|
DRILL BIT 4.3mm
|
Facility
|
OP
|
$1,105.00
|
|
| Hospital Charge Code |
270663307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$552.50 |
| Rate for Payer: Aetna Commercial |
$419.90
|
| Rate for Payer: Aetna Medicare Advantage |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$281.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$281.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$281.77
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$287.30
|
| Rate for Payer: Oxford Commercial |
$221.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$221.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.38
|
|
|
DRILL BIT 4.3MM
|
Facility
|
IP
|
$906.00
|
|
| Hospital Charge Code |
270668425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.90 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.90
|
|
|
DRILL BIT 4.3MM
|
Facility
|
OP
|
$906.00
|
|
| Hospital Charge Code |
270668425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Aetna Commercial |
$344.28
|
| Rate for Payer: Aetna Medicare Advantage |
$271.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.03
|
| Rate for Payer: Cigna Commercial |
$453.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$235.56
|
| Rate for Payer: Oxford Commercial |
$181.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$181.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.73
|
|
|
DRILL BIT 4.3 MM X 44
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270688029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
DRILL BIT 4.3 MM X 44
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270688029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Oxford Commercial |
$85.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$85.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
DRILL BIT 4.3x365mm
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
270637230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
|
|
DRILL BIT 4.3x365mm
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
270637230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Medicare Advantage |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.38
|
| Rate for Payer: Cigna Commercial |
$412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.50
|
| Rate for Payer: Oxford Commercial |
$165.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$123.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$165.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
DRILL BIT 4.4MM F/6.5MM SCREWS
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
270674142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$319.20
|
| Rate for Payer: Aetna Medicare Advantage |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$214.20
|
| Rate for Payer: Cigna Commercial |
$420.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$218.40
|
| Rate for Payer: Oxford Commercial |
$168.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.86
|
|
|
DRILL BIT 4.4MM F/6.5MM SCREWS
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
270674142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.00
|
|
|
DRILL BIT 4.4MM FOR 6.5MM SRW
|
Facility
|
OP
|
$1,200.00
|
|
| Hospital Charge Code |
270673594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$456.00
|
| Rate for Payer: Aetna Medicare Advantage |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$306.00
|
| Rate for Payer: Cigna Commercial |
$600.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$312.00
|
| Rate for Payer: Oxford Commercial |
$240.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$180.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$240.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$37.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.08
|
|
|
DRILL BIT 4.4MM FOR 6.5MM SRW
|
Facility
|
IP
|
$1,200.00
|
|
| Hospital Charge Code |
270673594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$180.00
|
|
|
DRILL BIT 4.5
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270687874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
|
|
DRILL BIT 4.5
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270645690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.74 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$1,535.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$2,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,050.40
|
| Rate for Payer: Oxford Commercial |
$808.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$808.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$127.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$114.74
|
|
|
DRILL BIT 4.5
|
Facility
|
OP
|
$4,040.00
|
|
| Hospital Charge Code |
270687874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.74 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$1,535.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1,212.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,030.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$2,020.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,050.40
|
| Rate for Payer: Oxford Commercial |
$808.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$808.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$127.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$114.74
|
|
|
DRILL BIT 4.5
|
Facility
|
IP
|
$4,040.00
|
|
| Hospital Charge Code |
270645690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$606.00
|
|
|
DRILL BIT 4.5 MM
|
Facility
|
OP
|
$1,370.00
|
|
| Hospital Charge Code |
270668342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Aetna Commercial |
$520.60
|
| Rate for Payer: Aetna Medicare Advantage |
$411.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$349.35
|
| Rate for Payer: Cigna Commercial |
$685.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.20
|
| Rate for Payer: Oxford Commercial |
$274.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$274.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$43.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.91
|
|
|
DRILL BIT 4.5 MM
|
Facility
|
IP
|
$1,370.00
|
|
| Hospital Charge Code |
270668342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.50 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$205.50
|
|
|
DRILL BIT 4.5MM GPS
|
Facility
|
IP
|
$5,330.00
|
|
| Hospital Charge Code |
270693236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$799.50 |
| Max. Negotiated Rate |
$799.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$799.50
|
|
|
DRILL BIT 4.5MM GPS
|
Facility
|
OP
|
$5,330.00
|
|
| Hospital Charge Code |
270693236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.37 |
| Max. Negotiated Rate |
$2,665.00 |
| Rate for Payer: Aetna Commercial |
$2,025.40
|
| Rate for Payer: Aetna Medicare Advantage |
$1,599.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,359.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,359.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,359.15
|
| Rate for Payer: Cigna Commercial |
$2,665.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,385.80
|
| Rate for Payer: Oxford Commercial |
$1,066.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$799.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,066.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$168.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$151.37
|
|
|
DRILL BIT 4.8MM CORNER
|
Facility
|
OP
|
$2,005.00
|
|
| Hospital Charge Code |
270693697
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$1,002.50 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Medicare Advantage |
$601.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$511.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$511.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$511.27
|
| Rate for Payer: Cigna Commercial |
$1,002.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$521.30
|
| Rate for Payer: Oxford Commercial |
$401.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$401.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.94
|
|
|
DRILL BIT 4.8MM CORNER
|
Facility
|
IP
|
$2,005.00
|
|
| Hospital Charge Code |
270693697
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.75 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.75
|
|
|
DRILL BIT 4.8MM X 300MM
|
Facility
|
IP
|
$1,800.00
|
|
| Hospital Charge Code |
270680280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.00
|
|
|
DRILL BIT 4.8MM X 300MM
|
Facility
|
OP
|
$1,800.00
|
|
| Hospital Charge Code |
270680280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Medicare Advantage |
$540.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$459.00
|
| Rate for Payer: Cigna Commercial |
$900.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$468.00
|
| Rate for Payer: Oxford Commercial |
$360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$270.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$360.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$56.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$51.12
|
|
|
DRILL BIT 4.8x240MM
|
Facility
|
IP
|
$747.50
|
|
| Hospital Charge Code |
270656629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.12 |
| Max. Negotiated Rate |
$112.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.12
|
|
|
DRILL BIT 4.8x240MM
|
Facility
|
OP
|
$747.50
|
|
| Hospital Charge Code |
270656629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$373.75 |
| Rate for Payer: Aetna Commercial |
$284.05
|
| Rate for Payer: Aetna Medicare Advantage |
$224.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$190.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$190.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$190.61
|
| Rate for Payer: Cigna Commercial |
$373.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$194.35
|
| Rate for Payer: Oxford Commercial |
$149.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$149.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.62
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.23
|
|