|
Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method
|
Facility
OP
|
$3,743.15
|
|
|
Service Code
|
CPT 28296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$549.50 |
| Max. Negotiated Rate |
$3,743.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$549.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method
|
Facility
OP
|
$3,743.15
|
|
|
Service Code
|
CPT 28292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$520.56 |
| Max. Negotiated Rate |
$3,743.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$520.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$578.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)
|
Facility
OP
|
$3,743.15
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.98 |
| Max. Negotiated Rate |
$3,743.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$416.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$463.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
CORRECT SKIN COLOR DEFECTS
|
Facility
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 11920
|
| Hospital Charge Code |
42201691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$120.79 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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: Elderplan Medicare Advantage |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$726.29
|
| Rate for Payer: Group Health Inc Medicare |
$726.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
CORTICAL BONE SCREW 120 / 40 MM
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.00
|
|
|
CORTICAL BONE SCREW 120 / 40 MM
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$241.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.50
|
| 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 |
$115.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$241.50
|
| Rate for Payer: Group Health Inc Commercial |
$115.00
|
| Rate for Payer: Group Health Inc Medicare |
$80.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.50
|
|
|
CORTICAL SCREW 3.5X20MM SELF-TAP
|
Facility
IP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
|
|
CORTICAL SCREW 3.5X20MM SELF-TAP
|
Facility
OP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.21
|
| 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 |
$103.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.04
|
| Rate for Payer: Group Health Inc Commercial |
$103.83
|
| Rate for Payer: Group Health Inc Medicare |
$72.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.98
|
|
|
CORTICAL SCREW 3.5X22MM SELF-TAP
|
Facility
IP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
|
|
CORTICAL SCREW 3.5X22MM SELF-TAP
|
Facility
OP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.21
|
| 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 |
$103.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.04
|
| Rate for Payer: Group Health Inc Commercial |
$103.83
|
| Rate for Payer: Group Health Inc Medicare |
$72.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.98
|
|
|
CORTICAL SCREW 3.5X24MM SELF-TAP
|
Facility
IP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
|
|
CORTICAL SCREW 3.5X24MM SELF-TAP
|
Facility
OP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.21
|
| 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 |
$103.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.04
|
| Rate for Payer: Group Health Inc Commercial |
$103.83
|
| Rate for Payer: Group Health Inc Medicare |
$72.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.98
|
|
|
CORTICAL SCREW 3.5X26MM SELF-TAP
|
Facility
OP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.21
|
| 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 |
$103.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.04
|
| Rate for Payer: Group Health Inc Commercial |
$103.83
|
| Rate for Payer: Group Health Inc Medicare |
$72.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.98
|
|
|
CORTICAL SCREW 3.5X26MM SELF-TAP
|
Facility
IP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
|
|
CORTICAL SCREW 3.5X28MM SELF-TAP
|
Facility
IP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
|
|
CORTICAL SCREW 3.5X28MM SELF-TAP
|
Facility
OP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.21
|
| 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 |
$103.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.04
|
| Rate for Payer: Group Health Inc Commercial |
$103.83
|
| Rate for Payer: Group Health Inc Medicare |
$72.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.98
|
|
|
CORTICAL SCREW 3.5X30MM SELF-TAP
|
Facility
IP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
|
|
CORTICAL SCREW 3.5X30MM SELF-TAP
|
Facility
OP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.21
|
| 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 |
$103.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.04
|
| Rate for Payer: Group Health Inc Commercial |
$103.83
|
| Rate for Payer: Group Health Inc Medicare |
$72.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.98
|
|
|
CORTICAL SCREW 3.5 X 32 MM
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
|
|
CORTICAL SCREW 3.5 X 32 MM
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
| 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 |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.00
|
| Rate for Payer: Group Health Inc Commercial |
$40.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
|
|
CORTICAL SCREW 3.5X32MM SELF-TAP
|
Facility
OP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.21
|
| 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 |
$103.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.04
|
| Rate for Payer: Group Health Inc Commercial |
$103.83
|
| Rate for Payer: Group Health Inc Medicare |
$72.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.98
|
|
|
CORTICAL SCREW 3.5X32MM SELF-TAP
|
Facility
IP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
|
|
CORTICAL SCREW 3.5X34MM SELF-TAP
|
Facility
OP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.21
|
| 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 |
$103.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.04
|
| Rate for Payer: Group Health Inc Commercial |
$103.83
|
| Rate for Payer: Group Health Inc Medicare |
$72.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.98
|
|
|
CORTICAL SCREW 3.5X34MM SELF-TAP
|
Facility
IP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
|
|
CORTICAL SCREW 3.5X36MM SELF-TAP
|
Facility
OP
|
$207.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.21
|
| 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 |
$103.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.04
|
| Rate for Payer: Group Health Inc Commercial |
$103.83
|
| Rate for Payer: Group Health Inc Medicare |
$72.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.98
|
|
