DRILL BONE
|
Facility
OP
|
$1,620.00
|
|
Hospital Charge Code |
64907403
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$567.00 |
Max. Negotiated Rate |
$1,296.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$891.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$810.00
|
Rate for Payer: Aetna Government |
$810.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,296.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,101.60
|
Rate for Payer: Group Health Inc Commercial |
$810.00
|
Rate for Payer: Group Health Inc Medicare |
$567.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$810.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$810.00
|
|
DRILL CANN 2.1MM
|
Facility
IP
|
$400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202436
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$200.00 |
Max. Negotiated Rate |
$200.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
|
DRILL CANN 2.1MM
|
Facility
OP
|
$400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202436
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$140.00 |
Max. Negotiated Rate |
$420.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
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 |
$200.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.00
|
Rate for Payer: Fidelis Medicare Advantage |
$420.00
|
Rate for Payer: Group Health Inc Commercial |
$200.00
|
Rate for Payer: Group Health Inc Medicare |
$140.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.00
|
|
DRILL CANN 3.5MM
|
Facility
OP
|
$367.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205085
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$128.45 |
Max. Negotiated Rate |
$385.35 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$201.85
|
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 |
$183.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$211.02
|
Rate for Payer: Fidelis Medicare Advantage |
$385.35
|
Rate for Payer: Group Health Inc Commercial |
$183.50
|
Rate for Payer: Group Health Inc Medicare |
$128.45
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.55
|
|
DRILL CANN 3.5MM
|
Facility
IP
|
$367.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205085
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$183.50 |
Max. Negotiated Rate |
$183.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.50
|
|
DRILL, CANN AO 2.3X120MM
|
Facility
OP
|
$393.93
|
|
Hospital Charge Code |
40004429
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$137.88 |
Max. Negotiated Rate |
$315.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.66
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$196.96
|
Rate for Payer: Aetna Government |
$196.96
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$315.14
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$267.87
|
Rate for Payer: Group Health Inc Commercial |
$196.96
|
Rate for Payer: Group Health Inc Medicare |
$137.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.96
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.96
|
|
DRILL CANN DIST 2.7
|
Facility
IP
|
$1,037.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907470
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$518.75 |
Max. Negotiated Rate |
$518.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$518.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$518.75
|
|
DRILL CANN DIST 2.7
|
Facility
OP
|
$1,037.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907470
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,089.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$570.62
|
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 |
$518.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$596.56
|
Rate for Payer: Fidelis Medicare Advantage |
$1,089.38
|
Rate for Payer: Group Health Inc Commercial |
$518.75
|
Rate for Payer: Group Health Inc Medicare |
$363.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$518.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$518.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$674.38
|
|
DRILL CANNLTD POLY 2.0
|
Facility
OP
|
$335.00
|
|
Hospital Charge Code |
64907051
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$117.25 |
Max. Negotiated Rate |
$268.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$184.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$167.50
|
Rate for Payer: Aetna Government |
$167.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$268.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$227.80
|
Rate for Payer: Group Health Inc Commercial |
$167.50
|
Rate for Payer: Group Health Inc Medicare |
$117.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$167.50
|
|
DRILL CANNULATED 4MM (AR-8973-40S
|
Facility
OP
|
$300.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906563
|
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
|
|
DRILL CANNULATED 4MM (AR-8973-40S
|
Facility
IP
|
$300.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906563
|
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
|
|
DRILL CORKSCREW KNOTLESS
|
Facility
OP
|
$262.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907365
|
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
|
|
DRILL CORKSCREW KNOTLESS
|
Facility
IP
|
$262.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907365
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$131.25 |
Max. Negotiated Rate |
$131.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$131.25
|
|
DRILL CROWN 04
|
Facility
IP
|
$1,283.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005911
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$641.50 |
Max. Negotiated Rate |
$641.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.50
|
|
DRILL CROWN 04
|
Facility
OP
|
$1,283.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005911
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,347.15 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$705.65
|
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 |
$641.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$737.72
|
Rate for Payer: Fidelis Medicare Advantage |
$1,347.15
|
Rate for Payer: Group Health Inc Commercial |
$641.50
|
Rate for Payer: Group Health Inc Medicare |
$449.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$833.95
|
|
DRILL DEEPDGUIDE DIA 2.0MM L30MM
|
Facility
IP
|
$310.31
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906392
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$155.16 |
Max. Negotiated Rate |
$155.16 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$155.16
|
|
DRILL DEEPDGUIDE DIA 2.0MM L30MM
|
Facility
OP
|
$310.31
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906392
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$108.61 |
Max. Negotiated Rate |
$325.83 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$170.67
|
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 |
$155.16
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.43
|
Rate for Payer: Fidelis Medicare Advantage |
$325.83
|
Rate for Payer: Group Health Inc Commercial |
$155.16
|
Rate for Payer: Group Health Inc Medicare |
$108.61
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$155.16
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.70
|
|
DRILL END 1.6X115MM
|
Facility
OP
|
$219.29
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906226
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$76.75 |
Max. Negotiated Rate |
$230.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$120.61
|
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 |
$109.64
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.09
|
Rate for Payer: Fidelis Medicare Advantage |
$230.25
|
Rate for Payer: Group Health Inc Commercial |
$109.64
|
Rate for Payer: Group Health Inc Medicare |
$76.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.64
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$109.64
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.54
|
|
DRILL END 1.6X115MM
|
Facility
IP
|
$219.29
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906226
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$109.64 |
Max. Negotiated Rate |
$109.64 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.64
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$109.64
|
|
DRILL FIXED
|
Facility
OP
|
$1,041.25
|
|
Hospital Charge Code |
64907343
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$364.44 |
Max. Negotiated Rate |
$833.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$572.69
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$520.62
|
Rate for Payer: Aetna Government |
$520.62
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$833.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$708.05
|
Rate for Payer: Group Health Inc Commercial |
$520.62
|
Rate for Payer: Group Health Inc Medicare |
$364.44
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$520.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$520.62
|
|
DRILL FLEX 8MM 88088
|
Facility
OP
|
$1,317.52
|
|
Hospital Charge Code |
64906736
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$461.13 |
Max. Negotiated Rate |
$1,054.02 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$724.64
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$658.76
|
Rate for Payer: Aetna Government |
$658.76
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,054.02
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$895.91
|
Rate for Payer: Group Health Inc Commercial |
$658.76
|
Rate for Payer: Group Health Inc Medicare |
$461.13
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$658.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$658.76
|
|
DRILL FLEX ANCHOR-C 10M-48328810
|
Facility
OP
|
$1,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906583
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,050.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
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 |
$500.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$575.00
|
Rate for Payer: Fidelis Medicare Advantage |
$1,050.00
|
Rate for Payer: Group Health Inc Commercial |
$500.00
|
Rate for Payer: Group Health Inc Medicare |
$350.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$500.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$650.00
|
|
DRILL FLEX ANCHOR-C 10M-48328810
|
Facility
IP
|
$1,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906583
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$500.00 |
Max. Negotiated Rate |
$500.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$500.00
|
|
DRILL FLIPCUTTER
|
Facility
OP
|
$1,037.50
|
|
Hospital Charge Code |
64907429
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$363.12 |
Max. Negotiated Rate |
$830.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$570.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$518.75
|
Rate for Payer: Aetna Government |
$518.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$830.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$705.50
|
Rate for Payer: Group Health Inc Commercial |
$518.75
|
Rate for Payer: Group Health Inc Medicare |
$363.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$518.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$518.75
|
|
DRILL FREEHAND(2351-4218S)
|
Facility
OP
|
$406.00
|
|
Hospital Charge Code |
64906344
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$142.10 |
Max. Negotiated Rate |
$324.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$223.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$203.00
|
Rate for Payer: Aetna Government |
$203.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$324.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$276.08
|
Rate for Payer: Group Health Inc Commercial |
$203.00
|
Rate for Payer: Group Health Inc Medicare |
$142.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$203.00
|
|