|
SCREW LOCK ST SS 3.5X24MM STR
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.10
|
| 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 |
$121.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$139.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$254.10
|
| Rate for Payer: Group Health Inc Commercial |
$121.00
|
| Rate for Payer: Group Health Inc Medicare |
$84.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.30
|
|
|
SCREW LOCK ST SS 3.5X26MM STR-DR
|
Facility
IP
|
$432.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.25 |
| Max. Negotiated Rate |
$216.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.25
|
|
|
SCREW LOCK ST SS 3.5X26MM STR-DR
|
Facility
OP
|
$432.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$454.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$237.88
|
| 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 |
$216.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$248.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$454.12
|
| Rate for Payer: Group Health Inc Commercial |
$216.25
|
| Rate for Payer: Group Health Inc Medicare |
$151.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$281.12
|
|
|
SCREW LOCK ST SS 3.5X28MM STR
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.00
|
|
|
SCREW LOCK ST SS 3.5X28MM STR
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$254.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.10
|
| 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 |
$121.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$139.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$254.10
|
| Rate for Payer: Group Health Inc Commercial |
$121.00
|
| Rate for Payer: Group Health Inc Medicare |
$84.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.30
|
|
|
SCREW LOCK ST SS 3.5X65MM STR-DR
|
Facility
IP
|
$284.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.20
|
|
|
SCREW LOCK ST SS 3.5X65MM STR-DR
|
Facility
OP
|
$284.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.54 |
| Max. Negotiated Rate |
$298.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$156.42
|
| 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 |
$142.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$298.62
|
| Rate for Payer: Group Health Inc Commercial |
$142.20
|
| Rate for Payer: Group Health Inc Medicare |
$99.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.86
|
|
|
SCREW LOCK ST SS 3.5X70MM STR-DR
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.00
|
|
|
SCREW LOCK ST SS 3.5X70MM STR-DR
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$298.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$156.20
|
| 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 |
$142.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$298.20
|
| Rate for Payer: Group Health Inc Commercial |
$142.00
|
| Rate for Payer: Group Health Inc Medicare |
$99.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.60
|
|
|
SCREW LOCK ST SS 3.5X STR-DR
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$298.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$156.20
|
| 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 |
$142.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$298.20
|
| Rate for Payer: Group Health Inc Commercial |
$142.00
|
| Rate for Payer: Group Health Inc Medicare |
$99.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.60
|
|
|
SCREW LOCK ST SS 3.5X STR-DR
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.00
|
|
|
SCREW LONG IWASTE 6.5X40MM
|
Facility
OP
|
$8,552.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$8,980.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,703.98
|
| 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 |
$4,276.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,917.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,980.34
|
| Rate for Payer: Group Health Inc Commercial |
$4,276.35
|
| Rate for Payer: Group Health Inc Medicare |
$2,993.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,276.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,276.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,559.26
|
|
|
SCREW LONG IWASTE 6.5X40MM
|
Facility
IP
|
$8,552.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,276.35 |
| Max. Negotiated Rate |
$4,276.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,276.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,276.35
|
|
|
SCREW LOPRO 3.5
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.50
|
| 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 |
$75.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.50
|
| Rate for Payer: Group Health Inc Commercial |
$75.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.50
|
|
|
SCREW LOPRO 3.5
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
|
|
SCREW LO PRO 3.5 22MM 131218022
|
Facility
OP
|
$144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.20
|
| 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 |
$72.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.20
|
| Rate for Payer: Group Health Inc Commercial |
$72.00
|
| Rate for Payer: Group Health Inc Medicare |
$50.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.60
|
|
|
SCREW LO PRO 3.5 22MM 131218022
|
Facility
IP
|
$144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.00
|
|
|
SCREW LO PRO 3.5 26M 1312-18-026
|
Facility
OP
|
$144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.20
|
| 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 |
$72.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.20
|
| Rate for Payer: Group Health Inc Commercial |
$72.00
|
| Rate for Payer: Group Health Inc Medicare |
$50.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.60
|
|
|
SCREW LO PRO 3.5 26M 1312-18-026
|
Facility
IP
|
$144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.00
|
|
|
SCREW LOPRO CANNLTD SS 4.0 X 40MM
|
Facility
IP
|
$330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.00
|
|
|
SCREW LOPRO CANNLTD SS 4.0 X 40MM
|
Facility
OP
|
$330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| 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 |
$165.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$189.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$346.50
|
| Rate for Payer: Group Health Inc Commercial |
$165.00
|
| Rate for Payer: Group Health Inc Medicare |
$115.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.50
|
|
|
SCREW LO PRO CORT
|
Facility
IP
|
$275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.50 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.50
|
|
|
SCREW LO PRO CORT
|
Facility
OP
|
$275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$288.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$151.25
|
| 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 |
$137.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$158.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.75
|
| Rate for Payer: Group Health Inc Commercial |
$137.50
|
| Rate for Payer: Group Health Inc Medicare |
$96.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.75
|
|
|
SCREW LO PRO CORT 1.4
|
Facility
IP
|
$275.00
|
|
| Hospital Charge Code |
64907243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.50 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.50
|
|
|
SCREW LO PRO CORT 1.4
|
Facility
OP
|
$275.00
|
|
| Hospital Charge Code |
64907243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$288.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$151.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$137.50
|
| Rate for Payer: Aetna Government |
$137.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$137.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$158.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.75
|
| Rate for Payer: Group Health Inc Commercial |
$137.50
|
| Rate for Payer: Group Health Inc Medicare |
$96.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.75
|
|
