|
SCREW BONE 4.5MM DIA 30MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902341
|
|
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 4.5MM DIA 30MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902341
|
|
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 4.5MM DIA 32MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901855
|
|
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 4.5MM DIA 32MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901855
|
|
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 4.5MM DIA 34MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901671
|
|
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 4.5MM DIA 34MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901671
|
|
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 4.5MM DIA 36MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901763
|
|
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 4.5MM DIA 36MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901763
|
|
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 4.5MM DIA 36MML TT
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.50
|
|
|
SCREW BONE 4.5MM DIA 36MML TT
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| 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 |
$57.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.75
|
| Rate for Payer: Group Health Inc Commercial |
$57.50
|
| Rate for Payer: Group Health Inc Medicare |
$40.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.75
|
|
|
SCREW BONE 4.5MM DIA 38MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901672
|
|
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 4.5MM DIA 38MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901672
|
|
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 4.5MM DIA 38MML TT
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
|
|
SCREW BONE 4.5MM DIA 38MML TT
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.00
|
| 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 |
$60.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.00
|
| Rate for Payer: Group Health Inc Commercial |
$60.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.00
|
|
|
SCREW BONE 4.5MM DIA 40MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901674
|
|
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 4.5MM DIA 40MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901674
|
|
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 4.5MM DIA 42MML STA
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901675
|
|
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 4.5MM DIA 42MML STA
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901675
|
|
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 4.5MM DIA 42MML TT
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
|
|
SCREW BONE 4.5MM DIA 42MML TT
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.00
|
| 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 |
$60.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.00
|
| Rate for Payer: Group Health Inc Commercial |
$60.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.00
|
|
|
SCREW BONE 4.5MM DIA 44MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902347
|
|
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 4.5MM DIA 44MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902347
|
|
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 4.5MM DIA 44MML TT
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
|
|
SCREW BONE 4.5MM DIA 44MML TT
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.00
|
| 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 |
$60.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.00
|
| Rate for Payer: Group Health Inc Commercial |
$60.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.00
|
|
|
SCREW BONE 4.5MM DIA 46MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901677
|
|
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
|
|
