|
SCREW BONE CANNUL 3MM 22MML T
|
Facility
OP
|
$450.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901960
|
|
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 38MML T
|
Facility
IP
|
$450.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902061
|
|
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 38MML T
|
Facility
OP
|
$450.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902061
|
|
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 40MML T
|
Facility
IP
|
$450.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902113
|
|
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 40MML T
|
Facility
OP
|
$450.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902113
|
|
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 4.0MM DIA 30MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
SCREW BONE CANNUL 4.0MM DIA 30MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| 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 |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
SCREW BONE CANNUL 4MM 36MML
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
SCREW BONE CANNUL 4MM 36MML
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| 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 |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
SCREW BONE CANNUL 4MM 65MML
|
Facility
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.50 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.50
|
|
|
SCREW BONE CANNUL 4MM 65MML
|
Facility
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,443.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$756.25
|
| 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 |
$687.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$790.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,443.75
|
| Rate for Payer: Group Health Inc Commercial |
$687.50
|
| Rate for Payer: Group Health Inc Medicare |
$481.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$893.75
|
|
|
SCREW BONE CANNUL 4MM DIA 28M
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| 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 |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
SCREW BONE CANNUL 4MM DIA 28M
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
SCREW BONE CANNUL 4MM DIA 28MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
SCREW BONE CANNUL 4MM DIA 28MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| 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 |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
SCREW BONE CANNUL 4MM DIA 32MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| 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 |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
SCREW BONE CANNUL 4MM DIA 32MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
SCREW BONE CANNUL 4MM DIA 34MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
SCREW BONE CANNUL 4MM DIA 34MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| 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 |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
SCREW BONE CANNUL 4MM DIA 38MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
SCREW BONE CANNUL 4MM DIA 38MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| 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 |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
SCREW BONE CANNUL 4MM DIA 40M
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
SCREW BONE CANNUL 4MM DIA 40M
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| 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 |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
SCREW BONE CANNUL 4MM DIA 40MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| 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 |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
SCREW BONE CANNUL 4MM DIA 40MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
