SCREW AP 6.25 X 40
|
Facility
OP
|
$3,497.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904585
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,672.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,923.62
|
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 |
$1,748.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,011.06
|
Rate for Payer: Fidelis Medicare Advantage |
$3,672.38
|
Rate for Payer: Group Health Inc Commercial |
$1,748.75
|
Rate for Payer: Group Health Inc Medicare |
$1,224.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,748.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,748.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,273.38
|
|
SCREW AP 6.25 X 40
|
Facility
IP
|
$3,497.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904585
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,748.75 |
Max. Negotiated Rate |
$1,748.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,748.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,748.75
|
|
SCREW ARM15T 6.5X45MM POLY
|
Facility
IP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903715
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,500.00 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
|
SCREW ARM15T 6.5X45MM POLY
|
Facility
OP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903715
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,150.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,650.00
|
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 |
$1,500.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,150.00
|
Rate for Payer: Group Health Inc Commercial |
$1,500.00
|
Rate for Payer: Group Health Inc Medicare |
$1,050.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,950.00
|
|
SCREW ARM15T 6.5X50 MM POLY
|
Facility
OP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903527
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,150.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,650.00
|
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 |
$1,500.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,150.00
|
Rate for Payer: Group Health Inc Commercial |
$1,500.00
|
Rate for Payer: Group Health Inc Medicare |
$1,050.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,950.00
|
|
SCREW ARM15T 6.5X50 MM POLY
|
Facility
IP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903527
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,500.00 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
|
SCREW ARM15T 7.5X50MM PA
|
Facility
IP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904461
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,500.00 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
|
SCREW ARM15T 7.5X50MM PA
|
Facility
OP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904461
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,150.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,650.00
|
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 |
$1,500.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,150.00
|
Rate for Payer: Group Health Inc Commercial |
$1,500.00
|
Rate for Payer: Group Health Inc Medicare |
$1,050.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,950.00
|
|
SCREW ARM15T 8.5X50MM POLY
|
Facility
IP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904077
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,500.00 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
|
SCREW ARM15T 8.5X50MM POLY
|
Facility
OP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904077
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,150.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,650.00
|
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 |
$1,500.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,150.00
|
Rate for Payer: Group Health Inc Commercial |
$1,500.00
|
Rate for Payer: Group Health Inc Medicare |
$1,050.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,950.00
|
|
SCREW ARTHRO 2.5
|
Facility
OP
|
$2,077.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907505
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,181.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,142.62
|
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 |
$1,038.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,194.56
|
Rate for Payer: Fidelis Medicare Advantage |
$2,181.38
|
Rate for Payer: Group Health Inc Commercial |
$1,038.75
|
Rate for Payer: Group Health Inc Medicare |
$727.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,350.38
|
|
SCREW ARTHRO 2.5
|
Facility
IP
|
$2,077.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907505
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,038.75 |
Max. Negotiated Rate |
$1,038.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.75
|
|
SCREW ARTM15T 6.5X40 POL
|
Facility
IP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903888
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,500.00 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
|
SCREW ARTM15T 6.5X40 POL
|
Facility
OP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903888
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,150.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,650.00
|
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 |
$1,500.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,150.00
|
Rate for Payer: Group Health Inc Commercial |
$1,500.00
|
Rate for Payer: Group Health Inc Medicare |
$1,050.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,950.00
|
|
SCREW ARTM15T 6.5X55 POL
|
Facility
OP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903890
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,150.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,650.00
|
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 |
$1,500.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,150.00
|
Rate for Payer: Group Health Inc Commercial |
$1,500.00
|
Rate for Payer: Group Health Inc Medicare |
$1,050.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,950.00
|
|
SCREW ARTM15T 6.5X55 POL
|
Facility
IP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903890
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,500.00 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
|
SCREW ASNIS 3.0
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903119
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW ASNIS 3.0
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903119
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW ASNIS 3.0 X 30
|
Facility
IP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903260
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.06 |
Max. Negotiated Rate |
$225.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
|
SCREW ASNIS 3.0 X 30
|
Facility
OP
|
$450.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903260
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.57
|
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 |
$225.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.82
|
Rate for Payer: Fidelis Medicare Advantage |
$472.64
|
Rate for Payer: Group Health Inc Commercial |
$225.06
|
Rate for Payer: Group Health Inc Medicare |
$157.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.58
|
|
SCREW ASNIS III 6.5X140MM-606140
|
Facility
IP
|
$223.58
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906388
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$111.79 |
Max. Negotiated Rate |
$111.79 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.79
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.79
|
|
SCREW ASNIS III 6.5X140MM-606140
|
Facility
OP
|
$223.58
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906388
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$78.25 |
Max. Negotiated Rate |
$234.76 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.97
|
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 |
$111.79
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$128.56
|
Rate for Payer: Fidelis Medicare Advantage |
$234.76
|
Rate for Payer: Group Health Inc Commercial |
$111.79
|
Rate for Payer: Group Health Inc Medicare |
$78.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.79
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.79
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.33
|
|
SCREW ASNIS III SS CAN 6.5X80MM
|
Facility
IP
|
$614.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905793
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$307.12 |
Max. Negotiated Rate |
$307.12 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
|
SCREW ASNIS III SS CAN 6.5X80MM
|
Facility
OP
|
$614.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905793
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$644.96 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.84
|
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 |
$307.12
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.19
|
Rate for Payer: Fidelis Medicare Advantage |
$644.96
|
Rate for Payer: Group Health Inc Commercial |
$307.12
|
Rate for Payer: Group Health Inc Medicare |
$214.99
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.26
|
|
SCREW ASNIS III SS CAN 6.5X95MM
|
Facility
OP
|
$614.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905791
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$644.96 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.84
|
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 |
$307.12
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.19
|
Rate for Payer: Fidelis Medicare Advantage |
$644.96
|
Rate for Payer: Group Health Inc Commercial |
$307.12
|
Rate for Payer: Group Health Inc Medicare |
$214.99
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$307.12
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.26
|
|