SCRW 3.5MM CORTEX S-TAP 36MM
|
Facility
OP
|
$34.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200256
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$12.08 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.98
|
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 |
$17.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.84
|
Rate for Payer: Fidelis Medicare Advantage |
$36.22
|
Rate for Payer: Group Health Inc Commercial |
$17.25
|
Rate for Payer: Group Health Inc Medicare |
$12.08
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.42
|
|
SCRW 3.5MM CORTEX S-TAP 36MM
|
Facility
IP
|
$34.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200256
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.25 |
Max. Negotiated Rate |
$17.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.25
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM1
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901425
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.44 |
Max. Negotiated Rate |
$28.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM1
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901425
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$19.91 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.28
|
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 |
$28.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.71
|
Rate for Payer: Fidelis Medicare Advantage |
$59.72
|
Rate for Payer: Group Health Inc Commercial |
$28.44
|
Rate for Payer: Group Health Inc Medicare |
$19.91
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.97
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM10
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902300
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$19.91 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.28
|
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 |
$28.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.71
|
Rate for Payer: Fidelis Medicare Advantage |
$59.72
|
Rate for Payer: Group Health Inc Commercial |
$28.44
|
Rate for Payer: Group Health Inc Medicare |
$19.91
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.97
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM10
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902300
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.44 |
Max. Negotiated Rate |
$28.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM11
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902759
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$19.91 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.28
|
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 |
$28.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.71
|
Rate for Payer: Fidelis Medicare Advantage |
$59.72
|
Rate for Payer: Group Health Inc Commercial |
$28.44
|
Rate for Payer: Group Health Inc Medicare |
$19.91
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.97
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM11
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902759
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.44 |
Max. Negotiated Rate |
$28.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM12
|
Facility
IP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903049
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM12
|
Facility
OP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903049
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.48 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.18
|
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 |
$29.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.64
|
Rate for Payer: Fidelis Medicare Advantage |
$61.42
|
Rate for Payer: Group Health Inc Commercial |
$29.25
|
Rate for Payer: Group Health Inc Medicare |
$20.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.02
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM14
|
Facility
IP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903198
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM14
|
Facility
OP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903198
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.48 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.18
|
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 |
$29.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.64
|
Rate for Payer: Fidelis Medicare Advantage |
$61.42
|
Rate for Payer: Group Health Inc Commercial |
$29.25
|
Rate for Payer: Group Health Inc Medicare |
$20.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.02
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM19
|
Facility
IP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903516
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM19
|
Facility
OP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903516
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.48 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.18
|
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 |
$29.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.64
|
Rate for Payer: Fidelis Medicare Advantage |
$61.42
|
Rate for Payer: Group Health Inc Commercial |
$29.25
|
Rate for Payer: Group Health Inc Medicare |
$20.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.02
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM2
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901427
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$19.91 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.28
|
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 |
$28.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.71
|
Rate for Payer: Fidelis Medicare Advantage |
$59.72
|
Rate for Payer: Group Health Inc Commercial |
$28.44
|
Rate for Payer: Group Health Inc Medicare |
$19.91
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.97
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM2
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901427
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.44 |
Max. Negotiated Rate |
$28.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM20
|
Facility
IP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903518
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM20
|
Facility
OP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903518
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.48 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.18
|
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 |
$29.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.64
|
Rate for Payer: Fidelis Medicare Advantage |
$61.42
|
Rate for Payer: Group Health Inc Commercial |
$29.25
|
Rate for Payer: Group Health Inc Medicare |
$20.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.02
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM21
|
Facility
OP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904195
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.48 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.18
|
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 |
$29.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.64
|
Rate for Payer: Fidelis Medicare Advantage |
$61.42
|
Rate for Payer: Group Health Inc Commercial |
$29.25
|
Rate for Payer: Group Health Inc Medicare |
$20.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.02
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM21
|
Facility
IP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904195
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM22
|
Facility
IP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904197
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM22
|
Facility
OP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904197
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.48 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.18
|
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 |
$29.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.64
|
Rate for Payer: Fidelis Medicare Advantage |
$61.42
|
Rate for Payer: Group Health Inc Commercial |
$29.25
|
Rate for Payer: Group Health Inc Medicare |
$20.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.02
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM23
|
Facility
IP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904199
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM23
|
Facility
OP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904199
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.48 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.18
|
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 |
$29.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.64
|
Rate for Payer: Fidelis Medicare Advantage |
$61.42
|
Rate for Payer: Group Health Inc Commercial |
$29.25
|
Rate for Payer: Group Health Inc Medicare |
$20.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.02
|
|
SCRW BONE CANCELL 6MM/1.9MM/4MM24
|
Facility
IP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904200
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
|