|
BIT DRILL 4.2X130MM AO ST
|
Facility
IP
|
$227.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.50 |
| Max. Negotiated Rate |
$113.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.50
|
|
|
BIT DRILL 4.3MM DIA 315M AO703541
|
Facility
IP
|
$168.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$84.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.35
|
|
|
BIT DRILL 4.3MM DIA 315M AO703541
|
Facility
OP
|
$168.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.04 |
| Max. Negotiated Rate |
$177.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.78
|
| 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 |
$84.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$97.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$177.14
|
| Rate for Payer: Group Health Inc Commercial |
$84.35
|
| Rate for Payer: Group Health Inc Medicare |
$59.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.66
|
|
|
BIT DRILL 4.9MM DIA LARGE CAN
|
Facility
OP
|
$616.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$646.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$338.80
|
| 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 |
$308.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$354.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$646.80
|
| Rate for Payer: Group Health Inc Commercial |
$308.00
|
| Rate for Payer: Group Health Inc Medicare |
$215.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$308.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$400.40
|
|
|
BIT DRILL 4.9MM DIA LARGE CAN
|
Facility
IP
|
$616.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$308.00
|
|
|
BIT DRILL, AO DIA 2.0MM X 135MM
|
Facility
OP
|
$530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.50
|
| 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 |
$265.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$304.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$556.50
|
| Rate for Payer: Group Health Inc Commercial |
$265.00
|
| Rate for Payer: Group Health Inc Medicare |
$185.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$265.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$344.50
|
|
|
BIT DRILL, AO DIA 2.0MM X 135MM
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$329.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.70
|
| 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 |
$157.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.70
|
| Rate for Payer: Group Health Inc Commercial |
$157.00
|
| Rate for Payer: Group Health Inc Medicare |
$109.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.10
|
|
|
BIT DRILL, AO DIA 2.0MM X 135MM
|
Facility
IP
|
$530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.00 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$265.00
|
|
|
BIT DRILL, AO DIA 2.0MM X 135MM
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
|
|
BIT DRILL, AO DIA 2.6MM X 135MM
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$329.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.70
|
| 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 |
$157.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.70
|
| Rate for Payer: Group Health Inc Commercial |
$157.00
|
| Rate for Payer: Group Health Inc Medicare |
$109.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.10
|
|
|
BIT DRILL, AO DIA 2.6MM X 135MM
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.00
|
|
|
BIT DRILL CAN 2.7MM QK CONN
|
Facility
OP
|
$382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$401.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.10
|
| 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 |
$191.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$219.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$401.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.00
|
| Rate for Payer: Group Health Inc Medicare |
$133.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$248.30
|
|
|
BIT DRILL CAN 2.7MM QK CONN
|
Facility
IP
|
$382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.00 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.00
|
|
|
BIT DRILL CANLTD 4.3MM
|
Facility
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
| 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 |
$250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$287.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$325.00
|
|
|
BIT DRILL CANLTD 4.3MM
|
Facility
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
|
BIT DRILL CANNL'D 2.6MM
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
| 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 |
$87.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$183.75
|
| Rate for Payer: Group Health Inc Commercial |
$87.50
|
| Rate for Payer: Group Health Inc Medicare |
$61.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.75
|
|
|
BIT DRILL CANNL'D 2.6MM
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
|
|
BIT DRILL CENTRAL S/S
|
Facility
OP
|
$422.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$443.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$232.38
|
| 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 |
$211.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$242.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$443.62
|
| Rate for Payer: Group Health Inc Commercial |
$211.25
|
| Rate for Payer: Group Health Inc Medicare |
$147.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$274.62
|
|
|
BIT DRILL CENTRAL S/S
|
Facility
IP
|
$422.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.25 |
| Max. Negotiated Rate |
$211.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.25
|
|
|
BIT DRILL LOCKING SHORT 3.1X21
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.00 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$244.00
|
|
|
BIT DRILL LOCKING SHORT 3.1X21
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$512.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$268.40
|
| 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 |
$244.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$512.40
|
| Rate for Payer: Group Health Inc Commercial |
$244.00
|
| Rate for Payer: Group Health Inc Medicare |
$170.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$244.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$317.20
|
|
|
BIT, DRILL NCB 3.3, 195MM
|
Facility
OP
|
$358.00
|
|
| Hospital Charge Code |
40204571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.30 |
| Max. Negotiated Rate |
$286.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$179.00
|
| Rate for Payer: Aetna Government |
$179.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$286.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$243.44
|
| 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
|
|
|
BIT, DRILL NCB 3.3, 195MM
|
Facility
OP
|
$252.16
|
|
| Hospital Charge Code |
40006597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$201.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$126.08
|
| Rate for Payer: Aetna Government |
$126.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$201.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$171.47
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
BIT DRILL NON-LOCKING SHORT 2 025
|
Facility
IP
|
$816.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$408.00
|
|
|
BIT DRILL NON-LOCKING SHORT 2 025
|
Facility
OP
|
$816.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$856.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$448.80
|
| 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 |
$408.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$469.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$856.80
|
| Rate for Payer: Group Health Inc Commercial |
$408.00
|
| Rate for Payer: Group Health Inc Medicare |
$285.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$408.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$530.40
|
|
