BIT DRILL QUICK 3.2MM X 20MM
|
Facility
OP
|
$300.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906718
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$105.00 |
Max. Negotiated Rate |
$315.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
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 |
$150.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$172.50
|
Rate for Payer: Fidelis Medicare Advantage |
$315.00
|
Rate for Payer: Group Health Inc Commercial |
$150.00
|
Rate for Payer: Group Health Inc Medicare |
$105.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.00
|
|
BIT DRILL QUICK 3.2MM X 20MM
|
Facility
IP
|
$300.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906718
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$150.00 |
Max. Negotiated Rate |
$150.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
|
BIT DRILL QUK-COUP 2.7X125MM
|
Facility
IP
|
$228.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40209005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$114.00 |
Max. Negotiated Rate |
$114.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$114.00
|
|
BIT DRILL QUK-COUP 2.7X125MM
|
Facility
OP
|
$228.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40209005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$79.80 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.40
|
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 |
$114.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$131.10
|
Rate for Payer: Fidelis Medicare Advantage |
$239.40
|
Rate for Payer: Group Health Inc Commercial |
$114.00
|
Rate for Payer: Group Health Inc Medicare |
$79.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$114.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.20
|
|
BIT DRILL TW 1.6MM X 5MM
|
Facility
OP
|
$193.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906929
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$67.86 |
Max. Negotiated Rate |
$203.57 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$106.63
|
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 |
$96.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$111.48
|
Rate for Payer: Fidelis Medicare Advantage |
$203.57
|
Rate for Payer: Group Health Inc Commercial |
$96.94
|
Rate for Payer: Group Health Inc Medicare |
$67.86
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$96.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.02
|
|
BIT DRILL TW 1.6MM X 5MM
|
Facility
IP
|
$193.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906929
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$96.94 |
Max. Negotiated Rate |
$96.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$96.94
|
|
BIT DRILL TWIST
|
Facility
IP
|
$367.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901342
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$183.75 |
Max. Negotiated Rate |
$183.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.75
|
|
BIT DRILL TWIST
|
Facility
OP
|
$367.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901342
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$128.62 |
Max. Negotiated Rate |
$385.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$202.12
|
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 |
$183.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$211.31
|
Rate for Payer: Fidelis Medicare Advantage |
$385.88
|
Rate for Payer: Group Health Inc Commercial |
$183.75
|
Rate for Payer: Group Health Inc Medicare |
$128.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.88
|
|
BIT DRILL TWIST 1.35 X 5MM
|
Facility
OP
|
$277.03
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903219
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$96.96 |
Max. Negotiated Rate |
$290.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$152.37
|
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 |
$138.52
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$159.29
|
Rate for Payer: Fidelis Medicare Advantage |
$290.88
|
Rate for Payer: Group Health Inc Commercial |
$138.52
|
Rate for Payer: Group Health Inc Medicare |
$96.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.52
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.07
|
|
BIT DRILL TWIST 1.35 X 5MM
|
Facility
IP
|
$277.03
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903219
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$138.52 |
Max. Negotiated Rate |
$138.52 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.52
|
|
BIT DRILL TWIST 1.4MM DIA 27M
|
Facility
IP
|
$187.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902566
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$93.75 |
Max. Negotiated Rate |
$93.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
|
BIT DRILL TWIST 1.4MM DIA 27M
|
Facility
OP
|
$187.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902566
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$65.62 |
Max. Negotiated Rate |
$196.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.12
|
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 |
$93.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$107.81
|
Rate for Payer: Fidelis Medicare Advantage |
$196.88
|
Rate for Payer: Group Health Inc Commercial |
$93.75
|
Rate for Payer: Group Health Inc Medicare |
$65.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.88
|
|
BIT DRILL TWIST 1.6MM 102
|
Facility
IP
|
$522.73
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904969
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$261.36 |
Max. Negotiated Rate |
$261.36 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$261.36
|
|
BIT DRILL TWIST 1.6MM 102
|
Facility
OP
|
$522.73
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904969
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$548.87 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$287.50
|
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 |
$261.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$300.57
|
Rate for Payer: Fidelis Medicare Advantage |
$548.87
|
Rate for Payer: Group Health Inc Commercial |
$261.36
|
Rate for Payer: Group Health Inc Medicare |
$182.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$261.36
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$339.77
|
|
BIT DRILL TWIST 1.9X70MM
|
Facility
OP
|
$367.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901339
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$128.62 |
Max. Negotiated Rate |
$385.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$202.12
|
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 |
$183.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$211.31
|
Rate for Payer: Fidelis Medicare Advantage |
$385.88
|
Rate for Payer: Group Health Inc Commercial |
$183.75
|
Rate for Payer: Group Health Inc Medicare |
$128.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.88
|
|
BIT DRILL TWIST 1.9X70MM
|
Facility
IP
|
$367.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901339
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$183.75 |
Max. Negotiated Rate |
$183.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.75
|
|
BIT DRILL TWIST 1MM DIA 22MML
|
Facility
OP
|
$187.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903636
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$65.62 |
Max. Negotiated Rate |
$196.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.12
|
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 |
$93.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$107.81
|
Rate for Payer: Fidelis Medicare Advantage |
$196.88
|
Rate for Payer: Group Health Inc Commercial |
$93.75
|
Rate for Payer: Group Health Inc Medicare |
$65.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.88
|
|
BIT DRILL TWIST 1MM DIA 22MML
|
Facility
IP
|
$187.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903636
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$93.75 |
Max. Negotiated Rate |
$93.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
|
BIT DRILL TWIST 2.5MM DIA 230
|
Facility
OP
|
$326.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902815
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$114.19 |
Max. Negotiated Rate |
$342.56 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.44
|
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 |
$163.12
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.59
|
Rate for Payer: Fidelis Medicare Advantage |
$342.56
|
Rate for Payer: Group Health Inc Commercial |
$163.12
|
Rate for Payer: Group Health Inc Medicare |
$114.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$163.12
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.06
|
|
BIT DRILL TWIST 2.5MM DIA 230
|
Facility
IP
|
$326.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902815
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$163.12 |
Max. Negotiated Rate |
$163.12 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$163.12
|
|
BIT DRILL TWIST 2.5MM DIA 285
|
Facility
OP
|
$385.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902634
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$404.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$211.75
|
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 |
$192.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$221.38
|
Rate for Payer: Fidelis Medicare Advantage |
$404.25
|
Rate for Payer: Group Health Inc Commercial |
$192.50
|
Rate for Payer: Group Health Inc Medicare |
$134.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$192.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.25
|
|
BIT DRILL TWIST 2.5MM DIA 285
|
Facility
IP
|
$385.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902634
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$192.50 |
Max. Negotiated Rate |
$192.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$192.50
|
|
BIT DRILL TWIST 2.6MM DIA 4.8
|
Facility
IP
|
$213.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901918
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$106.88 |
Max. Negotiated Rate |
$106.88 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$106.88
|
|
BIT DRILL TWIST 2.6MM DIA 4.8
|
Facility
OP
|
$213.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901918
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$74.81 |
Max. Negotiated Rate |
$224.44 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.56
|
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 |
$106.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.91
|
Rate for Payer: Fidelis Medicare Advantage |
$224.44
|
Rate for Payer: Group Health Inc Commercial |
$106.88
|
Rate for Payer: Group Health Inc Medicare |
$74.81
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$106.88
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.94
|
|
BIT DRILL TWIST 2.7MM DIA 125
|
Facility
OP
|
$262.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902541
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$91.88 |
Max. Negotiated Rate |
$275.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.38
|
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 |
$131.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$150.94
|
Rate for Payer: Fidelis Medicare Advantage |
$275.62
|
Rate for Payer: Group Health Inc Commercial |
$131.25
|
Rate for Payer: Group Health Inc Medicare |
$91.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$131.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.62
|
|