|
DRILL BIT Q-C 2.0MMX100MM
|
Facility
|
IP
|
$455.00
|
|
| Hospital Charge Code |
270697190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.25
|
|
|
DRILL BIT Q-C 2.0MMX100MM
|
Facility
|
OP
|
$455.00
|
|
| Hospital Charge Code |
270697190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Medicare Advantage |
$136.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$116.03
|
| Rate for Payer: Cigna Commercial |
$227.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.30
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$91.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.92
|
|
|
DRILL BIT QC 2.0x100mm
|
Facility
|
IP
|
$534.55
|
|
| Hospital Charge Code |
270650975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$80.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
|
|
DRILL BIT QC 2.0x100mm
|
Facility
|
OP
|
$534.55
|
|
| Hospital Charge Code |
270650975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$267.27 |
| Rate for Payer: Aetna Commercial |
$203.13
|
| Rate for Payer: Aetna Medicare Advantage |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.31
|
| Rate for Payer: Cigna Commercial |
$267.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$138.98
|
| Rate for Payer: Oxford Commercial |
$106.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$106.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.18
|
|
|
DRILL BIT QC 2.0x125MM
|
Facility
|
IP
|
$356.50
|
|
| Hospital Charge Code |
270604120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$53.48 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.48
|
|
|
DRILL BIT QC 2.0x125MM
|
Facility
|
OP
|
$356.50
|
|
| Hospital Charge Code |
270604120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$178.25 |
| Rate for Payer: Aetna Commercial |
$135.47
|
| Rate for Payer: Aetna Medicare Advantage |
$106.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.91
|
| Rate for Payer: Cigna Commercial |
$178.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$92.69
|
| Rate for Payer: Oxford Commercial |
$71.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$71.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.12
|
|
|
DRILL BIT QC 2.4X100MM
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270660914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Aetna Commercial |
$473.10
|
| Rate for Payer: Aetna Medicare Advantage |
$373.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$317.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$317.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$317.48
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$323.70
|
| Rate for Payer: Oxford Commercial |
$249.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$249.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.36
|
|
|
DRILL BIT QC 2.4X100MM
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270660914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.75 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.75
|
|
|
DRILL BIT Q-C 2.5MM DIA 110
|
Facility
|
OP
|
$378.33
|
|
| Hospital Charge Code |
270661151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$189.16 |
| Rate for Payer: Aetna Commercial |
$143.77
|
| Rate for Payer: Aetna Medicare Advantage |
$113.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$96.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$96.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$96.47
|
| Rate for Payer: Cigna Commercial |
$189.16
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.37
|
| Rate for Payer: Oxford Commercial |
$75.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.67
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.74
|
|
|
DRILL BIT Q-C 2.5MM DIA 110
|
Facility
|
IP
|
$378.33
|
|
| Hospital Charge Code |
270661151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$56.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.75
|
|
|
DRILL BIT Q-C 2.7MMX100MM
|
Facility
|
IP
|
$455.00
|
|
| Hospital Charge Code |
270697189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.25
|
|
|
DRILL BIT Q-C 2.7MMX100MM
|
Facility
|
OP
|
$455.00
|
|
| Hospital Charge Code |
270697189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Medicare Advantage |
$136.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$116.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$116.03
|
| Rate for Payer: Cigna Commercial |
$227.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.30
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$68.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$91.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.92
|
|
|
DRILL BIT QC 2.7x100MM
|
Facility
|
IP
|
$316.65
|
|
| Hospital Charge Code |
270604122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.50
|
|
|
DRILL BIT QC 2.7x100MM
|
Facility
|
OP
|
$316.65
|
|
| Hospital Charge Code |
270604122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$158.32 |
| Rate for Payer: Aetna Commercial |
$120.33
|
| Rate for Payer: Aetna Medicare Advantage |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$80.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$80.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$80.75
|
| Rate for Payer: Cigna Commercial |
$158.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.33
|
| Rate for Payer: Oxford Commercial |
$63.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$47.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$63.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.99
|
|
|
DRILL BIT QC 2.7x125MM
|
Facility
|
IP
|
$346.10
|
|
| Hospital Charge Code |
270604123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.91 |
| Max. Negotiated Rate |
$51.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.91
|
|
|
DRILL BIT QC 2.7x125MM
|
Facility
|
OP
|
$346.10
|
|
| Hospital Charge Code |
270604123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$173.05 |
| Rate for Payer: Aetna Commercial |
$131.52
|
| Rate for Payer: Aetna Medicare Advantage |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$88.26
|
| Rate for Payer: Cigna Commercial |
$173.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$89.99
|
| Rate for Payer: Oxford Commercial |
$69.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$69.22
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.83
|
|
|
DRILL BIT QC 2.8x165MM
|
Facility
|
IP
|
$394.65
|
|
| Hospital Charge Code |
270660400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$59.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.20
|
|
|
DRILL BIT QC 2.8x165MM
|
Facility
|
OP
|
$394.65
|
|
| Hospital Charge Code |
270660400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$197.32 |
| Rate for Payer: Aetna Commercial |
$149.97
|
| Rate for Payer: Aetna Medicare Advantage |
$118.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$100.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$100.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$100.64
|
| Rate for Payer: Cigna Commercial |
$197.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.61
|
| Rate for Payer: Oxford Commercial |
$78.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$78.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.21
|
|
|
DRILL BIT QC 2.8x165MM
|
Facility
|
OP
|
$394.65
|
|
| Hospital Charge Code |
270633523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$197.32 |
| Rate for Payer: Aetna Commercial |
$149.97
|
| Rate for Payer: Aetna Medicare Advantage |
$118.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$100.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$100.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$100.64
|
| Rate for Payer: Cigna Commercial |
$197.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.61
|
| Rate for Payer: Oxford Commercial |
$78.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$78.93
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.21
|
|
|
DRILL BIT QC 2.8x165MM
|
Facility
|
IP
|
$394.65
|
|
| Hospital Charge Code |
270633523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$59.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.20
|
|
|
DRILL BIT QC 2.9x150MM
|
Facility
|
IP
|
$372.00
|
|
| Hospital Charge Code |
270675549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$90.02 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.80
|
|
|
DRILL BIT QC 2.9x150MM
|
Facility
|
OP
|
$372.00
|
|
| Hospital Charge Code |
270675549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna Commercial |
$141.36
|
| Rate for Payer: Aetna Medicare Advantage |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$94.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$94.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$94.86
|
| Rate for Payer: Cigna Commercial |
$186.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.56
|
|
|
DRILL BIT QC 3.2x145MM
|
Facility
|
OP
|
$311.90
|
|
| Hospital Charge Code |
270606029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$155.95 |
| Rate for Payer: Aetna Commercial |
$118.52
|
| Rate for Payer: Aetna Medicare Advantage |
$93.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$79.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$79.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$79.53
|
| Rate for Payer: Cigna Commercial |
$155.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.09
|
| Rate for Payer: Oxford Commercial |
$62.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$62.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.86
|
|
|
DRILL BIT QC 3.2x145MM
|
Facility
|
IP
|
$311.90
|
|
| Hospital Charge Code |
270606029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.78 |
| Max. Negotiated Rate |
$46.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.78
|
|
|
DRILL BIT QC 3.2x145MM STER
|
Facility
|
IP
|
$525.15
|
|
| Hospital Charge Code |
270681479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.77 |
| Max. Negotiated Rate |
$78.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.77
|
|