|
STOCKING THIGH HI LARGE X-LARGE
|
Facility
OP
|
$11.13
|
|
| Hospital Charge Code |
64901694
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$8.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.56
|
| Rate for Payer: Aetna Government |
$5.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.57
|
| Rate for Payer: Group Health Inc Commercial |
$5.56
|
| Rate for Payer: Group Health Inc Medicare |
$3.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.56
|
|
|
STOCKING THIGH HI MEDIUM LONG
|
Facility
OP
|
$11.13
|
|
| Hospital Charge Code |
64901700
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$8.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.56
|
| Rate for Payer: Aetna Government |
$5.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.57
|
| Rate for Payer: Group Health Inc Commercial |
$5.56
|
| Rate for Payer: Group Health Inc Medicare |
$3.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.56
|
|
|
STOCKING THIGH HI MEDIUM REGULAR
|
Facility
OP
|
$22.49
|
|
| Hospital Charge Code |
64901517
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.24
|
| Rate for Payer: Aetna Government |
$11.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.29
|
| Rate for Payer: Group Health Inc Commercial |
$11.24
|
| Rate for Payer: Group Health Inc Medicare |
$7.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.24
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
IP
|
$43,127.60
|
|
|
Service Code
|
MS-DRG 327
|
| Min. Negotiated Rate |
$19,511.52 |
| Max. Negotiated Rate |
$43,127.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36,824.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41,960.26
|
| Rate for Payer: Aetna Government |
$41,960.26
|
| Rate for Payer: Brighton Health Commercial |
$36,212.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42,799.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43,127.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35,590.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$39,862.25
|
| Rate for Payer: EmblemHealth Commercial |
$21,415.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$41,960.26
|
| Rate for Payer: Group Health Inc Commercial |
$41,960.26
|
| Rate for Payer: Group Health Inc Medicare |
$41,960.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41,960.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19,511.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41,960.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41,960.26
|
| Rate for Payer: Wellcare Medicare |
$39,862.25
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
IP
|
$87,709.25
|
|
|
Service Code
|
MS-DRG 326
|
| Min. Negotiated Rate |
$36,158.53 |
| Max. Negotiated Rate |
$87,709.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74,889.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77,760.29
|
| Rate for Payer: Aetna Government |
$77,760.29
|
| Rate for Payer: Brighton Health Commercial |
$73,645.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79,315.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87,709.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72,381.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$73,872.28
|
| Rate for Payer: EmblemHealth Commercial |
$43,552.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$77,760.29
|
| Rate for Payer: Group Health Inc Commercial |
$77,760.29
|
| Rate for Payer: Group Health Inc Medicare |
$77,760.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77,760.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36,158.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77,760.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77,760.29
|
| Rate for Payer: Wellcare Medicare |
$73,872.28
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$30,067.77
|
|
|
Service Code
|
MS-DRG 328
|
| Min. Negotiated Rate |
$13,696.80 |
| Max. Negotiated Rate |
$30,067.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,552.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,478.21
|
| Rate for Payer: Aetna Government |
$29,478.21
|
| Rate for Payer: Brighton Health Commercial |
$23,160.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,067.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,583.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,763.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,004.30
|
| Rate for Payer: EmblemHealth Commercial |
$13,696.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,478.21
|
| Rate for Payer: Group Health Inc Commercial |
$29,478.21
|
| Rate for Payer: Group Health Inc Medicare |
$29,478.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,478.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,707.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,478.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,478.21
|
| Rate for Payer: Wellcare Medicare |
$28,004.30
|
|
|
STOMACH FEEDING BAG
|
Facility
OP
|
$7.80
|
|
| Hospital Charge Code |
40207609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.90
|
| Rate for Payer: Aetna Government |
$3.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.30
|
| Rate for Payer: Group Health Inc Commercial |
$3.90
|
| Rate for Payer: Group Health Inc Medicare |
$2.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.90
|
|
|
STONERETR BSKT 3FRX120CM ZTIP NIT
|
Facility
OP
|
$490.00
|
|
| Hospital Charge Code |
40201003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$269.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$245.00
|
| Rate for Payer: Aetna Government |
$245.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$392.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$333.20
|
| Rate for Payer: Group Health Inc Commercial |
$245.00
|
| Rate for Payer: Group Health Inc Medicare |
$171.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.00
|
|
|
STOOL CULTR AEROBIC BACT EA
|
Facility
OP
|
$23.60
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
40614336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.44
|
| Rate for Payer: Aetna Government |
$9.44
|
| Rate for Payer: Cash Price |
$9.44
|
| Rate for Payer: Cash Price |
$9.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.44
|
| Rate for Payer: EmblemHealth Commercial |
$9.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.40
|
| Rate for Payer: Group Health Inc Commercial |
$9.44
|
| Rate for Payer: Group Health Inc Medicare |
$9.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.44
|
| Rate for Payer: Healthfirst QHP |
$9.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.55
|
| Rate for Payer: Wellcare Medicare |
$8.50
|
|
|
STOOL CULTURE
|
Facility
OP
|
$83.63
|
|
|
Service Code
|
HCPCS 87427
|
| Hospital Charge Code |
40614218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.98
|
| Rate for Payer: Aetna Government |
$11.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.98
|
| Rate for Payer: EmblemHealth Commercial |
$11.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Group Health Inc Commercial |
$11.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.98
|
| Rate for Payer: Healthfirst QHP |
$11.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.58
|
| Rate for Payer: Wellcare Medicare |
$10.78
|
|
|
STOOL FOR OCCULT BLOOD
|
Facility
OP
|
$10.95
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
40602420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.38
|
| Rate for Payer: Aetna Government |
$4.38
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.38
|
| Rate for Payer: EmblemHealth Commercial |
$4.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.90
|
| Rate for Payer: Group Health Inc Commercial |
$4.38
|
| Rate for Payer: Group Health Inc Medicare |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.38
|
| Rate for Payer: Healthfirst QHP |
$4.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.50
|
| Rate for Payer: Wellcare Medicare |
$3.94
|
|
|
STOPCOCK THREE-WAY LL STERILE
|
Facility
OP
|
$7.24
|
|
| Hospital Charge Code |
64901704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.62
|
| Rate for Payer: Aetna Government |
$3.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.92
|
| Rate for Payer: Group Health Inc Commercial |
$3.62
|
| Rate for Payer: Group Health Inc Medicare |
$2.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.62
|
|
|
STR 1.35X50MM DRILL 5MM STOP END
|
Facility
OP
|
$248.74
|
|
| Hospital Charge Code |
40204676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.06 |
| Max. Negotiated Rate |
$198.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$124.37
|
| Rate for Payer: Aetna Government |
$124.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$198.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$169.14
|
| Rate for Payer: Group Health Inc Commercial |
$124.37
|
| Rate for Payer: Group Health Inc Medicare |
$87.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.37
|
|
|
STR 1.4X54MM DRILL 12MM STOP END
|
Facility
OP
|
$252.52
|
|
| Hospital Charge Code |
40204689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.38 |
| Max. Negotiated Rate |
$202.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$126.26
|
| Rate for Payer: Aetna Government |
$126.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$202.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$171.71
|
| Rate for Payer: Group Health Inc Commercial |
$126.26
|
| Rate for Payer: Group Health Inc Medicare |
$88.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.26
|
|
|
STR 1.4X54MM DRILL 8MM STOP END
|
Facility
OP
|
$280.14
|
|
| Hospital Charge Code |
40204675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.05 |
| Max. Negotiated Rate |
$224.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$140.07
|
| Rate for Payer: Aetna Government |
$140.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$224.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$190.50
|
| Rate for Payer: Group Health Inc Commercial |
$140.07
|
| Rate for Payer: Group Health Inc Medicare |
$98.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.07
|
|
|
STR 1.6 MM TWIST DRILL 35 MM
|
Facility
OP
|
$235.80
|
|
| Hospital Charge Code |
40203432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.53 |
| Max. Negotiated Rate |
$188.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$129.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$117.90
|
| Rate for Payer: Aetna Government |
$117.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$188.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$160.34
|
| Rate for Payer: Group Health Inc Commercial |
$117.90
|
| Rate for Payer: Group Health Inc Medicare |
$82.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.90
|
|
|
STR 1.7X12MM SCREW CRSS PIN SLFTP
|
Facility
OP
|
$110.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.73
|
| 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 |
$55.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.94
|
| Rate for Payer: Group Health Inc Commercial |
$55.21
|
| Rate for Payer: Group Health Inc Medicare |
$38.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.77
|
|
|
STR 1.7X12MM SCREW CRSS PIN SLFTP
|
Facility
IP
|
$110.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.21 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.21
|
|
|
STR 1.7X4MM SCR CROSS PIN SLFTP
|
Facility
IP
|
$110.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.21 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.21
|
|
|
STR 1.7X4MM SCR CROSS PIN SLFTP
|
Facility
OP
|
$110.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.73
|
| 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 |
$55.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.94
|
| Rate for Payer: Group Health Inc Commercial |
$55.21
|
| Rate for Payer: Group Health Inc Medicare |
$38.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.77
|
|
|
STR 1.7X4MM SCREW CROSS PIN SLFTP
|
Facility
IP
|
$90.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$45.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.32
|
|
|
STR 1.7X4MM SCREW CROSS PIN SLFTP
|
Facility
OP
|
$90.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.85
|
| 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 |
$45.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.17
|
| Rate for Payer: Group Health Inc Commercial |
$45.32
|
| Rate for Payer: Group Health Inc Medicare |
$31.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.92
|
|
|
STR 1.7X6MM SCREW CROSS PIN SLFTP
|
Facility
OP
|
$110.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.73
|
| 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 |
$55.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.94
|
| Rate for Payer: Group Health Inc Commercial |
$55.21
|
| Rate for Payer: Group Health Inc Medicare |
$38.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.77
|
|
|
STR 1.7X6MM SCREW CROSS PIN SLFTP
|
Facility
IP
|
$110.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.21 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.21
|
|
|
STR 1.7X8MM SCREW CROSS PIN SLFTP
|
Facility
IP
|
$110.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.21 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.21
|
|
