STAPLES X-SMALL 7 X 5MM
|
Facility
OP
|
$812.50
|
|
Hospital Charge Code |
64902127
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$284.38 |
Max. Negotiated Rate |
$650.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$446.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$406.25
|
Rate for Payer: Aetna Government |
$406.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$650.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$552.50
|
Rate for Payer: Group Health Inc Commercial |
$406.25
|
Rate for Payer: Group Health Inc Medicare |
$284.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$406.25
|
|
STAPLE TRI RELOD 60MM MD/THCK
|
Facility
OP
|
$933.94
|
|
Hospital Charge Code |
64906558
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$326.88 |
Max. Negotiated Rate |
$747.15 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$513.67
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$466.97
|
Rate for Payer: Aetna Government |
$466.97
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.15
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.08
|
Rate for Payer: Group Health Inc Commercial |
$466.97
|
Rate for Payer: Group Health Inc Medicare |
$326.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$466.97
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$466.97
|
|
STAPLE TRI RELOD 60MM XT/THCK-AXT
|
Facility
OP
|
$1,546.40
|
|
Hospital Charge Code |
64906702
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$541.24 |
Max. Negotiated Rate |
$1,237.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$850.52
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$773.20
|
Rate for Payer: Aetna Government |
$773.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,237.12
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,051.55
|
Rate for Payer: Group Health Inc Commercial |
$773.20
|
Rate for Payer: Group Health Inc Medicare |
$541.24
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$773.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$773.20
|
|
STAPLE X-SMALL 9 X 7MM
|
Facility
OP
|
$812.50
|
|
Hospital Charge Code |
64902129
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$284.38 |
Max. Negotiated Rate |
$650.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$446.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$406.25
|
Rate for Payer: Aetna Government |
$406.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$650.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$552.50
|
Rate for Payer: Group Health Inc Commercial |
$406.25
|
Rate for Payer: Group Health Inc Medicare |
$284.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$406.25
|
|
STARGRAFT DBM PUTTY 10CC
|
Facility
IP
|
$4,450.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904680
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,225.00 |
Max. Negotiated Rate |
$2,225.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,225.00
|
|
STARGRAFT DBM PUTTY 10CC
|
Facility
OP
|
$4,450.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904680
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,672.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,447.50
|
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 |
$2,225.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,558.75
|
Rate for Payer: Fidelis Medicare Advantage |
$4,672.50
|
Rate for Payer: Group Health Inc Commercial |
$2,225.00
|
Rate for Payer: Group Health Inc Medicare |
$1,557.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,225.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,892.50
|
|
STARGRAFT DEM 10CC PUTTY
|
Facility
IP
|
$4,325.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904124
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,162.50 |
Max. Negotiated Rate |
$2,162.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,162.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,162.50
|
|
STARGRAFT DEM 10CC PUTTY
|
Facility
OP
|
$4,325.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904124
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,541.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,378.75
|
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 |
$2,162.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,486.88
|
Rate for Payer: Fidelis Medicare Advantage |
$4,541.25
|
Rate for Payer: Group Health Inc Commercial |
$2,162.50
|
Rate for Payer: Group Health Inc Medicare |
$1,513.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,162.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,162.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,811.25
|
|
STATIN THERAPY/CURRENTLY TKN
|
Facility
OP
|
$0.01
|
|
Service Code
|
HCPCS 4013F
|
Hospital Charge Code |
30300373
|
Hospital Revenue Code
|
969
|
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
Rate for Payer: Aetna Government |
$0.01
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
Rate for Payer: Group Health Inc Commercial |
$0.01
|
Rate for Payer: Group Health Inc Medicare |
$0.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
STATLOCK CV PLUS SECUREMENT ORD
|
Facility
OP
|
$29.04
|
|
Hospital Charge Code |
64902516
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$10.16 |
Max. Negotiated Rate |
$23.23 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.97
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.52
|
Rate for Payer: Aetna Government |
$14.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.23
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.75
|
Rate for Payer: Group Health Inc Commercial |
$14.52
|
Rate for Payer: Group Health Inc Medicare |
$10.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14.52
|
|
STATLOCK,SWIVEL TRICOT
|
Facility
OP
|
$7.38
|
|
Hospital Charge Code |
64901909
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.58 |
Max. Negotiated Rate |
$5.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.06
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.69
|
Rate for Payer: Aetna Government |
$3.69
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.02
|
Rate for Payer: Group Health Inc Commercial |
$3.69
|
Rate for Payer: Group Health Inc Medicare |
$2.58
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.69
|
|
STAVUDINE 15 MG CAP
|
Facility
OP
|
$2.43
|
|
Hospital Charge Code |
41641069
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.85 |
Max. Negotiated Rate |
$1.94 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.34
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.22
|
Rate for Payer: Aetna Government |
$1.22
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.65
|
Rate for Payer: Group Health Inc Commercial |
$1.22
|
Rate for Payer: Group Health Inc Medicare |
$0.85
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.58
|
|
STAVUDINE 15 MG CAP
|
Facility
OP
|
$2.43
|
|
Hospital Charge Code |
41651069
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.85 |
Max. Negotiated Rate |
$1.94 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.34
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.22
|
Rate for Payer: Aetna Government |
$1.22
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.65
|
Rate for Payer: Group Health Inc Commercial |
$1.22
|
Rate for Payer: Group Health Inc Medicare |
$0.85
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.58
|
|
STAVUDINE 1 MG/ML LIQUID
|
Facility
OP
|
$0.76
|
|
Hospital Charge Code |
41642445
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.27 |
Max. Negotiated Rate |
$0.61 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
Rate for Payer: Aetna Government |
$0.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
Rate for Payer: Group Health Inc Commercial |
$0.38
|
Rate for Payer: Group Health Inc Medicare |
$0.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
STAVUDINE 1 MG/ML LIQUID
|
Facility
OP
|
$0.76
|
|
Hospital Charge Code |
41652445
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.27 |
Max. Negotiated Rate |
$0.61 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
Rate for Payer: Aetna Government |
$0.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
Rate for Payer: Group Health Inc Commercial |
$0.38
|
Rate for Payer: Group Health Inc Medicare |
$0.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
STAVUDINE 20 MG CAP
|
Facility
OP
|
$12.00
|
|
Hospital Charge Code |
41640222
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$4.20 |
Max. Negotiated Rate |
$9.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
Rate for Payer: Aetna Government |
$6.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
Rate for Payer: Group Health Inc Commercial |
$6.00
|
Rate for Payer: Group Health Inc Medicare |
$4.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
STAVUDINE 20 MG CAP
|
Facility
OP
|
$12.00
|
|
Hospital Charge Code |
41650222
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$4.20 |
Max. Negotiated Rate |
$9.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
Rate for Payer: Aetna Government |
$6.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
Rate for Payer: Group Health Inc Commercial |
$6.00
|
Rate for Payer: Group Health Inc Medicare |
$4.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
STAVUDINE 30 MG CAP
|
Facility
OP
|
$3.00
|
|
Hospital Charge Code |
41650250
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$2.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
Rate for Payer: Aetna Government |
$1.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
Rate for Payer: Group Health Inc Commercial |
$1.50
|
Rate for Payer: Group Health Inc Medicare |
$1.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
STAVUDINE 30 MG CAP
|
Facility
OP
|
$3.00
|
|
Hospital Charge Code |
41640250
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$2.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
Rate for Payer: Aetna Government |
$1.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
Rate for Payer: Group Health Inc Commercial |
$1.50
|
Rate for Payer: Group Health Inc Medicare |
$1.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
STAVUDINE 40 MG CAP
|
Facility
OP
|
$2.30
|
|
Hospital Charge Code |
41651534
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.81 |
Max. Negotiated Rate |
$1.84 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.26
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
Rate for Payer: Aetna Government |
$1.15
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.84
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.56
|
Rate for Payer: Group Health Inc Commercial |
$1.15
|
Rate for Payer: Group Health Inc Medicare |
$0.81
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.50
|
|
STAVUDINE 40 MG CAP
|
Facility
OP
|
$2.30
|
|
Hospital Charge Code |
41641534
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.81 |
Max. Negotiated Rate |
$1.84 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.26
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
Rate for Payer: Aetna Government |
$1.15
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.84
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.56
|
Rate for Payer: Group Health Inc Commercial |
$1.15
|
Rate for Payer: Group Health Inc Medicare |
$0.81
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.50
|
|
STEEL WASHERS
|
Facility
OP
|
$57.40
|
|
Hospital Charge Code |
40209841
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$20.09 |
Max. Negotiated Rate |
$45.92 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.57
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.70
|
Rate for Payer: Aetna Government |
$28.70
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.92
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.03
|
Rate for Payer: Group Health Inc Commercial |
$28.70
|
Rate for Payer: Group Health Inc Medicare |
$20.09
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.70
|
|
STEINMANN PIN 9/64X9
|
Facility
IP
|
$154.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202046
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$77.00 |
Max. Negotiated Rate |
$77.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
|
STEINMANN PIN 9/64X9
|
Facility
OP
|
$154.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202046
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$53.90 |
Max. Negotiated Rate |
$161.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.70
|
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 |
$77.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.55
|
Rate for Payer: Fidelis Medicare Advantage |
$161.70
|
Rate for Payer: Group Health Inc Commercial |
$77.00
|
Rate for Payer: Group Health Inc Medicare |
$53.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.10
|
|
STEM 3 STD, AVENIR MULL
|
Facility
IP
|
$11,670.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64905556
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$5,835.00 |
Max. Negotiated Rate |
$5,835.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,835.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5,835.00
|
|