|
TI IM SPLINT MEDIUM-4MM WIDTH
|
Facility
OP
|
$900.00
|
|
| Hospital Charge Code |
40209500
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$495.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$450.00
|
| Rate for Payer: Aetna Government |
$450.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$720.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$612.00
|
| Rate for Payer: Group Health Inc Commercial |
$450.00
|
| Rate for Payer: Group Health Inc Medicare |
$315.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.00
|
|
|
TI IM SPLINT SMALL-3 MM WIDTH
|
Facility
OP
|
$900.00
|
|
| Hospital Charge Code |
40209499
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$495.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$450.00
|
| Rate for Payer: Aetna Government |
$450.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$720.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$612.00
|
| Rate for Payer: Group Health Inc Commercial |
$450.00
|
| Rate for Payer: Group Health Inc Medicare |
$315.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.00
|
|
|
TI MATRIX MIDFACE SCRW SLF D 4MM
|
Facility
OP
|
$164.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$94.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.20
|
| Rate for Payer: Group Health Inc Commercial |
$82.00
|
| Rate for Payer: Group Health Inc Medicare |
$57.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.60
|
|
|
TI MATRIX MIDFACE SCRW SLF D 4MM
|
Facility
IP
|
$164.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.00
|
|
|
TIME OUT BAG PBTO
|
Facility
OP
|
$140.90
|
|
| Hospital Charge Code |
64905077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$112.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.45
|
| Rate for Payer: Aetna Government |
$70.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.81
|
| Rate for Payer: Group Health Inc Commercial |
$70.45
|
| Rate for Payer: Group Health Inc Medicare |
$49.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.45
|
|
|
TIMOLOL 0.25% OPHTHALMIC SOLN
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41643526
|
|
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
|
|
|
TIMOLOL 0.25% OPHTHALMIC SOLN
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41653526
|
|
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
|
|
|
TIMOLOL 0.5% OPHTHALMIC SOLN
|
Facility
OP
|
$2.12
|
|
| Hospital Charge Code |
41644902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.06
|
| Rate for Payer: Aetna Government |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.44
|
| Rate for Payer: Group Health Inc Commercial |
$1.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.38
|
|
|
TIMOLOL 0.5% OPHTHALMIC SOLN
|
Facility
OP
|
$2.12
|
|
| Hospital Charge Code |
41654902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.06
|
| Rate for Payer: Aetna Government |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.44
|
| Rate for Payer: Group Health Inc Commercial |
$1.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.38
|
|
|
TIOTROPIUM BROMIDE 2.5MCG RSPMT
|
Facility
OP
|
$97.05
|
|
| Hospital Charge Code |
41657851
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$77.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.52
|
| Rate for Payer: Aetna Government |
$48.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.99
|
| Rate for Payer: Group Health Inc Commercial |
$48.52
|
| Rate for Payer: Group Health Inc Medicare |
$33.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.08
|
|
|
TIOTROPIUM BROMIDE 2.5MCG RSPMT
|
Facility
OP
|
$97.05
|
|
| Hospital Charge Code |
41647851
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$77.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.52
|
| Rate for Payer: Aetna Government |
$48.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.99
|
| Rate for Payer: Group Health Inc Commercial |
$48.52
|
| Rate for Payer: Group Health Inc Medicare |
$33.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.08
|
|
|
TIOTROPIUM INHALER (18 MCG/PUFF)
|
Facility
OP
|
$133.64
|
|
| Hospital Charge Code |
41654002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$106.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.82
|
| Rate for Payer: Aetna Government |
$66.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.88
|
| Rate for Payer: Group Health Inc Commercial |
$66.82
|
| Rate for Payer: Group Health Inc Medicare |
$46.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.87
|
|
|
TIOTROPIUM INHALER (18 MCG/PUFF)
|
Facility
OP
|
$133.64
|
|
| Hospital Charge Code |
41644002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$106.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.82
|
| Rate for Payer: Aetna Government |
$66.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.88
|
| Rate for Payer: Group Health Inc Commercial |
$66.82
|
| Rate for Payer: Group Health Inc Medicare |
$46.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.87
|
|
|
TIP DRILL
|
Facility
OP
|
$337.75
|
|
| Hospital Charge Code |
64907310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$118.21 |
| Max. Negotiated Rate |
$270.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$185.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$168.88
|
| Rate for Payer: Aetna Government |
$168.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$270.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$229.67
|
| Rate for Payer: Group Health Inc Commercial |
$168.88
|
| Rate for Payer: Group Health Inc Medicare |
$118.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.88
|
|
|
TIP EAR INFANT RED-BROWN 4.5MM
|
Facility
OP
|
$2.30
|
|
| Hospital Charge Code |
64903476
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
TIP EAR INFANT TREE YELLOW
|
Facility
OP
|
$2.52
|
|
| Hospital Charge Code |
64903402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.26
|
| Rate for Payer: Aetna Government |
$1.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.71
|
| Rate for Payer: Group Health Inc Commercial |
$1.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.26
|
|
|
TIP EXTENDER BASE
|
Facility
IP
|
$5,707.50
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
64907150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,853.75 |
| Max. Negotiated Rate |
$2,853.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,853.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,853.75
|
|
|
TIP EXTENDER BASE
|
Facility
OP
|
$5,707.50
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
64907150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,997.62 |
| Max. Negotiated Rate |
$5,992.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,139.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,853.75
|
| Rate for Payer: Aetna Government |
$2,853.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,853.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,281.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,992.88
|
| Rate for Payer: Group Health Inc Commercial |
$2,853.75
|
| Rate for Payer: Group Health Inc Medicare |
$1,997.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,853.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,853.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,709.88
|
|
|
TI PL 15 HOLES LEFT RIB 3
|
Facility
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
|
|
TI PL 15 HOLES LEFT RIB 3
|
Facility
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,375.00
|
| 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 |
$1,250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,437.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,625.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,625.00
|
|
|
TI PL 15 HOLES RIGHT RIB 3
|
Facility
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,375.00
|
| 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 |
$1,250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,437.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,625.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,625.00
|
|
|
TI PL 15 HOLES RIGHT RIB 3
|
Facility
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
|
|
TI PL 16 HOLES LEFT RIBS 4&5
|
Facility
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
|
|
TI PL 16 HOLES LEFT RIBS 4&5
|
Facility
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,375.00
|
| 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 |
$1,250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,437.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,625.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,625.00
|
|
|
TI PL 16 HOLES RIGHT RIBS 4&5
|
Facility
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,375.00
|
| 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 |
$1,250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,437.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,625.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,625.00
|
|
