|
4.0MMX40MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006983
|
|
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 SCR TI STRL
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006983
|
|
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
|
|
|
4.0MMX42MM MOTIONLOC SCREW TI
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007248
|
|
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
|
|
|
4.0MMX42MM MOTIONLOC SCREW TI
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007248
|
|
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
|
|
|
4.0MMX42MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006984
|
|
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
|
|
|
4.0MMX42MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006984
|
|
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
|
|
|
4.0MMX44MM MOTIONLOC SCREW TI
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007249
|
|
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
|
|
|
4.0MMX44MM MOTIONLOC SCREW TI
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007249
|
|
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
|
|
|
4.0MMX44MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006985
|
|
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
|
|
|
4.0MMX44MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006985
|
|
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
|
|
|
4.0MMX46MM MOTIONLOC SCREW TI
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007250
|
|
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
|
|
|
4.0MMX46MM MOTIONLOC SCREW TI
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007250
|
|
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
|
|
|
4.0MMX46MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006986
|
|
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
|
|
|
4.0MMX46MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$252.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006986
|
|
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
|
|
|
4.3MM DRILL MEASURING SLEEVE
|
Facility
OP
|
$912.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$501.60
|
| 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 |
$456.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$524.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$957.60
|
| Rate for Payer: Group Health Inc Commercial |
$456.00
|
| Rate for Payer: Group Health Inc Medicare |
$319.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$456.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$456.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$592.80
|
|
|
4.3MM DRILL MEASURING SLEEVE
|
Facility
IP
|
$912.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$456.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$456.00
|
|
|
4.3MM FREE HAND DRILL 152.5MM
|
Facility
IP
|
$273.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.80
|
|
|
4.3MM FREE HAND DRILL 152.5MM
|
Facility
OP
|
$273.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.76 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$150.48
|
| 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 |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$157.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.28
|
| Rate for Payer: Group Health Inc Commercial |
$136.80
|
| Rate for Payer: Group Health Inc Medicare |
$95.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$177.84
|
|
|
4.3MML DISTAL GRADUATED DRILL
|
Facility
IP
|
$624.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.00
|
|
|
4.3MML DISTAL GRADUATED DRILL
|
Facility
OP
|
$624.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$655.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.20
|
| 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 |
$312.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$358.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$655.20
|
| Rate for Payer: Group Health Inc Commercial |
$312.00
|
| Rate for Payer: Group Health Inc Medicare |
$218.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.60
|
|
|
4.3MM NCB CANNULA
|
Facility
OP
|
$281.82
|
|
| Hospital Charge Code |
40006770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$225.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$155.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$140.91
|
| Rate for Payer: Aetna Government |
$140.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$191.64
|
| Rate for Payer: Group Health Inc Commercial |
$140.91
|
| Rate for Payer: Group Health Inc Medicare |
$98.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.91
|
|
|
4.3MMS DISTAL GRADUATED DRILL
|
Facility
OP
|
$624.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$655.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.20
|
| 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 |
$312.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$358.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$655.20
|
| Rate for Payer: Group Health Inc Commercial |
$312.00
|
| Rate for Payer: Group Health Inc Medicare |
$218.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.60
|
|
|
4.3MMS DISTAL GRADUATED DRILL
|
Facility
IP
|
$624.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.00
|
|
|
4.3X45MM TIT CANN SCRW
|
Facility
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$346.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$346.00
|
|
|
4.3X45MM TIT CANN SCRW
|
Facility
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$726.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$380.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$346.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$397.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.60
|
| Rate for Payer: Group Health Inc Commercial |
$346.00
|
| Rate for Payer: Group Health Inc Medicare |
$242.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$346.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$449.80
|
|
