|
DRILL BIT QC 3.2x145MM STER
|
Facility
|
OP
|
$525.15
|
|
| Hospital Charge Code |
270681479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$262.57 |
| Rate for Payer: Aetna Commercial |
$199.56
|
| Rate for Payer: Aetna Medicare Advantage |
$157.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.91
|
| Rate for Payer: Cigna Commercial |
$262.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$136.54
|
| Rate for Payer: Oxford Commercial |
$105.03
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$105.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.91
|
|
|
DRILL BIT Q-C 3.5M DIA 110M
|
Facility
|
OP
|
$378.33
|
|
| Hospital Charge Code |
270661148
|
|
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 3.5M DIA 110M
|
Facility
|
IP
|
$378.33
|
|
| Hospital Charge Code |
270661148
|
|
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 QC 3.5x110MM
|
Facility
|
OP
|
$337.40
|
|
| Hospital Charge Code |
270601915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$168.70 |
| Rate for Payer: Aetna Commercial |
$128.21
|
| Rate for Payer: Aetna Medicare Advantage |
$101.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.04
|
| Rate for Payer: Cigna Commercial |
$168.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.72
|
| Rate for Payer: Oxford Commercial |
$67.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$67.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.58
|
|
|
DRILL BIT QC 3.5x110MM
|
Facility
|
IP
|
$337.40
|
|
| Hospital Charge Code |
270601915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$50.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.61
|
|
|
DRILL BIT QC 3.5x110MM STER
|
Facility
|
OP
|
$550.60
|
|
| Hospital Charge Code |
270678039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| Rate for Payer: Aetna Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.40
|
| Rate for Payer: Cigna Commercial |
$275.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.16
|
| Rate for Payer: Oxford Commercial |
$110.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|
|
DRILL BIT QC 3.5x110MM STER
|
Facility
|
IP
|
$550.60
|
|
| Hospital Charge Code |
270678039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$82.59 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
|
|
DRILL BIT QC 3.5x195MM
|
Facility
|
OP
|
$356.50
|
|
| Hospital Charge Code |
270604124
|
|
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 3.5x195MM
|
Facility
|
IP
|
$356.50
|
|
| Hospital Charge Code |
270604124
|
|
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 4.3x180MM
|
Facility
|
IP
|
$522.20
|
|
| Hospital Charge Code |
270637798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$78.33 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.33
|
|
|
DRILL BIT QC 4.3x180MM
|
Facility
|
OP
|
$522.20
|
|
| Hospital Charge Code |
270637798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$261.10 |
| Rate for Payer: Aetna Commercial |
$198.44
|
| Rate for Payer: Aetna Medicare Advantage |
$156.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.16
|
| Rate for Payer: Cigna Commercial |
$261.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.77
|
| Rate for Payer: Oxford Commercial |
$104.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$104.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.83
|
|
|
DRILL BIT QC 4.5X145MM 310.44
|
Facility
|
OP
|
$271.25
|
|
| Hospital Charge Code |
270619719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$135.62 |
| Rate for Payer: Aetna Commercial |
$103.08
|
| Rate for Payer: Aetna Medicare Advantage |
$81.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$69.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$69.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$69.17
|
| Rate for Payer: Cigna Commercial |
$135.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$70.53
|
| Rate for Payer: Oxford Commercial |
$54.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$54.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.70
|
|
|
DRILL BIT QC 4.5X145MM 310.44
|
Facility
|
IP
|
$271.25
|
|
| Hospital Charge Code |
270619719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$40.69
|
|
|
DRILL BIT QC 4.5x145MM STER
|
Facility
|
IP
|
$526.50
|
|
| Hospital Charge Code |
270681478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.97 |
| Max. Negotiated Rate |
$78.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.97
|
|
|
DRILL BIT QC 4.5x145MM STER
|
Facility
|
OP
|
$526.50
|
|
| Hospital Charge Code |
270681478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Aetna Commercial |
$200.07
|
| Rate for Payer: Aetna Medicare Advantage |
$157.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$134.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$134.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$134.26
|
| Rate for Payer: Cigna Commercial |
$263.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$136.89
|
| Rate for Payer: Oxford Commercial |
$105.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$105.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.95
|
|
|
DRILL BIT QC CALIBR 3.2X300MM
|
Facility
|
IP
|
$2,495.00
|
|
| Hospital Charge Code |
270699499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.25 |
| Max. Negotiated Rate |
$374.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$374.25
|
|
|
DRILL BIT QC CALIBR 3.2X300MM
|
Facility
|
OP
|
$2,495.00
|
|
| Hospital Charge Code |
270699499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$1,247.50 |
| Rate for Payer: Aetna Commercial |
$948.10
|
| Rate for Payer: Aetna Medicare Advantage |
$748.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$636.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$636.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$636.23
|
| Rate for Payer: Cigna Commercial |
$1,247.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$648.70
|
| Rate for Payer: Oxford Commercial |
$499.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$374.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$499.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.86
|
|
|
DRILL BIT QC CANNULAT 1.6X95MM
|
Facility
|
OP
|
$2,139.50
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270697772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$1,069.75 |
| Rate for Payer: Aetna Commercial |
$813.01
|
| Rate for Payer: Aetna Medicare Advantage |
$641.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$545.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$545.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$545.57
|
| Rate for Payer: Cigna Commercial |
$1,069.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$556.27
|
| Rate for Payer: Oxford Commercial |
$427.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$320.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$427.90
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.76
|
|
|
DRILL BIT QC CANNULAT 1.6X95MM
|
Facility
|
IP
|
$2,139.50
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
270697772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.93 |
| Max. Negotiated Rate |
$320.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$320.93
|
|
|
DRILL BIT QC GOLD 2.5x110MM
|
Facility
|
OP
|
$316.65
|
|
| Hospital Charge Code |
270601914
|
|
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 GOLD 2.5x110MM
|
Facility
|
IP
|
$316.65
|
|
| Hospital Charge Code |
270601914
|
|
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 GOLD 2.5x180MM
|
Facility
|
IP
|
$356.50
|
|
| Hospital Charge Code |
270604439
|
|
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 GOLD 2.5x180MM
|
Facility
|
OP
|
$356.50
|
|
| Hospital Charge Code |
270604439
|
|
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 ORANGE 2x125MM
|
Facility
|
IP
|
$324.00
|
|
| Hospital Charge Code |
270675735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.60
|
|
|
DRILL BIT QC ORANGE 2x125MM
|
Facility
|
OP
|
$324.00
|
|
| Hospital Charge Code |
270675735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna Medicare Advantage |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$82.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$82.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$82.62
|
| Rate for Payer: Cigna Commercial |
$162.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.24
|
| Rate for Payer: Oxford Commercial |
$64.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$48.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$64.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.20
|
|