|
SCREW BONE CANNUL LP 6MM/3.2MM8
|
Facility
OP
|
$427.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$448.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$235.06
|
| 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 |
$213.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$245.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$448.75
|
| Rate for Payer: Group Health Inc Commercial |
$213.69
|
| Rate for Payer: Group Health Inc Medicare |
$149.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.80
|
|
|
SCREW BONE CANNUL LP 6MM/3.2MM9
|
Facility
OP
|
$427.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$448.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$235.06
|
| 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 |
$213.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$245.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$448.75
|
| Rate for Payer: Group Health Inc Commercial |
$213.69
|
| Rate for Payer: Group Health Inc Medicare |
$149.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.80
|
|
|
SCREW BONE CANNUL LP 6MM/3.2MM9
|
Facility
IP
|
$427.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.69 |
| Max. Negotiated Rate |
$213.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.69
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM1
|
Facility
IP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM1
|
Facility
OP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$644.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.84
|
| 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 |
$307.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.96
|
| Rate for Payer: Group Health Inc Commercial |
$307.12
|
| Rate for Payer: Group Health Inc Medicare |
$214.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.26
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM10
|
Facility
OP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$644.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.84
|
| 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 |
$307.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.96
|
| Rate for Payer: Group Health Inc Commercial |
$307.12
|
| Rate for Payer: Group Health Inc Medicare |
$214.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.26
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM10
|
Facility
IP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM2
|
Facility
OP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$644.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.84
|
| 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 |
$307.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.96
|
| Rate for Payer: Group Health Inc Commercial |
$307.12
|
| Rate for Payer: Group Health Inc Medicare |
$214.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.26
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM2
|
Facility
IP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM3
|
Facility
IP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM3
|
Facility
OP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$644.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.84
|
| 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 |
$307.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.96
|
| Rate for Payer: Group Health Inc Commercial |
$307.12
|
| Rate for Payer: Group Health Inc Medicare |
$214.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.26
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM4
|
Facility
OP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$644.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.84
|
| 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 |
$307.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.96
|
| Rate for Payer: Group Health Inc Commercial |
$307.12
|
| Rate for Payer: Group Health Inc Medicare |
$214.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.26
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM4
|
Facility
IP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM5
|
Facility
OP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$644.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.84
|
| 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 |
$307.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.96
|
| Rate for Payer: Group Health Inc Commercial |
$307.12
|
| Rate for Payer: Group Health Inc Medicare |
$214.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.26
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM5
|
Facility
IP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM6
|
Facility
OP
|
$614.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$645.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$338.11
|
| 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 |
$307.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$645.49
|
| Rate for Payer: Group Health Inc Commercial |
$307.38
|
| Rate for Payer: Group Health Inc Medicare |
$215.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.59
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM6
|
Facility
IP
|
$614.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.38 |
| Max. Negotiated Rate |
$307.38 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.38
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM7
|
Facility
IP
|
$614.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.38 |
| Max. Negotiated Rate |
$307.38 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.38
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM7
|
Facility
OP
|
$614.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$645.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$338.11
|
| 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 |
$307.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$645.49
|
| Rate for Payer: Group Health Inc Commercial |
$307.38
|
| Rate for Payer: Group Health Inc Medicare |
$215.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.59
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM8
|
Facility
OP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$644.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.84
|
| 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 |
$307.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.96
|
| Rate for Payer: Group Health Inc Commercial |
$307.12
|
| Rate for Payer: Group Health Inc Medicare |
$214.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.26
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM8
|
Facility
IP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM9
|
Facility
IP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
|
|
SCREW BONE CANNUL LP 8MM/4.75MM9
|
Facility
OP
|
$614.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$644.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.84
|
| 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 |
$307.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.96
|
| Rate for Payer: Group Health Inc Commercial |
$307.12
|
| Rate for Payer: Group Health Inc Medicare |
$214.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.26
|
|
|
SCREW BONE CANNUL LP 8MM DIA 6
|
Facility
OP
|
$607.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$638.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$334.26
|
| 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 |
$303.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$349.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$638.14
|
| Rate for Payer: Group Health Inc Commercial |
$303.88
|
| Rate for Payer: Group Health Inc Medicare |
$212.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$395.04
|
|
|
SCREW BONE CANNUL LP 8MM DIA 6
|
Facility
IP
|
$607.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.88 |
| Max. Negotiated Rate |
$303.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.88
|
|
