Rate |
$1,342.50 |
| Rate for Payer: Aetna Commercial |
$805.50
|
| Rate for Payer: Aetna Medicare Advantage |
$805.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$684.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$684.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$537.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$684.67
|
| Rate for Payer: Cigna Commercial |
$1,342.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$649.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$402.75
|
|
|
26MM 2 LEVEL PLATE
|
Facility
|
IP
|
$2,685.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.75 |
| Max. Negotiated Rate |
$649.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$537.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$649.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$402.75
|
|
|
26 MM CAGE
|
Facility
|
IP
|
$29,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270690558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,425.00 |
| Max. Negotiated Rate |
$7,139.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,139.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,425.00
|
|
|
26 MM CAGE
|
Facility
|
OP
|
$29,500.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270690558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,425.00 |
| Max. Negotiated Rate |
$14,750.00 |
| Rate for Payer: Aetna Commercial |
$8,850.00
|
| Rate for Payer: Aetna Medicare Advantage |
$8,850.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,522.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,522.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,900.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,522.50
|
| Rate for Payer: Cigna Commercial |
$14,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,139.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,425.00
|
|
|
26MM PLATE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703095
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
|
|
26MM PLATE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703095
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,500.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$650.00
|
| Rate for Payer: Oxford Commercial |
$2,500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$750.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,500.00
|
|
|
26X32X10-15H HARRIER SA
|
Facility
|
OP
|
$27,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,125.00 |
| Max. Negotiated Rate |
$13,750.00 |
| Rate for Payer: Aetna Commercial |
$8,250.00
|
| Rate for Payer: Aetna Medicare Advantage |
$8,250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,012.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,012.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,012.50
|
| Rate for Payer: Cigna Commercial |
$13,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,655.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,125.00
|
|
|
26X32X10-15H HARRIER SA
|
Facility
|
IP
|
$27,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,125.00 |
| Max. Negotiated Rate |
$6,655.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,655.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,125.00
|
|
|
26X35MM ALIF CAGE 8 DEGREES
|
Facility
|
IP
|
$32,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,875.00 |
| Max. Negotiated Rate |
$7,865.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,865.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,875.00
|
|
|
26X35MM ALIF CAGE 8 DEGREES
|
Facility
|
OP
|
$32,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,875.00 |
| Max. Negotiated Rate |
$16,250.00 |
| Rate for Payer: Aetna Commercial |
$9,750.00
|
| Rate for Payer: Aetna Medicare Advantage |
$9,750.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8,287.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8,287.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8,287.50
|
| Rate for Payer: Cigna Commercial |
$16,250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7,865.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,875.00
|
|
|
270618636
|
Facility
|
OP
|
$4,767.25
|
|
| Hospital Charge Code |
270618619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.09 |
| Max. Negotiated Rate |
$2,383.62 |
| Rate for Payer: Aetna Commercial |
$1,430.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,430.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,215.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,215.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$953.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,215.65
|
| Rate for Payer: Cigna Commercial |
$2,383.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,153.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$715.09
|
|
|
270618636
|
Facility
|
IP
|
$4,767.25
|
|
| Hospital Charge Code |
270618619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.09 |
| Max. Negotiated Rate |
$1,153.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$953.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,153.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$715.09
|
|
|
270641500
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
270641453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.90
|
|
|
270641500
|
Facility
|
OP
|
$46.00
|
|
| Hospital Charge Code |
270641453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare Advantage |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.73
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.98
|
| Rate for Payer: Oxford Commercial |
$23.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.00
|
|
|
270665585
|
Facility
|
OP
|
$42.55
|
|
| Hospital Charge Code |
270665585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Aetna Commercial |
$12.77
|
| Rate for Payer: Aetna Medicare Advantage |
$12.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.85
|
| Rate for Payer: Cigna Commercial |
$21.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.53
|
| Rate for Payer: Oxford Commercial |
$21.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.27
|
|
|
270665585
|
Facility
|
IP
|
$42.55
|
|
| Hospital Charge Code |
270665585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.38
|
|
|
270674684
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
3210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.17 |
| Max. Negotiated Rate |
$654.50 |
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Aetna Medicare Advantage |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$333.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$333.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$333.80
|
| Rate for Payer: Cigna Commercial |
$654.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$170.17
|
| Rate for Payer: Oxford Commercial |
$654.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$654.50
|
|
|
270674684
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
3210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$196.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$196.35
|
|
|
270683467N
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270683467N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$275.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.00
|
|
|
270683467N
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270683467N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$342.00
|
| Rate for Payer: Aetna Medicare Advantage |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$290.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$290.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$290.70
|
| Rate for Payer: Cigna Commercial |
$570.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$275.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$171.00
|
|
|
270698417
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.55
|
| Rate for Payer: Oxford Commercial |
$67.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$67.50
|
|
|
270698417
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270698417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
270701711
|
Facility
|
OP
|
$1,086.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.94 |
| Max. Negotiated Rate |
$543.12 |
| Rate for Payer: Aetna Commercial |
$325.88
|
| Rate for Payer: Aetna Medicare Advantage |
$325.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$276.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$276.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$217.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$276.99
|
| Rate for Payer: Cigna Commercial |
$543.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$262.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.94
|
|
|
270701711
|
Facility
|
IP
|
$1,086.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.94 |
| Max. Negotiated Rate |
$262.87 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$217.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$262.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.94
|
|