|
SCREW BONE 2.3 X 8MM CROSS PIN
|
Facility
IP
|
$131.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.59 |
| Max. Negotiated Rate |
$65.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.59
|
|
|
SCREW BONE 2.3 X 8MM CROSS PIN
|
Facility
OP
|
$131.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.91 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.15
|
| 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 |
$65.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.74
|
| Rate for Payer: Group Health Inc Commercial |
$65.59
|
| Rate for Payer: Group Health Inc Medicare |
$45.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.27
|
|
|
SCREW BONE 2.3 X9MM
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40206054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.00
|
|
|
SCREW BONE 2.3 X9MM
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40206054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$68.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$71.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.20
|
| Rate for Payer: Group Health Inc Commercial |
$62.00
|
| Rate for Payer: Group Health Inc Medicare |
$43.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.60
|
|
|
SCREW BONE 2.7MM DIA 10MM
|
Facility
IP
|
$134.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.44
|
|
|
SCREW BONE 2.7MM DIA 10MM
|
Facility
OP
|
$134.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.21 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.18
|
| 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 |
$67.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.62
|
| Rate for Payer: Group Health Inc Commercial |
$67.44
|
| Rate for Payer: Group Health Inc Medicare |
$47.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.67
|
|
|
SCREW BONE 2.7MM DIA 12MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$28.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
|
|
SCREW BONE 2.7MM DIA 12MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.28
|
| 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 |
$28.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.72
|
| Rate for Payer: Group Health Inc Commercial |
$28.44
|
| Rate for Payer: Group Health Inc Medicare |
$19.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.97
|
|
|
SCREW BONE 2.7MM DIA 12MML TT
|
Facility
OP
|
$134.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.21 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.18
|
| 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 |
$67.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.62
|
| Rate for Payer: Group Health Inc Commercial |
$67.44
|
| Rate for Payer: Group Health Inc Medicare |
$47.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.67
|
|
|
SCREW BONE 2.7MM DIA 12MML TT
|
Facility
IP
|
$134.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.44
|
|
|
SCREW BONE 2.7MM DIA 14MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$28.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
|
|
SCREW BONE 2.7MM DIA 14MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.28
|
| 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 |
$28.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.72
|
| Rate for Payer: Group Health Inc Commercial |
$28.44
|
| Rate for Payer: Group Health Inc Medicare |
$19.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.97
|
|
|
SCREW BONE 2.7MM DIA 14MML TT
|
Facility
OP
|
$134.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.21 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.18
|
| 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 |
$67.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.62
|
| Rate for Payer: Group Health Inc Commercial |
$67.44
|
| Rate for Payer: Group Health Inc Medicare |
$47.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.67
|
|
|
SCREW BONE 2.7MM DIA 14MML TT
|
Facility
IP
|
$134.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.44
|
|
|
SCREW BONE 2.7MM DIA 16MML STA
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
|
SCREW BONE 2.7MM DIA 16MML STA
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| 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 |
$25.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.50
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.50
|
|
|
SCREW BONE 2.7MM DIA 16MML TT
|
Facility
IP
|
$134.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.44
|
|
|
SCREW BONE 2.7MM DIA 16MML TT
|
Facility
OP
|
$134.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.21 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.18
|
| 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 |
$67.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.62
|
| Rate for Payer: Group Health Inc Commercial |
$67.44
|
| Rate for Payer: Group Health Inc Medicare |
$47.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.67
|
|
|
SCREW BONE 2.7MM DIA 18MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$28.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
|
|
SCREW BONE 2.7MM DIA 18MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.28
|
| 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 |
$28.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.72
|
| Rate for Payer: Group Health Inc Commercial |
$28.44
|
| Rate for Payer: Group Health Inc Medicare |
$19.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.97
|
|
|
SCREW BONE 2.7MM DIA 18MML TT
|
Facility
OP
|
$287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$301.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$157.85
|
| 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 |
$143.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$301.35
|
| Rate for Payer: Group Health Inc Commercial |
$143.50
|
| Rate for Payer: Group Health Inc Medicare |
$100.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.55
|
|
|
SCREW BONE 2.7MM DIA 18MML TT
|
Facility
IP
|
$287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$143.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.50
|
|
|
SCREW BONE 2.7MM DIA 30MML TT
|
Facility
OP
|
$134.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.21 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.18
|
| 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 |
$67.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.62
|
| Rate for Payer: Group Health Inc Commercial |
$67.44
|
| Rate for Payer: Group Health Inc Medicare |
$47.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.67
|
|
|
SCREW BONE 2.7MM DIA 30MML TT
|
Facility
IP
|
$134.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.44
|
|
|
SCREW BONE 2.7MM DIA 38MML TT
|
Facility
IP
|
$406.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.00
|
|
