|
SCREW BONE 4.5MM DIA 46MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901677
|
|
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 46MML TT
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903254
|
|
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 TT
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903254
|
|
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 48MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902515
|
|
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 48MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902515
|
|
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 48MML TT
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903840
|
|
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 48MML TT
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903840
|
|
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 50MML TT
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904032
|
|
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 50MML TT
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904032
|
|
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 52MML
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902390
|
|
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 52MML
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902390
|
|
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 54MML
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902211
|
|
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 54MML
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902211
|
|
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 55MML TT
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903838
|
|
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 55MML TT
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903838
|
|
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 58MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902392
|
|
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 58MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902392
|
|
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 60MML STA
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902214
|
|
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 60MML STA
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902214
|
|
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 60MML TT
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904981
|
|
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 60MML TT
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904981
|
|
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 75MML TT
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903869
|
|
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 75MML TT
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903869
|
|
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 95MML TT
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904036
|
|
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 95MML TT
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904036
|
|
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
|
|
