SCREW CAN 3.75 X 32MM FT
|
Facility
IP
|
$400.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906863
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$200.00 |
Max. Negotiated Rate |
$200.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
|
SCREW CAN 3.75 X 32MM FT
|
Facility
OP
|
$400.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906863
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$420.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
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 |
$200.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.00
|
Rate for Payer: Fidelis Medicare Advantage |
$420.00
|
Rate for Payer: Group Health Inc Commercial |
$200.00
|
Rate for Payer: Group Health Inc Medicare |
$140.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.00
|
|
SCREW CAN 4.0 X 80MM
|
Facility
OP
|
$36.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205099
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$12.60 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
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 |
$18.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.70
|
Rate for Payer: Fidelis Medicare Advantage |
$37.80
|
Rate for Payer: Group Health Inc Commercial |
$18.00
|
Rate for Payer: Group Health Inc Medicare |
$12.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$18.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.40
|
|
SCREW CAN 4.0 X 80MM
|
Facility
IP
|
$36.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205099
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$18.00 |
Max. Negotiated Rate |
$18.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$18.00
|
|
SCREW CANC BONE FT 4.0 X 24MM
|
Facility
OP
|
$44.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901800
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$15.53 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.41
|
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 |
$22.19
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.52
|
Rate for Payer: Fidelis Medicare Advantage |
$46.60
|
Rate for Payer: Group Health Inc Commercial |
$22.19
|
Rate for Payer: Group Health Inc Medicare |
$15.53
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.19
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$22.19
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.85
|
|
SCREW CANC BONE FT 4.0 X 24MM
|
Facility
IP
|
$44.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901800
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$22.19 |
Max. Negotiated Rate |
$22.19 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.19
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$22.19
|
|
SCREW CANCEL 4.0 X 10MM FT SS
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901741
|
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 CANCEL 4.0 X 10MM FT SS
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901741
|
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 CANCEL 4.0 X 12MM FT SS
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901680
|
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 CANCEL 4.0 X 12MM FT SS
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901680
|
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 CANCEL 4.0 X 14MM FT SS
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901423
|
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 CANCEL 4.0 X 14MM FT SS
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901423
|
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 CANCEL 4.0 X 20MM FT SS
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901742
|
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 CANCEL 4.0 X 20MM FT SS
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901742
|
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 CANCEL 4.0 X 28MM FT SS
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902525
|
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 CANCEL 4.0 X 28MM FT SS
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902525
|
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 CANCEL 4.0 X 32MM FT SS
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901745
|
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 CANCEL 4.0 X 32MM FT SS
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901745
|
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 CANCEL 4.0 X 34MM PT SS
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901752
|
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 CANCEL 4.0 X 34MM PT SS
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901752
|
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 CANCEL 4.0 X 38MM FT SS
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901947
|
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 CANCEL 4.0 X 38MM FT SS
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901947
|
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 CANCEL 4.0 X 40MM FT SS
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901746
|
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 CANCEL 4.0 X 40MM FT SS
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901746
|
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 CANCEL 4.0 X 40MM PT SS
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901857
|
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
|
|