|
SCREW LOCKING 4 X 45MM FT T2
|
Facility
OP
|
$425.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$447.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$234.16
|
| 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 |
$212.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$244.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$447.04
|
| Rate for Payer: Group Health Inc Commercial |
$212.88
|
| Rate for Payer: Group Health Inc Medicare |
$149.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$276.74
|
|
|
SCREW LOCKING 4X50MM FT T2
|
Facility
IP
|
$425.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.88 |
| Max. Negotiated Rate |
$212.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.88
|
|
|
SCREW LOCKING 4X50MM FT T2
|
Facility
OP
|
$425.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$447.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$234.16
|
| 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 |
$212.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$244.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$447.04
|
| Rate for Payer: Group Health Inc Commercial |
$212.88
|
| Rate for Payer: Group Health Inc Medicare |
$149.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$276.74
|
|
|
SCREW LOCKING 5'
|
Facility
IP
|
$691.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.60 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$345.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.60
|
|
|
SCREW LOCKING 5'
|
Facility
OP
|
$691.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$725.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$380.16
|
| 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 |
$345.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$397.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$725.76
|
| Rate for Payer: Group Health Inc Commercial |
$345.60
|
| Rate for Payer: Group Health Inc Medicare |
$241.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$345.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$449.28
|
|
|
SCREW LOCKING 5.0 MM 34
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$297.00
|
| 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 |
$270.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$310.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$567.00
|
| Rate for Payer: Group Health Inc Commercial |
$270.00
|
| Rate for Payer: Group Health Inc Medicare |
$189.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$351.00
|
|
|
SCREW LOCKING 5.0 MM 34
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.00
|
|
|
SCREW LOCKING 5.0 MM 36
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.00
|
|
|
SCREW LOCKING 5.0 MM 36
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$297.00
|
| 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 |
$270.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$310.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$567.00
|
| Rate for Payer: Group Health Inc Commercial |
$270.00
|
| Rate for Payer: Group Health Inc Medicare |
$189.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$351.00
|
|
|
SCREW LOCKING 5.0 X 24
|
Facility
OP
|
$667.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$700.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$367.12
|
| 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 |
$333.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$383.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$700.88
|
| Rate for Payer: Group Health Inc Commercial |
$333.75
|
| Rate for Payer: Group Health Inc Medicare |
$233.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$333.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$333.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$433.88
|
|
|
SCREW LOCKING 5.0 X 24
|
Facility
IP
|
$667.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.75 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$333.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$333.75
|
|
|
SCREW LOCKING 5.0 X 28
|
Facility
IP
|
$667.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.75 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$333.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$333.75
|
|
|
SCREW LOCKING 5.0 X 28
|
Facility
OP
|
$667.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$700.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$367.12
|
| 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 |
$333.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$383.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$700.88
|
| Rate for Payer: Group Health Inc Commercial |
$333.75
|
| Rate for Payer: Group Health Inc Medicare |
$233.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$333.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$333.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$433.88
|
|
|
SCREW LOCKING 5.0 X 36
|
Facility
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
| 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 |
$350.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$402.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$735.00
|
| Rate for Payer: Group Health Inc Commercial |
$350.00
|
| Rate for Payer: Group Health Inc Medicare |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$455.00
|
|
|
SCREW LOCKING 5.0 X 36
|
Facility
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
|
|
SCREW LOCKING 5.0 X 36MM
|
Facility
OP
|
$256.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.69 |
| Max. Negotiated Rate |
$269.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.94
|
| 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 |
$128.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$147.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$269.06
|
| Rate for Payer: Group Health Inc Commercial |
$128.12
|
| Rate for Payer: Group Health Inc Medicare |
$89.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.56
|
|
|
SCREW LOCKING 5.0 X 36MM
|
Facility
IP
|
$256.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.12 |
| Max. Negotiated Rate |
$128.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.12
|
|
|
SCREW LOCKING 5.0 X 42
|
Facility
OP
|
$1,417.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,488.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$779.62
|
| 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 |
$708.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$815.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,488.38
|
| Rate for Payer: Group Health Inc Commercial |
$708.75
|
| Rate for Payer: Group Health Inc Medicare |
$496.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$708.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$921.38
|
|
|
SCREW LOCKING 5.0 X 42
|
Facility
IP
|
$1,417.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903247
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.75 |
| Max. Negotiated Rate |
$708.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$708.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.75
|
|
|
SCREW LOCKING 5.0 X 44
|
Facility
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
|
|
SCREW LOCKING 5.0 X 44
|
Facility
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
| 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 |
$350.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$402.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$735.00
|
| Rate for Payer: Group Health Inc Commercial |
$350.00
|
| Rate for Payer: Group Health Inc Medicare |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$455.00
|
|
|
SCREW LOCKING 5.0 X 50MM
|
Facility
OP
|
$256.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.69 |
| Max. Negotiated Rate |
$269.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.94
|
| 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 |
$128.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$147.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$269.06
|
| Rate for Payer: Group Health Inc Commercial |
$128.12
|
| Rate for Payer: Group Health Inc Medicare |
$89.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.56
|
|
|
SCREW LOCKING 5.0 X 50MM
|
Facility
IP
|
$256.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.12 |
| Max. Negotiated Rate |
$128.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.12
|
|
|
SCREW LOCKING 5.0 X 65
|
Facility
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
|
|
SCREW LOCKING 5.0 X 65
|
Facility
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
| 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 |
$350.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$402.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$735.00
|
| Rate for Payer: Group Health Inc Commercial |
$350.00
|
| Rate for Payer: Group Health Inc Medicare |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$455.00
|
|
