BIT DRILL
|
Facility
OP
|
$455.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907232
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$477.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$250.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$227.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$261.62
|
Rate for Payer: Fidelis Medicare Advantage |
$477.75
|
Rate for Payer: Group Health Inc Commercial |
$227.50
|
Rate for Payer: Group Health Inc Medicare |
$159.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$227.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.75
|
|
BIT DRILL 1.0X50M 6M STOP-6010506
|
Facility
OP
|
$100.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906520
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$35.00 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.50
|
Rate for Payer: Fidelis Medicare Advantage |
$105.00
|
Rate for Payer: Group Health Inc Commercial |
$50.00
|
Rate for Payer: Group Health Inc Medicare |
$35.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.00
|
|
BIT DRILL 1.0X50M 6M STOP-6010506
|
Facility
IP
|
$100.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906520
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$50.00 |
Max. Negotiated Rate |
$50.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
BIT DRILL 1.2MM -6009504
|
Facility
OP
|
$219.22
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906695
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$76.73 |
Max. Negotiated Rate |
$230.18 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$120.57
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.61
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.05
|
Rate for Payer: Fidelis Medicare Advantage |
$230.18
|
Rate for Payer: Group Health Inc Commercial |
$109.61
|
Rate for Payer: Group Health Inc Medicare |
$76.73
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.61
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$109.61
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.49
|
|
BIT DRILL 1.2MM -6009504
|
Facility
IP
|
$219.22
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906695
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$109.61 |
Max. Negotiated Rate |
$109.61 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.61
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$109.61
|
|
BIT DRILL 1.3 X 54MM 12M STOP
|
Facility
IP
|
$101.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906466
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$50.50 |
Max. Negotiated Rate |
$50.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
|
BIT DRILL 1.3 X 54MM 12M STOP
|
Facility
OP
|
$101.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906466
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$35.35 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.08
|
Rate for Payer: Fidelis Medicare Advantage |
$106.05
|
Rate for Payer: Group Health Inc Commercial |
$50.50
|
Rate for Payer: Group Health Inc Medicare |
$35.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.65
|
|
BIT DRILL 1.5MM J-LATCH 110MM
|
Facility
IP
|
$272.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202437
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$136.00 |
Max. Negotiated Rate |
$136.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$136.00
|
|
BIT DRILL 1.5MM J-LATCH 110MM
|
Facility
OP
|
$272.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202437
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$95.20 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$149.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.40
|
Rate for Payer: Fidelis Medicare Advantage |
$285.60
|
Rate for Payer: Group Health Inc Commercial |
$136.00
|
Rate for Payer: Group Health Inc Medicare |
$95.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$136.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.80
|
|
BIT DRILL 1.5MM J LATCH 12MM
|
Facility
IP
|
$636.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202446
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$318.00 |
Max. Negotiated Rate |
$318.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$318.00
|
|
BIT DRILL 1.5MM J LATCH 12MM
|
Facility
OP
|
$636.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202446
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$222.60 |
Max. Negotiated Rate |
$667.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$365.70
|
Rate for Payer: Fidelis Medicare Advantage |
$667.80
|
Rate for Payer: Group Health Inc Commercial |
$318.00
|
Rate for Payer: Group Health Inc Medicare |
$222.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$318.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.40
|
|
BIT DRILL 1.6 X 26MM (6016526)
|
Facility
IP
|
$126.72
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906404
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$63.36 |
Max. Negotiated Rate |
$63.36 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$63.36
|
|
BIT DRILL 1.6 X 26MM (6016526)
|
Facility
OP
|
$126.72
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906404
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.35 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.86
|
Rate for Payer: Fidelis Medicare Advantage |
$133.06
|
Rate for Payer: Group Health Inc Commercial |
$63.36
|
Rate for Payer: Group Health Inc Medicare |
$44.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$63.36
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.37
|
|
BIT DRILL 1.6 X 35MM
|
Facility
OP
|
$438.58
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906772
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$460.51 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$241.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$219.29
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$252.18
|
Rate for Payer: Fidelis Medicare Advantage |
$460.51
|
Rate for Payer: Group Health Inc Commercial |
$219.29
|
Rate for Payer: Group Health Inc Medicare |
$153.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.29
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$219.29
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.08
|
|
BIT DRILL 1.6 X 35MM
|
Facility
IP
|
$438.58
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906772
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$219.29 |
Max. Negotiated Rate |
$219.29 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.29
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$219.29
|
|
BIT DRILL 1.8 X 125 CALIB
|
Facility
OP
|
$358.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205074
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$125.30 |
Max. Negotiated Rate |
$375.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$179.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$205.85
|
Rate for Payer: Fidelis Medicare Advantage |
$375.90
|
Rate for Payer: Group Health Inc Commercial |
$179.00
|
Rate for Payer: Group Health Inc Medicare |
$125.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.70
|
|
BIT DRILL 1.8 X 125 CALIB
|
Facility
IP
|
$358.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205074
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$179.00 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
|
BIT DRILL 2.0 882701
|
Facility
OP
|
$170.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906646
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$59.50 |
Max. Negotiated Rate |
$178.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$97.75
|
Rate for Payer: Fidelis Medicare Advantage |
$178.50
|
Rate for Payer: Group Health Inc Commercial |
$85.00
|
Rate for Payer: Group Health Inc Medicare |
$59.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$85.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.50
|
|
BIT DRILL 2.0 882701
|
Facility
IP
|
$170.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906646
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$85.00 |
Max. Negotiated Rate |
$85.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$85.00
|
|
BIT DRILL 2.0M CALBRATED 894316
|
Facility
IP
|
$190.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906652
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$95.00 |
Max. Negotiated Rate |
$95.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
|
BIT DRILL 2.0M CALBRATED 894316
|
Facility
OP
|
$190.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906652
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$66.50 |
Max. Negotiated Rate |
$199.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$95.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$109.25
|
Rate for Payer: Fidelis Medicare Advantage |
$199.50
|
Rate for Payer: Group Health Inc Commercial |
$95.00
|
Rate for Payer: Group Health Inc Medicare |
$66.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.50
|
|
BIT DRILL 2.0MM CALIBRTD
|
Facility
IP
|
$390.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906901
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$195.00 |
Max. Negotiated Rate |
$195.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
BIT DRILL 2.0MM CALIBRTD
|
Facility
OP
|
$390.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906901
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$409.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
Rate for Payer: Group Health Inc Commercial |
$195.00
|
Rate for Payer: Group Health Inc Medicare |
$136.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
BIT DRILL 2.2MM DIA 100MML F/
|
Facility
IP
|
$152.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906560
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$76.00 |
Max. Negotiated Rate |
$76.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$76.00
|
|
BIT DRILL 2.2MM DIA 100MML F/
|
Facility
OP
|
$152.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906560
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$53.20 |
Max. Negotiated Rate |
$159.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$76.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.40
|
Rate for Payer: Fidelis Medicare Advantage |
$159.60
|
Rate for Payer: Group Health Inc Commercial |
$76.00
|
Rate for Payer: Group Health Inc Medicare |
$53.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$76.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.80
|
|