|
SCREW CORTICAL SS 2.7X20MM
|
Facility
IP
|
$6.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.44
|
|
|
SCREW CORTICAL ST 3.5X26
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.50
|
|
|
SCREW CORTICAL ST 3.5X26
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.75
|
| 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 |
$32.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.25
|
| Rate for Payer: Group Health Inc Commercial |
$32.50
|
| Rate for Payer: Group Health Inc Medicare |
$22.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.25
|
|
|
SCREW CORTICAL ST 3.5X55
|
Facility
OP
|
$53.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.51
|
| 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 |
$26.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.33
|
| Rate for Payer: Group Health Inc Commercial |
$26.82
|
| Rate for Payer: Group Health Inc Medicare |
$18.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.87
|
|
|
SCREW CORTICAL ST 3.5X55
|
Facility
IP
|
$53.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$26.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.82
|
|
|
SCREW CORTICAL ST 4.5X58MM SS
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| 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 |
$20.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.00
|
| Rate for Payer: Group Health Inc Commercial |
$20.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.00
|
|
|
SCREW CORTICAL ST 4.5X58MM SS
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.00
|
|
|
SCREW CORTICOL 4.5 X 22
|
Facility
OP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903875
|
|
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 CORTICOL 4.5 X 22
|
Facility
IP
|
$56.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903875
|
|
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 CORT LCK 3.5 X 11MM
|
Facility
OP
|
$285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$156.75
|
| 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 |
$142.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$299.25
|
| Rate for Payer: Group Health Inc Commercial |
$142.50
|
| Rate for Payer: Group Health Inc Medicare |
$99.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.25
|
|
|
SCREW CORT LCK 3.5 X 11MM
|
Facility
IP
|
$285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.50
|
|
|
SCREW CORT LOCK 3.5
|
Facility
OP
|
$285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$156.75
|
| 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 |
$142.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$299.25
|
| Rate for Payer: Group Health Inc Commercial |
$142.50
|
| Rate for Payer: Group Health Inc Medicare |
$99.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.25
|
|
|
SCREW CORT LOCK 3.5
|
Facility
IP
|
$285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.50
|
|
|
SCREW CORT LOCKING 3.5 X 14MM
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
|
|
SCREW CORT LOCKING 3.5 X 14MM
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
| 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 |
$87.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$183.75
|
| Rate for Payer: Group Health Inc Commercial |
$87.50
|
| Rate for Payer: Group Health Inc Medicare |
$61.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.75
|
|
|
SCREW CORT LOCKING 3.5 X 16MM
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
|
|
SCREW CORT LOCKING 3.5 X 16MM
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
| 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 |
$87.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$183.75
|
| Rate for Payer: Group Health Inc Commercial |
$87.50
|
| Rate for Payer: Group Health Inc Medicare |
$61.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.75
|
|
|
SCREW CORT LOCKING 3.5 X 18MM
|
Facility
IP
|
$187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
|
|
SCREW CORT LOCKING 3.5 X 18MM
|
Facility
OP
|
$187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.62 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.12
|
| 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 |
$93.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$107.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.88
|
| Rate for Payer: Group Health Inc Commercial |
$93.75
|
| Rate for Payer: Group Health Inc Medicare |
$65.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.88
|
|
|
SCREW CORT LOPRO SS 3.5X40MM
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906364
|
|
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 CORT LOPRO SS 3.5X40MM
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906364
|
|
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 CORT NOLCK 3.5 X 14MM
|
Facility
OP
|
$285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$156.75
|
| 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 |
$142.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$299.25
|
| Rate for Payer: Group Health Inc Commercial |
$142.50
|
| Rate for Payer: Group Health Inc Medicare |
$99.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.25
|
|
|
SCREW CORT NOLCK 3.5 X 14MM
|
Facility
IP
|
$285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.50
|
|
|
SCREW CORT PART THR 4X40MM
|
Facility
IP
|
$6,294.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,147.15 |
| Max. Negotiated Rate |
$3,147.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,147.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,147.15
|
|
|
SCREW CORT PART THR 4X40MM
|
Facility
OP
|
$6,294.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$6,609.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,461.86
|
| 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 |
$3,147.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,619.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.02
|
| Rate for Payer: Group Health Inc Commercial |
$3,147.15
|
| Rate for Payer: Group Health Inc Medicare |
$2,203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,147.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,147.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,091.30
|
|
