3.5MM NCV DR OVRSZ HOLE FOR 4.0NC
|
Facility
OP
|
$318.90
|
|
Hospital Charge Code |
40006772
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$111.62 |
Max. Negotiated Rate |
$255.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$175.40
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$159.45
|
Rate for Payer: Aetna Government |
$159.45
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$255.12
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$216.85
|
Rate for Payer: Group Health Inc Commercial |
$159.45
|
Rate for Payer: Group Health Inc Medicare |
$111.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.45
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$159.45
|
|
3.5MMS HEX DRIVER DISTAL SCREW
|
Facility
IP
|
$800.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40006146
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$400.00 |
Max. Negotiated Rate |
$400.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
|
3.5MMS HEX DRIVER DISTAL SCREW
|
Facility
OP
|
$800.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40006146
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$840.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$440.00
|
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 |
$400.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$460.00
|
Rate for Payer: Fidelis Medicare Advantage |
$840.00
|
Rate for Payer: Group Health Inc Commercial |
$400.00
|
Rate for Payer: Group Health Inc Medicare |
$280.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.00
|
|
3.5MMX10CM ROC XS NONABS&CP2 NDLS
|
Facility
IP
|
$902.34
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202051
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$451.17 |
Max. Negotiated Rate |
$451.17 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$451.17
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$451.17
|
|
3.5MMX10CM ROC XS NONABS&CP2 NDLS
|
Facility
OP
|
$902.34
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202051
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$947.46 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$496.29
|
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 |
$451.17
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$518.85
|
Rate for Payer: Fidelis Medicare Advantage |
$947.46
|
Rate for Payer: Group Health Inc Commercial |
$451.17
|
Rate for Payer: Group Health Inc Medicare |
$315.82
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$451.17
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$451.17
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$586.52
|
|
3.5 NON LOCKING SCREW
|
Facility
OP
|
$32.00
|
|
Hospital Charge Code |
40202392
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$11.20 |
Max. Negotiated Rate |
$25.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.00
|
Rate for Payer: Aetna Government |
$16.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.76
|
Rate for Payer: Group Health Inc Commercial |
$16.00
|
Rate for Payer: Group Health Inc Medicare |
$11.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
|
3.5X16 LOCKING SCREW 212.104
|
Facility
OP
|
$270.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202750
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$94.50 |
Max. Negotiated Rate |
$283.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$148.50
|
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 |
$135.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.25
|
Rate for Payer: Fidelis Medicare Advantage |
$283.50
|
Rate for Payer: Group Health Inc Commercial |
$135.00
|
Rate for Payer: Group Health Inc Medicare |
$94.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.50
|
|
3.5X16 LOCKING SCREW 212.104
|
Facility
IP
|
$270.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202750
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$135.00 |
Max. Negotiated Rate |
$135.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
|
3D FL PROFIL PLT .6MM 2X2L QUAD
|
Facility
OP
|
$366.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201064
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$128.10 |
Max. Negotiated Rate |
$384.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$201.30
|
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 |
$183.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$210.45
|
Rate for Payer: Fidelis Medicare Advantage |
$384.30
|
Rate for Payer: Group Health Inc Commercial |
$183.00
|
Rate for Payer: Group Health Inc Medicare |
$128.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.90
|
|
3D FL PROFIL PLT .6MM 2X2L QUAD
|
Facility
IP
|
$366.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201064
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$183.00 |
Max. Negotiated Rate |
$183.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.00
|
|
3D PLT 2X2 H SQ 6MM PROFILE
|
Facility
IP
|
$366.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201061
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$183.00 |
Max. Negotiated Rate |
$183.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.00
|
|
3D PLT 2X2 H SQ 6MM PROFILE
|
Facility
OP
|
$366.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201061
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$128.10 |
Max. Negotiated Rate |
$384.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$201.30
|
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 |
$183.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$210.45
|
Rate for Payer: Fidelis Medicare Advantage |
$384.30
|
Rate for Payer: Group Health Inc Commercial |
$183.00
|
Rate for Payer: Group Health Inc Medicare |
$128.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.90
|
|
3D PLT,3 X 2 HOLE,RECTANGLE
|
Facility
IP
|
$520.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201068
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$260.00 |
Max. Negotiated Rate |
$260.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$260.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$260.00
|
|
3D PLT,3 X 2 HOLE,RECTANGLE
|
Facility
OP
|
$520.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201068
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$546.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$286.00
|
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 |
$260.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$299.00
|
Rate for Payer: Fidelis Medicare Advantage |
$546.00
|
Rate for Payer: Group Health Inc Commercial |
$260.00
|
Rate for Payer: Group Health Inc Medicare |
$182.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$260.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$260.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$338.00
|
|
3D PLT, 4 X 2 HOLE , SQUARE
|
Facility
OP
|
$582.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201069
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$611.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$320.10
|
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 |
$291.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$334.65
|
Rate for Payer: Fidelis Medicare Advantage |
$611.10
|
Rate for Payer: Group Health Inc Commercial |
$291.00
|
Rate for Payer: Group Health Inc Medicare |
$203.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$291.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.30
|
|
3D PLT, 4 X 2 HOLE , SQUARE
|
Facility
IP
|
$582.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201069
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$291.00 |
Max. Negotiated Rate |
$291.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$291.00
|
|
3D PLT 4X2H, SQUARE
|
Facility
OP
|
$584.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209833
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$613.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$321.20
|
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 |
$292.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$335.80
|
Rate for Payer: Fidelis Medicare Advantage |
$613.20
|
Rate for Payer: Group Health Inc Commercial |
$292.00
|
Rate for Payer: Group Health Inc Medicare |
$204.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$292.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$292.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$379.60
|
|
3D PLT 4X2H, SQUARE
|
Facility
IP
|
$584.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209833
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$292.00 |
Max. Negotiated Rate |
$292.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$292.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$292.00
|
|
3D PLT 6X2H, CURVED SQUARE
|
Facility
IP
|
$656.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209834
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$328.00 |
Max. Negotiated Rate |
$328.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$328.00
|
|
3D PLT 6X2H, CURVED SQUARE
|
Facility
OP
|
$656.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209834
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$688.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$360.80
|
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 |
$328.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$377.20
|
Rate for Payer: Fidelis Medicare Advantage |
$688.80
|
Rate for Payer: Group Health Inc Commercial |
$328.00
|
Rate for Payer: Group Health Inc Medicare |
$229.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$328.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$426.40
|
|
3D PLT,6X2 HOLE,CURVED SQUARE
|
Facility
IP
|
$656.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201070
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$328.00 |
Max. Negotiated Rate |
$328.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$328.00
|
|
3D PLT,6X2 HOLE,CURVED SQUARE
|
Facility
OP
|
$656.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201070
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$688.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$360.80
|
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 |
$328.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$377.20
|
Rate for Payer: Fidelis Medicare Advantage |
$688.80
|
Rate for Payer: Group Health Inc Commercial |
$328.00
|
Rate for Payer: Group Health Inc Medicare |
$229.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$328.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$426.40
|
|
3D PLTE 3X2 HOLE SQUR 6MM PROFILE
|
Facility
OP
|
$408.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201067
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$428.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.40
|
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 |
$204.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.60
|
Rate for Payer: Fidelis Medicare Advantage |
$428.40
|
Rate for Payer: Group Health Inc Commercial |
$204.00
|
Rate for Payer: Group Health Inc Medicare |
$142.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$204.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.20
|
|
3D PLTE 3X2 HOLE SQUR 6MM PROFILE
|
Facility
IP
|
$408.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201067
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$204.00 |
Max. Negotiated Rate |
$204.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$204.00
|
|
3D PROFIL PLT .6MM 2X2L RECTNGL
|
Facility
IP
|
$365.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201063
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$182.50 |
Max. Negotiated Rate |
$182.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$182.50
|
|