|
BURR ROUND 3.5 MM 10 FLUTE
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270691593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$84.15
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.90
|
| Rate for Payer: Oxford Commercial |
$165.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$165.00
|
|
|
BURR ROUND 3.5 MM 10 FLUTE
|
Facility
|
IP
|
$330.00
|
|
| Hospital Charge Code |
270691593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
|
|
BURR ROUND 5.0x45MM MINI QC
|
Facility
|
OP
|
$381.50
|
|
| Hospital Charge Code |
270674542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$190.75 |
| Rate for Payer: Aetna Commercial |
$114.45
|
| Rate for Payer: Aetna Medicare Advantage |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$97.28
|
| Rate for Payer: Cigna Commercial |
$190.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$49.59
|
| Rate for Payer: Oxford Commercial |
$190.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.75
|
|
|
BURR ROUND 5.0x45MM MINI QC
|
Facility
|
IP
|
$381.50
|
|
| Hospital Charge Code |
270674542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.23
|
|
|
BURR ROUND 6-FLUTE 4mm
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
270601439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$60.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.00
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.00
|
| Rate for Payer: Oxford Commercial |
$100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.00
|
|
|
BURR ROUND 6-FLUTE 4mm
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
270601439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.00
|
|
|
BURR ROUND 8 FLUTE 4.0MM X 13
|
Facility
|
OP
|
$295.00
|
|
| Hospital Charge Code |
270688457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$147.50 |
| Rate for Payer: Aetna Commercial |
$88.50
|
| Rate for Payer: Aetna Medicare Advantage |
$88.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.22
|
| Rate for Payer: Cigna Commercial |
$147.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.35
|
| Rate for Payer: Oxford Commercial |
$147.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$147.50
|
|
|
BURR ROUND 8 FLUTE 4.0MM X 13
|
Facility
|
IP
|
$295.00
|
|
| Hospital Charge Code |
270688457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.25 |
| Max. Negotiated Rate |
$44.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.25
|
|
|
BURR ROUND 8FLUTED
|
Facility
|
IP
|
$295.00
|
|
| Hospital Charge Code |
270688425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.25 |
| Max. Negotiated Rate |
$44.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.25
|
|
|
BURR ROUND 8FLUTED
|
Facility
|
OP
|
$295.00
|
|
| Hospital Charge Code |
270688425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$147.50 |
| Rate for Payer: Aetna Commercial |
$88.50
|
| Rate for Payer: Aetna Medicare Advantage |
$88.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$75.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$75.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$75.22
|
| Rate for Payer: Cigna Commercial |
$147.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.35
|
| Rate for Payer: Oxford Commercial |
$147.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$44.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$147.50
|
|
|
BURR ROUNDE 3.0
|
Facility
|
IP
|
$330.00
|
|
| Hospital Charge Code |
270687619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
|
|
BURR ROUNDE 3.0
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270687619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$84.15
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.90
|
| Rate for Payer: Oxford Commercial |
$165.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$165.00
|
|
|
BURR ROUNDED DIA. LONG
|
Facility
|
OP
|
$2,472.00
|
|
| Hospital Charge Code |
270665099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$321.36 |
| Max. Negotiated Rate |
$1,236.00 |
| Rate for Payer: Aetna Commercial |
$741.60
|
| Rate for Payer: Aetna Medicare Advantage |
$741.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$630.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$630.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$630.36
|
| Rate for Payer: Cigna Commercial |
$1,236.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$321.36
|
| Rate for Payer: Oxford Commercial |
$1,236.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$370.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,236.00
|
|
|
BURR ROUNDED DIA. LONG
|
Facility
|
IP
|
$2,472.00
|
|
| Hospital Charge Code |
270665099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$370.80
|
|
|
BURR ROUND HL FLUTED 5MM 19CM
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
270679506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$84.15
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.90
|
| Rate for Payer: Oxford Commercial |
$165.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$165.00
|
|
|
BURR ROUND HL FLUTED 5MM 19CM
|
Facility
|
IP
|
$330.00
|
|
| Hospital Charge Code |
270679506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.50
|
|
|
BURR ROUND L 1.0MM
|
Facility
|
IP
|
$283.50
|
|
| Hospital Charge Code |
270674387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
|
|
BURR ROUND L 1.0MM
|
Facility
|
OP
|
$283.50
|
|
| Hospital Charge Code |
270674387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$85.05
|
| Rate for Payer: Aetna Medicare Advantage |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.29
|
| Rate for Payer: Cigna Commercial |
$141.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.85
|
| Rate for Payer: Oxford Commercial |
$141.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$141.75
|
|
|
BURR ROUND L 1.0MM DIAMOND
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$129.15
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.97
|
| Rate for Payer: Oxford Commercial |
$215.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.25
|
|
|
BURR ROUND L 1.0MM DIAMOND
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR ROUND L 1.5MM
|
Facility
|
IP
|
$283.50
|
|
| Hospital Charge Code |
270674390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
|
|
BURR ROUND L 1.5MM
|
Facility
|
OP
|
$283.50
|
|
| Hospital Charge Code |
270674390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna Commercial |
$85.05
|
| Rate for Payer: Aetna Medicare Advantage |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$72.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$72.29
|
| Rate for Payer: Cigna Commercial |
$141.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.85
|
| Rate for Payer: Oxford Commercial |
$141.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$141.75
|
|
|
BURR ROUND L 1.5MM DIAMOND
|
Facility
|
OP
|
$430.50
|
|
| Hospital Charge Code |
270674414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$129.15
|
| Rate for Payer: Aetna Medicare Advantage |
$129.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$109.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$109.78
|
| Rate for Payer: Cigna Commercial |
$215.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.97
|
| Rate for Payer: Oxford Commercial |
$215.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.25
|
|
|
BURR ROUND L 1.5MM DIAMOND
|
Facility
|
IP
|
$430.50
|
|
| Hospital Charge Code |
270674414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.58
|
|
|
BURR ROUND L 2.0MM
|
Facility
|
IP
|
$283.50
|
|
| Hospital Charge Code |
270674619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.52
|
|