|
BUR DIAMOND RND 5MM
|
Facility
|
IP
|
$621.00
|
|
| Hospital Charge Code |
270672679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
|
|
BUR DIAMOND RND 6MM
|
Facility
|
OP
|
$948.90
|
|
| Hospital Charge Code |
270672706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$474.45 |
| Rate for Payer: Aetna Commercial |
$360.58
|
| Rate for Payer: Aetna Medicare Advantage |
$284.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$241.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$241.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$241.97
|
| Rate for Payer: Cigna Commercial |
$474.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$246.71
|
| Rate for Payer: Oxford Commercial |
$189.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$189.78
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.95
|
|
|
BUR DIAMOND RND 6MM
|
Facility
|
IP
|
$948.90
|
|
| Hospital Charge Code |
270672706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.34 |
| Max. Negotiated Rate |
$142.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.34
|
|
|
BUR DIAMOND RND COARSE 2MM
|
Facility
|
OP
|
$621.00
|
|
| Hospital Charge Code |
270679193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: Aetna Medicare Advantage |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$158.35
|
| Rate for Payer: Cigna Commercial |
$310.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.46
|
| Rate for Payer: Oxford Commercial |
$124.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.64
|
|
|
BUR DIAMOND RND COARSE 2MM
|
Facility
|
IP
|
$621.00
|
|
| Hospital Charge Code |
270679193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
|
|
BUR DIAMOND RND COARSE 3MM
|
Facility
|
OP
|
$621.00
|
|
| Hospital Charge Code |
270672703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: Aetna Medicare Advantage |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$158.35
|
| Rate for Payer: Cigna Commercial |
$310.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.46
|
| Rate for Payer: Oxford Commercial |
$124.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.64
|
|
|
BUR DIAMOND RND COARSE 3MM
|
Facility
|
IP
|
$621.00
|
|
| Hospital Charge Code |
270672703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
|
|
BUR DIAMOND RND COARSE 4MM
|
Facility
|
OP
|
$621.00
|
|
| Hospital Charge Code |
270672704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: Aetna Medicare Advantage |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$158.35
|
| Rate for Payer: Cigna Commercial |
$310.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.46
|
| Rate for Payer: Oxford Commercial |
$124.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.64
|
|
|
BUR DIAMOND RND COARSE 4MM
|
Facility
|
IP
|
$621.00
|
|
| Hospital Charge Code |
270672704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
|
|
BUR DIAMOND RND COARSE 6MM
|
Facility
|
IP
|
$621.00
|
|
| Hospital Charge Code |
270679295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
|
|
BUR DIAMOND RND COARSE 6MM
|
Facility
|
OP
|
$621.00
|
|
| Hospital Charge Code |
270679294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: Aetna Medicare Advantage |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$158.35
|
| Rate for Payer: Cigna Commercial |
$310.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.46
|
| Rate for Payer: Oxford Commercial |
$124.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.64
|
|
|
BUR DIAMOND RND COARSE 6MM
|
Facility
|
IP
|
$621.00
|
|
| Hospital Charge Code |
270679294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
|
|
BUR DIAMOND RND COARSE 6MM
|
Facility
|
OP
|
$621.00
|
|
| Hospital Charge Code |
270679295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: Aetna Medicare Advantage |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$158.35
|
| Rate for Payer: Cigna Commercial |
$310.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.46
|
| Rate for Payer: Oxford Commercial |
$124.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.64
|
|
|
BUR DIAMOND ROUND 5MM
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270698414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
BUR DIAMOND ROUND 5MM
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270698414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Oxford Commercial |
$75.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.65
|
|
|
BUR DRILL NEURO 3.0X3.8MM
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
270698407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
|
|
BUR DRILL NEURO 3.0X3.8MM
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
270698407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$95.62
|
| Rate for Payer: Cigna Commercial |
$187.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Oxford Commercial |
$75.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$56.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.65
|
|
|
BUR EGG 5.0MM
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
270673894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
|
|
BUR EGG 5.0MM
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
270673894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Medicare Advantage |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.65
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$59.80
|
| Rate for Payer: Oxford Commercial |
$46.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$46.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.53
|
|
|
BUR EGG STANDARD 8 FLUTE 5.0MM
|
Facility
|
IP
|
$1,553.50
|
|
| Hospital Charge Code |
270658041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.03 |
| Max. Negotiated Rate |
$375.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$310.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$375.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$233.03
|
|
|
BUR EGG STANDARD 8 FLUTE 5.0MM
|
Facility
|
OP
|
$1,553.50
|
|
| Hospital Charge Code |
270658041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.12 |
| Max. Negotiated Rate |
$776.75 |
| Rate for Payer: Aetna Commercial |
$590.33
|
| Rate for Payer: Aetna Medicare Advantage |
$466.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$396.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$396.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$310.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$396.14
|
| Rate for Payer: Cigna Commercial |
$776.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$375.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$233.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$49.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$44.12
|
|
|
BUR FLUTED RND SFT TOUCH 2.0MM
|
Facility
|
IP
|
$607.50
|
|
| Hospital Charge Code |
270681017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.12 |
| Max. Negotiated Rate |
$91.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.12
|
|
|
BUR FLUTED RND SFT TOUCH 2.0MM
|
Facility
|
OP
|
$607.50
|
|
| Hospital Charge Code |
270681017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna Commercial |
$230.85
|
| Rate for Payer: Aetna Medicare Advantage |
$182.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$154.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$154.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$154.91
|
| Rate for Payer: Cigna Commercial |
$303.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$157.95
|
| Rate for Payer: Oxford Commercial |
$121.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$91.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$121.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.25
|
|
|
BUR FLUTED RND SFT TOUCH 4MM
|
Facility
|
OP
|
$621.00
|
|
| Hospital Charge Code |
270672677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna Commercial |
$235.98
|
| Rate for Payer: Aetna Medicare Advantage |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$158.35
|
| Rate for Payer: Cigna Commercial |
$310.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$161.46
|
| Rate for Payer: Oxford Commercial |
$124.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.64
|
|
|
BUR FLUTED RND SFT TOUCH 4MM
|
Facility
|
IP
|
$621.00
|
|
| Hospital Charge Code |
270672677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.15
|
|