|
DRILL STRAIGHT 3.0
|
Facility
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907512
|
|
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
|
|
|
DRILL STRAIGHT 3.0
|
Facility
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907512
|
|
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
|
|
|
DRILL SURG 3.2MM DIA 200MML
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.00
|
| 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 |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$92.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.00
|
| Rate for Payer: Group Health Inc Commercial |
$80.00
|
| Rate for Payer: Group Health Inc Medicare |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.00
|
|
|
DRILL SURG 3.2MM DIA 200MML
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
|
|
DRILL SURG 4.2MM DIA 180MML
|
Facility
OP
|
$252.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.22 |
| Max. Negotiated Rate |
$264.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.63
|
| 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 |
$126.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.66
|
| Rate for Payer: Group Health Inc Commercial |
$126.03
|
| Rate for Payer: Group Health Inc Medicare |
$88.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.84
|
|
|
DRILL SURG 4.2MM DIA 180MML
|
Facility
IP
|
$252.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.03 |
| Max. Negotiated Rate |
$126.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.03
|
|
|
DRILL SURG 4.2MM DIA 340MML
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.25
|
| 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 |
$67.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.75
|
| Rate for Payer: Group Health Inc Commercial |
$67.50
|
| Rate for Payer: Group Health Inc Medicare |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.75
|
|
|
DRILL SURG 4.2MM DIA 340MML
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
|
|
DRILL SURG CANNUL 2.1MM DIA 005S
|
Facility
OP
|
$242.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$254.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.21
|
| 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 |
$121.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$139.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$254.31
|
| Rate for Payer: Group Health Inc Commercial |
$121.10
|
| Rate for Payer: Group Health Inc Medicare |
$84.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.43
|
|
|
DRILL SURG CANNUL 2.1MM DIA 005S
|
Facility
IP
|
$242.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$121.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.10
|
|
|
DRILL SURGICAL TWIST 4.5MM DIA
|
Facility
OP
|
$322.50
|
|
| Hospital Charge Code |
64905068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$177.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$161.25
|
| Rate for Payer: Aetna Government |
$161.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$258.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$219.30
|
| Rate for Payer: Group Health Inc Commercial |
$161.25
|
| Rate for Payer: Group Health Inc Medicare |
$112.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.25
|
|
|
DRILL SURG SOLD F/LAG SCREW 3026S
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.00
|
|
|
DRILL SURG SOLD F/LAG SCREW 3026S
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$344.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$180.40
|
| 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 |
$164.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$188.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$344.40
|
| Rate for Payer: Group Health Inc Commercial |
$164.00
|
| Rate for Payer: Group Health Inc Medicare |
$114.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.20
|
|
|
DRILL SURG TWIST 1.6 35MM
|
Facility
OP
|
$294.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.16 |
| Max. Negotiated Rate |
$309.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$162.11
|
| 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 |
$147.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$169.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$309.49
|
| Rate for Payer: Group Health Inc Commercial |
$147.38
|
| Rate for Payer: Group Health Inc Medicare |
$103.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.59
|
|
|
DRILL SURG TWIST 1.6 35MM
|
Facility
IP
|
$294.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.38 |
| Max. Negotiated Rate |
$147.38 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.38
|
|
|
DRILL SURG TWIST 1.9MM DIA
|
Facility
IP
|
$187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903190
|
|
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
|
|
|
DRILL SURG TWIST 1.9MM DIA
|
Facility
OP
|
$187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903190
|
|
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
|
|
|
DRILL TW / 1.6 5MM STOP
|
Facility
OP
|
$251.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$264.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.53
|
| 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 |
$125.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.47
|
| Rate for Payer: Group Health Inc Commercial |
$125.94
|
| Rate for Payer: Group Health Inc Medicare |
$88.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.72
|
|
|
DRILL TW / 1.6 5MM STOP
|
Facility
IP
|
$251.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.94 |
| Max. Negotiated Rate |
$125.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.94
|
|
|
DRILL TW / 1.6 85MM 26
|
Facility
OP
|
$273.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.74 |
| Max. Negotiated Rate |
$287.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$150.44
|
| 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 |
$136.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$157.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.21
|
| Rate for Payer: Group Health Inc Commercial |
$136.76
|
| Rate for Payer: Group Health Inc Medicare |
$95.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$177.79
|
|
|
DRILL TW / 1.6 85MM 26
|
Facility
IP
|
$273.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.76 |
| Max. Negotiated Rate |
$136.76 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.76
|
|
|
DRILL TWIST 1.1X50MM 5MM STOP
|
Facility
IP
|
$327.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.54 |
| Max. Negotiated Rate |
$163.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.54
|
|
|
DRILL TWIST 1.1X50MM 5MM STOP
|
Facility
OP
|
$327.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$343.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.89
|
| 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 |
$163.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$188.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$343.43
|
| Rate for Payer: Group Health Inc Commercial |
$163.54
|
| Rate for Payer: Group Health Inc Medicare |
$114.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.60
|
|
|
DRILL TWIST 1.5
|
Facility
IP
|
$347.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.75 |
| Max. Negotiated Rate |
$173.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.75
|
|
|
DRILL TWIST 1.5
|
Facility
OP
|
$347.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$364.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.12
|
| 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 |
$173.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$199.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$364.88
|
| Rate for Payer: Group Health Inc Commercial |
$173.75
|
| Rate for Payer: Group Health Inc Medicare |
$121.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.88
|
|
