SCREW BONE CANNUL 2MM 11MML T
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902422
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 2MM 11MML T
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902422
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 2MM 12MML T
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902424
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 2MM 12MML T
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902424
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 2MM 14MML T
|
Facility
OP
|
$484.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902315
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$508.99 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$266.61
|
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 |
$242.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$278.73
|
Rate for Payer: Fidelis Medicare Advantage |
$508.99
|
Rate for Payer: Group Health Inc Commercial |
$242.38
|
Rate for Payer: Group Health Inc Medicare |
$169.66
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$242.38
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$315.09
|
|
SCREW BONE CANNUL 2MM 14MML T
|
Facility
IP
|
$484.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902315
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$242.38 |
Max. Negotiated Rate |
$242.38 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$242.38
|
|
SCREW BONE CANNUL 2MM 16MML
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902021
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 2MM 16MML
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902021
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 2MM 18MML T
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902107
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 2MM 18MML T
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902107
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 2MM 20MML T
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902109
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 2MM 20MML T
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902109
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 2MM 8MML TI
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902420
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 2MM 8MML TI
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902420
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 3.0MM 5/6
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905591
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 3.0MM 5/6
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905591
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 3MM 14MML T
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902026
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 3MM 14MML T
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902026
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 3MM 16MML T
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901901
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 3MM 16MML T
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901901
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 3MM 18MML T
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901903
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 3MM 18MML T
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901903
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 3MM 20MML T
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901905
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW BONE CANNUL 3MM 20MML T
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901905
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW BONE CANNUL 3MM 22MML T
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901960
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|