|
SCREW BONE 3.5MM DIA 65MML TT
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
SCREW BONE 3.5MM DIA 70MML TT
|
Facility
OP
|
$147.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$155.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
| 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 |
$73.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
| Rate for Payer: Group Health Inc Commercial |
$73.94
|
| Rate for Payer: Group Health Inc Medicare |
$51.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
|
SCREW BONE 3.5MM DIA 70MML TT
|
Facility
IP
|
$147.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$73.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
|
SCREW BONE 3.5MM DIA 75MML TT
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
SCREW BONE 3.5MM DIA 75MML TT
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| 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 |
$50.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.00
|
|
|
SCREW BONE 3.5MM DIA 80MML TT
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| 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 |
$52.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.25
|
| Rate for Payer: Group Health Inc Commercial |
$52.50
|
| Rate for Payer: Group Health Inc Medicare |
$36.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.25
|
|
|
SCREW BONE 3.5MM DIA 80MML TT
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
|
|
SCREW BONE 3.5MM DIA 85MML TT
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
|
|
SCREW BONE 3.5MM DIA 85MML TT
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| 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 |
$52.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.25
|
| Rate for Payer: Group Health Inc Commercial |
$52.50
|
| Rate for Payer: Group Health Inc Medicare |
$36.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.25
|
|
|
SCREW BONE 3.5MM DIA 90MML TT
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| 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 |
$52.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.25
|
| Rate for Payer: Group Health Inc Commercial |
$52.50
|
| Rate for Payer: Group Health Inc Medicare |
$36.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.25
|
|
|
SCREW BONE 3.5MM DIA 90MML TT
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
|
|
SCREW BONE 3.5MM X 20MM
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.50
|
|
|
SCREW BONE 3.5MM X 20MM
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$551.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$288.75
|
| 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 |
$262.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$301.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.25
|
| Rate for Payer: Group Health Inc Commercial |
$262.50
|
| Rate for Payer: Group Health Inc Medicare |
$183.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.25
|
|
|
SCREW BONE 3.5MM X 30 MML TT
|
Facility
OP
|
$147.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$155.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
| 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 |
$73.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
| Rate for Payer: Group Health Inc Commercial |
$73.94
|
| Rate for Payer: Group Health Inc Medicare |
$51.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
|
SCREW BONE 3.5MM X 30 MML TT
|
Facility
IP
|
$147.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$73.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
|
SCREW BONE 3.5 X 10MM
|
Facility
IP
|
$147.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$73.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
|
SCREW BONE 3.5 X 10MM
|
Facility
OP
|
$147.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$155.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
| 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 |
$73.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
| Rate for Payer: Group Health Inc Commercial |
$73.94
|
| Rate for Payer: Group Health Inc Medicare |
$51.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
|
SCREW BONE 3.5 X 12MM A
|
Facility
IP
|
$147.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$73.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
|
SCREW BONE 3.5 X 12MM A
|
Facility
OP
|
$147.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$155.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
| 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 |
$73.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
| Rate for Payer: Group Health Inc Commercial |
$73.94
|
| Rate for Payer: Group Health Inc Medicare |
$51.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
|
SCREW BONE 3.5 X 12MM B
|
Facility
IP
|
$147.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$73.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
|
SCREW BONE 3.5 X 12MM B
|
Facility
OP
|
$147.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$155.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
| 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 |
$73.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
| Rate for Payer: Group Health Inc Commercial |
$73.94
|
| Rate for Payer: Group Health Inc Medicare |
$51.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
|
SCREW BONE 3.5 X 14 A
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$187.00
|
| 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 |
$170.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$357.00
|
| Rate for Payer: Group Health Inc Commercial |
$170.00
|
| Rate for Payer: Group Health Inc Medicare |
$119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.00
|
|
|
SCREW BONE 3.5 X 14 A
|
Facility
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.00
|
|
|
SCREW BONE 3.5 X 14 B
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$551.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$288.75
|
| 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 |
$262.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$301.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.25
|
| Rate for Payer: Group Health Inc Commercial |
$262.50
|
| Rate for Payer: Group Health Inc Medicare |
$183.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.25
|
|
|
SCREW BONE 3.5 X 14 B
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.50
|
|
