|
4.0MMX28MM MOTIONLOC SCREW TI
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX28MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX28MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX30MM MOTIONLOC SCREW TI
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX30MM MOTIONLOC SCREW TI
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX30MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX30MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX32MM MOTIONLOC SCREW TI
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX32MM MOTIONLOC SCREW TI
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX32MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX32MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX34MM MOTIONLOC SCREW TI
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX34MM MOTIONLOC SCREW TI
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX34MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX34MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX36MM MOTIONLOC SCREW TI
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX36MM MOTIONLOC SCREW TI
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX36MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX36MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX38MM MOTIONLOC SCREW TI
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX38MM MOTIONLOC SCREW TI
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX38MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
|
4.0MMX38MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX40MM MOTIONLOC SCREW TI
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$126.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
|
|
4.0MMX40MM MOTIONLOC SCREW TI
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$264.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.69
|
| 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 |
$126.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.77
|
| Rate for Payer: Group Health Inc Commercial |
$126.08
|
| Rate for Payer: Group Health Inc Medicare |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.90
|
|
