|
SCREW LOPRO CORTEX SS 2.7 X 12MM
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
|
|
SCREW LOPRO CORTEX SS 2.7 X 12MM
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
| 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 |
$45.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.50
|
| Rate for Payer: Group Health Inc Commercial |
$45.00
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.50
|
|
|
SCREW LO-PRO CORT SS 3.5X45
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906365
|
|
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 LO-PRO CORT SS 3.5X45
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906365
|
|
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 LO-PRO CRTCL 3.5X16M 883514
|
Facility
OP
|
$70.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.50
|
| 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 |
$35.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.50
|
| Rate for Payer: Group Health Inc Commercial |
$35.00
|
| Rate for Payer: Group Health Inc Medicare |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.50
|
|
|
SCREW LO-PRO CRTCL 3.5X16M 883514
|
Facility
IP
|
$70.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
|
|
SCREW LOPROFL 4.0
|
Facility
IP
|
$330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906886
|
|
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 LOPROFL 4.0
|
Facility
OP
|
$330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906886
|
|
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 LCK SS 2.7X10
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906674
|
|
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 LO-PRO LCK SS 2.7X10
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906674
|
|
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 LOPRO LOCK 2.7 X 10MM
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906940
|
|
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 LOPRO LOCK 2.7 X 10MM
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906940
|
|
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 LO-PRO LOCK 2.7X18M 882718
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906649
|
|
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 LO-PRO LOCK 2.7X18M 882718
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906649
|
|
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 LO PRO SS 2.7
|
Facility
OP
|
$112.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.38 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.88
|
| 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 |
$56.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.12
|
| Rate for Payer: Group Health Inc Commercial |
$56.25
|
| Rate for Payer: Group Health Inc Medicare |
$39.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.12
|
|
|
SCREW LO PRO SS 2.7
|
Facility
IP
|
$112.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.25
|
|
|
SCREW LO-PRO SS 2.7 X 16MM
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
|
|
SCREW LO-PRO SS 2.7 X 16MM
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| 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 |
$22.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.25
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.25
|
|
|
SCREW LO-PRO TM SS 2.7X22MM
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
|
|
SCREW LO-PRO TM SS 2.7X22MM
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
| 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 |
$45.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.50
|
| Rate for Payer: Group Health Inc Commercial |
$45.00
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.50
|
|
|
SCREW LO-PRO TM SS 2.7X24MM
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
| 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 |
$45.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.50
|
| Rate for Payer: Group Health Inc Commercial |
$45.00
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.50
|
|
|
SCREW LO-PRO TM SS 2.7X24MM
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
|
|
SCREW LO-PR SS 2.7X22MM CRTX
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
|
|
SCREW LO-PR SS 2.7X22MM CRTX
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
| 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 |
$45.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.50
|
| Rate for Payer: Group Health Inc Commercial |
$45.00
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.50
|
|
|
SCREW LOW PRO HEX
|
Facility
IP
|
$385.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.50
|
|
