LOCKING SCREW FT 2.7MM / L14MM
|
Facility
|
OP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904477
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$591.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$309.72
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$337.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$281.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$323.80
|
Rate for Payer: EmblemHealth Commercial |
$281.56
|
Rate for Payer: Fidelis Medicare Advantage |
$591.29
|
Rate for Payer: Group Health Inc Commercial |
$281.56
|
Rate for Payer: Group Health Inc Medicare |
$197.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.03
|
|
LOCKING SCREW FT 2.7MM / L14MM
|
Facility
|
IP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904477
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$281.56 |
Max. Negotiated Rate |
$281.56 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
|
LOCKING SCREW FT 2.7MM / L16MM
|
Facility
|
OP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904479
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$591.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$309.72
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$337.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$281.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$323.80
|
Rate for Payer: EmblemHealth Commercial |
$281.56
|
Rate for Payer: Fidelis Medicare Advantage |
$591.29
|
Rate for Payer: Group Health Inc Commercial |
$281.56
|
Rate for Payer: Group Health Inc Medicare |
$197.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.03
|
|
LOCKING SCREW FT 2.7MM / L16MM
|
Facility
|
IP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904479
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$281.56 |
Max. Negotiated Rate |
$281.56 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
|
LOCKING SCREW FT 2.7MM / L18MM
|
Facility
|
OP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904520
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$591.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$309.72
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$337.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$281.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$323.80
|
Rate for Payer: EmblemHealth Commercial |
$281.56
|
Rate for Payer: Fidelis Medicare Advantage |
$591.29
|
Rate for Payer: Group Health Inc Commercial |
$281.56
|
Rate for Payer: Group Health Inc Medicare |
$197.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.03
|
|
LOCKING SCREW FT 2.7MM / L18MM
|
Facility
|
IP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904520
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$281.56 |
Max. Negotiated Rate |
$281.56 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
|
LOCKING SCREW FT 2.7MM / L20MM
|
Facility
|
IP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904534
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$281.56 |
Max. Negotiated Rate |
$281.56 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
|
LOCKING SCREW FT 2.7MM / L20MM
|
Facility
|
OP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904534
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$591.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$309.72
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$337.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$281.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$323.80
|
Rate for Payer: EmblemHealth Commercial |
$281.56
|
Rate for Payer: Fidelis Medicare Advantage |
$591.29
|
Rate for Payer: Group Health Inc Commercial |
$281.56
|
Rate for Payer: Group Health Inc Medicare |
$197.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.03
|
|
LOCKING SCREW FT 2.7MM / L22MM
|
Facility
|
OP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904632
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$591.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$309.72
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$337.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$281.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$323.80
|
Rate for Payer: EmblemHealth Commercial |
$281.56
|
Rate for Payer: Fidelis Medicare Advantage |
$591.29
|
Rate for Payer: Group Health Inc Commercial |
$281.56
|
Rate for Payer: Group Health Inc Medicare |
$197.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.03
|
|
LOCKING SCREW FT 2.7MM / L22MM
|
Facility
|
IP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904632
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$281.56 |
Max. Negotiated Rate |
$281.56 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
|
LOCKING SCREW FT 2.7MM / L24MM
|
Facility
|
OP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904990
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$591.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$309.72
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$337.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$281.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$323.80
|
Rate for Payer: EmblemHealth Commercial |
$281.56
|
Rate for Payer: Fidelis Medicare Advantage |
$591.29
|
Rate for Payer: Group Health Inc Commercial |
$281.56
|
Rate for Payer: Group Health Inc Medicare |
$197.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.03
|
|
LOCKING SCREW FT 2.7MM / L24MM
|
Facility
|
IP
|
$563.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904990
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$281.56 |
Max. Negotiated Rate |
$281.56 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
|
LOCKING SCREW FT 3.5MM / L10MM
|
Facility
|
IP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904688
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$313.44 |
Max. Negotiated Rate |
$313.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
|
LOCKING SCREW FT 3.5MM / L10MM
|
Facility
|
OP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904688
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$658.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$344.78
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$376.13
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$313.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.46
|
Rate for Payer: EmblemHealth Commercial |
$313.44
|
Rate for Payer: Fidelis Medicare Advantage |
$658.22
|
Rate for Payer: Group Health Inc Commercial |
$313.44
|
Rate for Payer: Group Health Inc Medicare |
$219.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.47
|
|
LOCKING SCREW FT 3.5MM / L12MM
|
Facility
|
OP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904690
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$658.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$344.78
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$376.13
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$313.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.46
|
Rate for Payer: EmblemHealth Commercial |
$313.44
|
Rate for Payer: Fidelis Medicare Advantage |
$658.22
|
Rate for Payer: Group Health Inc Commercial |
$313.44
|
Rate for Payer: Group Health Inc Medicare |
$219.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.47
|
|
LOCKING SCREW FT 3.5MM / L12MM
|
Facility
|
IP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904690
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$313.44 |
Max. Negotiated Rate |
$313.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
|
LOCKING SCREW FT 3.5MM / L14MM
|
Facility
|
IP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904789
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$313.44 |
Max. Negotiated Rate |
$313.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
|
LOCKING SCREW FT 3.5MM / L14MM
|
Facility
|
OP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904789
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$658.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$344.78
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$376.13
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$313.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.46
|
Rate for Payer: EmblemHealth Commercial |
$313.44
|
Rate for Payer: Fidelis Medicare Advantage |
$658.22
|
Rate for Payer: Group Health Inc Commercial |
$313.44
|
Rate for Payer: Group Health Inc Medicare |
$219.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.47
|
|
LOCKING SCREW FT 3.5MM / L16MM
|
Facility
|
OP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904743
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$658.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$344.78
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$376.13
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$313.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.46
|
Rate for Payer: EmblemHealth Commercial |
$313.44
|
Rate for Payer: Fidelis Medicare Advantage |
$658.22
|
Rate for Payer: Group Health Inc Commercial |
$313.44
|
Rate for Payer: Group Health Inc Medicare |
$219.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.47
|
|
LOCKING SCREW FT 3.5MM / L16MM
|
Facility
|
IP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904743
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$313.44 |
Max. Negotiated Rate |
$313.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
|
LOCKING SCREW FT 3.5MM / L18MM
|
Facility
|
IP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904747
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$313.44 |
Max. Negotiated Rate |
$313.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
|
LOCKING SCREW FT 3.5MM / L18MM
|
Facility
|
OP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904747
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$658.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$344.78
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$376.13
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$313.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.46
|
Rate for Payer: EmblemHealth Commercial |
$313.44
|
Rate for Payer: Fidelis Medicare Advantage |
$658.22
|
Rate for Payer: Group Health Inc Commercial |
$313.44
|
Rate for Payer: Group Health Inc Medicare |
$219.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.47
|
|
LOCKING SCREW FT 3.5MM / L20MM
|
Facility
|
IP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904550
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$313.44 |
Max. Negotiated Rate |
$313.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
|
LOCKING SCREW FT 3.5MM / L20MM
|
Facility
|
OP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904550
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$658.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$344.78
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$376.13
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$313.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.46
|
Rate for Payer: EmblemHealth Commercial |
$313.44
|
Rate for Payer: Fidelis Medicare Advantage |
$658.22
|
Rate for Payer: Group Health Inc Commercial |
$313.44
|
Rate for Payer: Group Health Inc Medicare |
$219.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.47
|
|
LOCKING SCREW FT 3.5MM / L24MM
|
Facility
|
IP
|
$737.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904745
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$368.75 |
Max. Negotiated Rate |
$368.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$368.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$368.75
|
|