SCREW CORTICAL 2.0 X 16MM
|
Facility
IP
|
$462.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906957
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$231.25 |
Max. Negotiated Rate |
$231.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$231.25
|
|
SCREW CORTICAL 2.0 X 16MM
|
Facility
OP
|
$462.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906957
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$485.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.38
|
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 |
$231.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$265.94
|
Rate for Payer: Fidelis Medicare Advantage |
$485.62
|
Rate for Payer: Group Health Inc Commercial |
$231.25
|
Rate for Payer: Group Health Inc Medicare |
$161.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$231.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.62
|
|
SCREW CORTICAL 2.7MM AR8827
|
Facility
OP
|
$90.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906566
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$31.50 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
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 |
$45.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.75
|
Rate for Payer: Fidelis Medicare Advantage |
$94.50
|
Rate for Payer: Group Health Inc Commercial |
$45.00
|
Rate for Payer: Group Health Inc Medicare |
$31.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.50
|
|
SCREW CORTICAL 2.7MM AR8827
|
Facility
IP
|
$90.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906566
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$45.00 |
Max. Negotiated Rate |
$45.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
|
SCREW CORTICAL 2.7 X 28MM
|
Facility
OP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905262
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.48 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.18
|
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 |
$29.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.64
|
Rate for Payer: Fidelis Medicare Advantage |
$61.42
|
Rate for Payer: Group Health Inc Commercial |
$29.25
|
Rate for Payer: Group Health Inc Medicare |
$20.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.02
|
|
SCREW CORTICAL 2.7 X 28MM
|
Facility
IP
|
$58.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905262
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.25
|
|
SCREW CORTICAL 3.5 22MM
|
Facility
OP
|
$35.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906357
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$12.25 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
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 |
$17.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.12
|
Rate for Payer: Fidelis Medicare Advantage |
$36.75
|
Rate for Payer: Group Health Inc Commercial |
$17.50
|
Rate for Payer: Group Health Inc Medicare |
$12.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.75
|
|
SCREW CORTICAL 3.5 22MM
|
Facility
IP
|
$35.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906357
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.50 |
Max. Negotiated Rate |
$17.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
|
SCREW CORTICAL 3.5 X 12
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905266
|
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 CORTICAL 3.5 X 12
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905266
|
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 CORTICAL 3.5 X 22MM
|
Facility
OP
|
$105.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905063
|
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 CORTICAL 3.5 X 22MM
|
Facility
IP
|
$105.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905063
|
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 CORTICAL 3.5X44MM
|
Facility
OP
|
$51.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902767
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.94 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.19
|
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 |
$25.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.47
|
Rate for Payer: Fidelis Medicare Advantage |
$53.81
|
Rate for Payer: Group Health Inc Commercial |
$25.62
|
Rate for Payer: Group Health Inc Medicare |
$17.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$25.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.31
|
|
SCREW CORTICAL 3.5X44MM
|
Facility
IP
|
$51.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902767
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$25.62 |
Max. Negotiated Rate |
$25.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$25.62
|
|
SCREW CORTICAL 35 X 70
|
Facility
OP
|
$100.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905147
|
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 CORTICAL 35 X 70
|
Facility
IP
|
$100.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905147
|
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 CORTICAL 3.8 X 48
|
Facility
IP
|
$89.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905362
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.62 |
Max. Negotiated Rate |
$44.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$44.62
|
|
SCREW CORTICAL 3.8 X 48
|
Facility
OP
|
$89.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905362
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$31.24 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.09
|
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 |
$44.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.32
|
Rate for Payer: Fidelis Medicare Advantage |
$93.71
|
Rate for Payer: Group Health Inc Commercial |
$44.62
|
Rate for Payer: Group Health Inc Medicare |
$31.24
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$44.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.01
|
|
SCREW CORTICAL 4.5MM X 16MM
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902845
|
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 CORTICAL 4.5MM X 16MM
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902845
|
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 CORTICAL BONE 5.0MMX38MM
|
Facility
IP
|
$496.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204643
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$248.00 |
Max. Negotiated Rate |
$248.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$248.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$248.00
|
|
SCREW CORTICAL BONE 5.0MMX38MM
|
Facility
OP
|
$496.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204643
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$520.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$272.80
|
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 |
$248.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$285.20
|
Rate for Payer: Fidelis Medicare Advantage |
$520.80
|
Rate for Payer: Group Health Inc Commercial |
$248.00
|
Rate for Payer: Group Health Inc Medicare |
$173.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$248.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$248.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$322.40
|
|
SCREW CORTICAL NO-LOCK 14MM
|
Facility
IP
|
$35.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906366
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.50 |
Max. Negotiated Rate |
$17.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
|
SCREW CORTICAL NO-LOCK 14MM
|
Facility
OP
|
$35.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906366
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$12.25 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
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 |
$17.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.12
|
Rate for Payer: Fidelis Medicare Advantage |
$36.75
|
Rate for Payer: Group Health Inc Commercial |
$17.50
|
Rate for Payer: Group Health Inc Medicare |
$12.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.75
|
|
SCREW CORTICAL SS 2.7X20MM
|
Facility
OP
|
$6.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901684
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.41 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.78
|
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 |
$3.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.96
|
Rate for Payer: Fidelis Medicare Advantage |
$7.22
|
Rate for Payer: Group Health Inc Commercial |
$3.44
|
Rate for Payer: Group Health Inc Medicare |
$2.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.47
|
|