|
SCREW HEADLESS COMPRESSION 5.0B
|
Facility
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,443.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$756.25
|
| 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 |
$687.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$790.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,443.75
|
| Rate for Payer: Group Health Inc Commercial |
$687.50
|
| Rate for Payer: Group Health Inc Medicare |
$481.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$893.75
|
|
|
SCREW HEADLESS COMPRESSION 5.0B
|
Facility
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.50 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.50
|
|
|
SCREW HEADLESS COMPRESSION 5.0C
|
Facility
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.50 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.50
|
|
|
SCREW HEADLESS COMPRESSION 5.0C
|
Facility
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,443.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$756.25
|
| 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 |
$687.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$790.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,443.75
|
| Rate for Payer: Group Health Inc Commercial |
$687.50
|
| Rate for Payer: Group Health Inc Medicare |
$481.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$893.75
|
|
|
SCREW HEADLESS COMPRESSION 5.0D
|
Facility
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,443.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$756.25
|
| 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 |
$687.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$790.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,443.75
|
| Rate for Payer: Group Health Inc Commercial |
$687.50
|
| Rate for Payer: Group Health Inc Medicare |
$481.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$893.75
|
|
|
SCREW HEADLESS COMPRESSION 5.0D
|
Facility
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.50 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.50
|
|
|
SCREW HEADLESS COMPRESSION 5.0M
|
Facility
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.50 |
| Max. Negotiated Rate |
$687.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.50
|
|
|
SCREW HEADLESS COMPRESSION 5.0M
|
Facility
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,443.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$756.25
|
| 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 |
$687.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$790.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,443.75
|
| Rate for Payer: Group Health Inc Commercial |
$687.50
|
| Rate for Payer: Group Health Inc Medicare |
$481.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$687.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$893.75
|
|
|
SCREW HEAD MINI
|
Facility
IP
|
$813.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.52 |
| Max. Negotiated Rate |
$406.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$406.52
|
|
|
SCREW HEAD MINI
|
Facility
OP
|
$813.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$853.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$447.18
|
| 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 |
$406.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$467.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$853.70
|
| Rate for Payer: Group Health Inc Commercial |
$406.52
|
| Rate for Payer: Group Health Inc Medicare |
$284.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$406.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$528.48
|
|
|
SCREW HEX FEMALE 2.5MM
|
Facility
OP
|
$372.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.38 |
| Max. Negotiated Rate |
$391.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.88
|
| 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 |
$186.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$214.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.12
|
| Rate for Payer: Group Health Inc Commercial |
$186.25
|
| Rate for Payer: Group Health Inc Medicare |
$130.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.12
|
|
|
SCREW HEX FEMALE 2.5MM
|
Facility
IP
|
$372.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$186.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.25
|
|
|
SCREW HEX PSN 2.5M FEM 25MM
|
Facility
OP
|
$372.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.38 |
| Max. Negotiated Rate |
$391.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.88
|
| 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 |
$186.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$214.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.12
|
| Rate for Payer: Group Health Inc Commercial |
$186.25
|
| Rate for Payer: Group Health Inc Medicare |
$130.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.12
|
|
|
SCREW HEX PSN 2.5M FEM 25MM
|
Facility
IP
|
$372.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$186.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.25
|
|
|
SCREW HEX PSN 2.5MM FEMALE 25MM
|
Facility
IP
|
$542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.00 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.00
|
|
|
SCREW HEX PSN 2.5MM FEMALE 25MM
|
Facility
OP
|
$542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$569.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$298.10
|
| 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 |
$271.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$311.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$569.10
|
| Rate for Payer: Group Health Inc Commercial |
$271.00
|
| Rate for Payer: Group Health Inc Medicare |
$189.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.30
|
|
|
SCREW, HEX PSN 2.5MM FEMALE 25MM
|
Facility
OP
|
$542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$569.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$298.10
|
| 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 |
$271.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$311.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$569.10
|
| Rate for Payer: Group Health Inc Commercial |
$271.00
|
| Rate for Payer: Group Health Inc Medicare |
$189.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.30
|
|
|
SCREW, HEX PSN 2.5MM FEMALE 25MM
|
Facility
IP
|
$542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.00 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.00
|
|
|
SCREW HFN LAG 10.5MM X 115MM
|
Facility
IP
|
$1,696.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40003337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.00 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
|
|
SCREW HFN LAG 10.5MM X 115MM
|
Facility
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,166.00
|
| 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 |
$1,060.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,219.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,226.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,060.00
|
| Rate for Payer: Group Health Inc Medicare |
$742.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,060.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,060.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,378.00
|
|
|
SCREW HFN LAG 10.5MM X 115MM
|
Facility
OP
|
$1,696.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40003337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,780.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$932.80
|
| 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 |
$848.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$975.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,780.80
|
| Rate for Payer: Group Health Inc Commercial |
$848.00
|
| Rate for Payer: Group Health Inc Medicare |
$593.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,102.40
|
|
|
SCREW HFN LAG 10.5MM X 115MM
|
Facility
IP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.00 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,060.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,060.00
|
|
|
SCREW HFN LAG 10.5MMX115MM
|
Facility
IP
|
$1,696.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.00 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
|
|
SCREW HFN LAG 10.5MMX115MM
|
Facility
OP
|
$1,696.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,780.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$932.80
|
| 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 |
$848.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$975.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,780.80
|
| Rate for Payer: Group Health Inc Commercial |
$848.00
|
| Rate for Payer: Group Health Inc Medicare |
$593.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,102.40
|
|
|
SCREW HFN LAG 10.5MM X 95MM
|
Facility
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,166.00
|
| 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 |
$1,060.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,219.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,226.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,060.00
|
| Rate for Payer: Group Health Inc Medicare |
$742.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,060.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,060.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,378.00
|
|
