|
SCREW BONE CANNUL 4MM DIA 42M
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902762
|
|
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 42M
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902762
|
|
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 42MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901968
|
|
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 42MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901968
|
|
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 44M
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903009
|
|
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 44M
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903009
|
|
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 44MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901965
|
|
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 44MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901965
|
|
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 46M
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902750
|
|
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 46M
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902750
|
|
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 46MM
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.00
|
| 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 |
$210.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$241.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$441.00
|
| Rate for Payer: Group Health Inc Commercial |
$210.00
|
| Rate for Payer: Group Health Inc Medicare |
$147.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.00
|
|
|
SCREW BONE CANNUL 4MM DIA 46MM
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.00
|
|
|
SCREW BONE CANNUL 4MM DIA 48M
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902720
|
|
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 48M
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902720
|
|
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 48MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901651
|
|
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 48MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901651
|
|
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 50M
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902763
|
|
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 50M
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902763
|
|
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 50MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901653
|
|
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 50MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901653
|
|
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 55M
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902939
|
|
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 55M
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902939
|
|
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 55MM
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901966
|
|
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 55MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901966
|
|
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 60MM
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901655
|
|
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
|
|
