|
SCREW LOCKING 27 14MM 882714
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$241.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.50
|
| 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 |
$115.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$241.50
|
| Rate for Payer: Group Health Inc Commercial |
$115.00
|
| Rate for Payer: Group Health Inc Medicare |
$80.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.50
|
|
|
SCREW LOCKING 27 16MM 882716
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.00
|
|
|
SCREW LOCKING 27 16MM 882716
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$241.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.50
|
| 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 |
$115.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$241.50
|
| Rate for Payer: Group Health Inc Commercial |
$115.00
|
| Rate for Payer: Group Health Inc Medicare |
$80.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.50
|
|
|
SCREW LOCKING 2.7 26
|
Facility
IP
|
$287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$143.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.50
|
|
|
SCREW LOCKING 2.7 26
|
Facility
OP
|
$287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$301.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$157.85
|
| 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 |
$143.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$301.35
|
| Rate for Payer: Group Health Inc Commercial |
$143.50
|
| Rate for Payer: Group Health Inc Medicare |
$100.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.55
|
|
|
SCREW LOCKING 2.7MM L52MM
|
Facility
OP
|
$456.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$479.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$251.00
|
| 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 |
$228.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$262.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$479.18
|
| Rate for Payer: Group Health Inc Commercial |
$228.18
|
| Rate for Payer: Group Health Inc Medicare |
$159.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$296.63
|
|
|
SCREW LOCKING 2.7MM L52MM
|
Facility
IP
|
$456.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.18 |
| Max. Negotiated Rate |
$228.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.18
|
|
|
SCREW LOCKING 2.7MM X 16MM ST
|
Facility
OP
|
$407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$427.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.12
|
| 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 |
$203.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$427.88
|
| Rate for Payer: Group Health Inc Commercial |
$203.75
|
| Rate for Payer: Group Health Inc Medicare |
$142.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$264.88
|
|
|
SCREW LOCKING 2.7MM X 16MM ST
|
Facility
IP
|
$407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$203.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.75
|
|
|
SCREW LOCKING 2.7MM X 18MM
|
Facility
OP
|
$407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$427.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.12
|
| 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 |
$203.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$427.88
|
| Rate for Payer: Group Health Inc Commercial |
$203.75
|
| Rate for Payer: Group Health Inc Medicare |
$142.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$264.88
|
|
|
SCREW LOCKING 2.7MM X 18MM
|
Facility
IP
|
$407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$203.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.75
|
|
|
SCREW LOCKING 2.7MM X 20MM
|
Facility
OP
|
$407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$427.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.12
|
| 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 |
$203.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$427.88
|
| Rate for Payer: Group Health Inc Commercial |
$203.75
|
| Rate for Payer: Group Health Inc Medicare |
$142.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$264.88
|
|
|
SCREW LOCKING 2.7MM X 20MM
|
Facility
IP
|
$407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$203.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.75
|
|
|
SCREW LOCKING 2.7 STRY
|
Facility
OP
|
$792.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$832.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$435.88
|
| 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 |
$396.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$455.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$832.12
|
| Rate for Payer: Group Health Inc Commercial |
$396.25
|
| Rate for Payer: Group Health Inc Medicare |
$277.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$515.12
|
|
|
SCREW LOCKING 2.7 STRY
|
Facility
IP
|
$792.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$396.25 |
| Max. Negotiated Rate |
$396.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.25
|
|
|
SCREW LOCKING 2.7X10
|
Facility
OP
|
$317.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.12 |
| Max. Negotiated Rate |
$333.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.62
|
| 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 |
$158.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$182.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$333.38
|
| Rate for Payer: Group Health Inc Commercial |
$158.75
|
| Rate for Payer: Group Health Inc Medicare |
$111.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.38
|
|
|
SCREW LOCKING 2.7X10
|
Facility
IP
|
$317.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.75 |
| Max. Negotiated Rate |
$158.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.75
|
|
|
SCREW LOCKING 2.7X11
|
Facility
OP
|
$302.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.88 |
| Max. Negotiated Rate |
$317.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$166.38
|
| 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 |
$151.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$317.62
|
| Rate for Payer: Group Health Inc Commercial |
$151.25
|
| Rate for Payer: Group Health Inc Medicare |
$105.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.62
|
|
|
SCREW LOCKING 2.7X11
|
Facility
IP
|
$302.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.25 |
| Max. Negotiated Rate |
$151.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.25
|
|
|
SCREW LOCKING 2.7X12
|
Facility
IP
|
$302.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.25 |
| Max. Negotiated Rate |
$151.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.25
|
|
|
SCREW LOCKING 2.7X12
|
Facility
OP
|
$302.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.88 |
| Max. Negotiated Rate |
$317.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$166.38
|
| 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 |
$151.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$317.62
|
| Rate for Payer: Group Health Inc Commercial |
$151.25
|
| Rate for Payer: Group Health Inc Medicare |
$105.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.62
|
|
|
SCREW LOCKING 2.7 X 12MM A
|
Facility
OP
|
$287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$301.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$157.85
|
| 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 |
$143.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$301.35
|
| Rate for Payer: Group Health Inc Commercial |
$143.50
|
| Rate for Payer: Group Health Inc Medicare |
$100.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.55
|
|
|
SCREW LOCKING 2.7 X 12MM A
|
Facility
IP
|
$287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$143.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.50
|
|
|
SCREW LOCKING 2.7X13
|
Facility
IP
|
$317.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.75 |
| Max. Negotiated Rate |
$158.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.75
|
|
|
SCREW LOCKING 2.7X13
|
Facility
OP
|
$317.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.12 |
| Max. Negotiated Rate |
$333.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.62
|
| 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 |
$158.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$182.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$333.38
|
| Rate for Payer: Group Health Inc Commercial |
$158.75
|
| Rate for Payer: Group Health Inc Medicare |
$111.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.38
|
|
