SCREW BONE T10 FT 2.7MM/L12MM
|
Facility
OP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905480
|
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 T10 FT 2.7MM/L12MM
|
Facility
IP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905480
|
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 T10 FT 2.7MM/L16MM
|
Facility
IP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905801
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$313.44 |
Max. Negotiated Rate |
$313.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
|
SCREW BONE T10 FT 2.7MM/L16MM
|
Facility
OP
|
$626.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905801
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$658.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$344.78
|
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 |
$313.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.46
|
Rate for Payer: Fidelis Medicare Advantage |
$658.22
|
Rate for Payer: Group Health Inc Commercial |
$313.44
|
Rate for Payer: Group Health Inc Medicare |
$219.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.47
|
|
SCREW BONE T10 FT 2.7MM / L20MM
|
Facility
IP
|
$272.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906512
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$136.00 |
Max. Negotiated Rate |
$136.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$136.00
|
|
SCREW BONE T10 FT 2.7MM / L20MM
|
Facility
OP
|
$272.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906512
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$95.20 |
Max. Negotiated Rate |
$285.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$149.60
|
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 |
$136.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.40
|
Rate for Payer: Fidelis Medicare Advantage |
$285.60
|
Rate for Payer: Group Health Inc Commercial |
$136.00
|
Rate for Payer: Group Health Inc Medicare |
$95.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$136.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.80
|
|
SCREW BONE T10 FT 2.7MM/L34MM
|
Facility
OP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905797
|
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 T10 FT 2.7MM/L34MM
|
Facility
IP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905797
|
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 T10 FT 2.7MM / L40MM
|
Facility
OP
|
$136.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906273
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$47.60 |
Max. Negotiated Rate |
$142.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.80
|
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 |
$68.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
Rate for Payer: Fidelis Medicare Advantage |
$142.80
|
Rate for Payer: Group Health Inc Commercial |
$68.00
|
Rate for Payer: Group Health Inc Medicare |
$47.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$68.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.40
|
|
SCREW BONE T10 FT 2.7MM / L40MM
|
Facility
IP
|
$136.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906273
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$68.00 |
Max. Negotiated Rate |
$68.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$68.00
|
|
SCREW BONE T10 FT 3.5MM / L55MM
|
Facility
IP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905639
|
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 T10 FT 3.5MM / L55MM
|
Facility
OP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905639
|
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 T10 FULL 3.5 L42
|
Facility
IP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905031
|
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 T10 FULL 3.5 L42
|
Facility
OP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905031
|
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 T10 FULL 3.5 L50
|
Facility
OP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905033
|
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 T10 FULL 3.5 L50
|
Facility
IP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905033
|
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 T2 5MM
|
Facility
OP
|
$866.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907502
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$909.56 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$476.44
|
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 |
$433.12
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$498.09
|
Rate for Payer: Fidelis Medicare Advantage |
$909.56
|
Rate for Payer: Group Health Inc Commercial |
$433.12
|
Rate for Payer: Group Health Inc Medicare |
$303.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$433.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$433.12
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$563.06
|
|
SCREW BONE T2 5MM
|
Facility
IP
|
$866.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907502
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$433.12 |
Max. Negotiated Rate |
$433.12 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$433.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$433.12
|
|
SCREW BONE T2 FT 5 X 27.5MM
|
Facility
IP
|
$429.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905729
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$214.50 |
Max. Negotiated Rate |
$214.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$214.50
|
|
SCREW BONE T2 FT 5 X 27.5MM
|
Facility
OP
|
$429.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905729
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$450.45 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$235.95
|
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 |
$214.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$246.68
|
Rate for Payer: Fidelis Medicare Advantage |
$450.45
|
Rate for Payer: Group Health Inc Commercial |
$214.50
|
Rate for Payer: Group Health Inc Medicare |
$150.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$214.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.85
|
|
SCREW BONE T8 2.7MM
|
Facility
IP
|
$230.18
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907501
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$115.09 |
Max. Negotiated Rate |
$115.09 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.09
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$115.09
|
|
SCREW BONE T8 2.7MM
|
Facility
OP
|
$230.18
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907501
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$80.56 |
Max. Negotiated Rate |
$241.69 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.60
|
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 |
$115.09
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.35
|
Rate for Payer: Fidelis Medicare Advantage |
$241.69
|
Rate for Payer: Group Health Inc Commercial |
$115.09
|
Rate for Payer: Group Health Inc Medicare |
$80.56
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.09
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$115.09
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.62
|
|
SCREW BONE T8 FL THRD 2.7X32MML
|
Facility
IP
|
$239.78
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906529
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$119.89 |
Max. Negotiated Rate |
$119.89 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.89
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$119.89
|
|
SCREW BONE T8 FL THRD 2.7X32MML
|
Facility
OP
|
$239.78
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906529
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$83.92 |
Max. Negotiated Rate |
$251.77 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$131.88
|
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 |
$119.89
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$137.87
|
Rate for Payer: Fidelis Medicare Advantage |
$251.77
|
Rate for Payer: Group Health Inc Commercial |
$119.89
|
Rate for Payer: Group Health Inc Medicare |
$83.92
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.89
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$119.89
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.86
|
|
SCREW BONE T8 F-THRD 2.7MMX30MML
|
Facility
OP
|
$239.78
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906528
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$83.92 |
Max. Negotiated Rate |
$251.77 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$131.88
|
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 |
$119.89
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$137.87
|
Rate for Payer: Fidelis Medicare Advantage |
$251.77
|
Rate for Payer: Group Health Inc Commercial |
$119.89
|
Rate for Payer: Group Health Inc Medicare |
$83.92
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.89
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$119.89
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.86
|
|