SCREW NONBIAS 12MM
|
Facility
OP
|
$3,755.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902603
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,943.59 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,065.69
|
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 |
$1,877.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,159.58
|
Rate for Payer: Fidelis Medicare Advantage |
$3,943.59
|
Rate for Payer: Group Health Inc Commercial |
$1,877.90
|
Rate for Payer: Group Health Inc Medicare |
$1,314.53
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,877.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,877.90
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,441.27
|
|
SCREW NONBIAS 14MM
|
Facility
IP
|
$3,755.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902500
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,877.90 |
Max. Negotiated Rate |
$1,877.90 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,877.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,877.90
|
|
SCREW NONBIAS 14MM
|
Facility
OP
|
$3,755.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902500
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,943.59 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,065.69
|
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 |
$1,877.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,159.58
|
Rate for Payer: Fidelis Medicare Advantage |
$3,943.59
|
Rate for Payer: Group Health Inc Commercial |
$1,877.90
|
Rate for Payer: Group Health Inc Medicare |
$1,314.53
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,877.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,877.90
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,441.27
|
|
SCREW, NONDRILL FREE 2.0X7MM
|
Facility
IP
|
$135.70
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905717
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$67.85 |
Max. Negotiated Rate |
$67.85 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.85
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$67.85
|
|
SCREW, NONDRILL FREE 2.0X7MM
|
Facility
OP
|
$135.70
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905717
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$47.50 |
Max. Negotiated Rate |
$142.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.64
|
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 |
$67.85
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.03
|
Rate for Payer: Fidelis Medicare Advantage |
$142.48
|
Rate for Payer: Group Health Inc Commercial |
$67.85
|
Rate for Payer: Group Health Inc Medicare |
$47.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.85
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$67.85
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.20
|
|
SCREW NONLOCK 2.0
|
Facility
IP
|
$462.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907030
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$231.25 |
Max. Negotiated Rate |
$231.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$231.25
|
|
SCREW NONLOCK 2.0
|
Facility
OP
|
$462.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907030
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$485.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.38
|
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 |
$231.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$265.94
|
Rate for Payer: Fidelis Medicare Advantage |
$485.62
|
Rate for Payer: Group Health Inc Commercial |
$231.25
|
Rate for Payer: Group Health Inc Medicare |
$161.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$231.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.62
|
|
SCREW NON-LOCK 2.3 X 13MM
|
Facility
IP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901980
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$89.38 |
Max. Negotiated Rate |
$89.38 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$89.38
|
|
SCREW NON-LOCK 2.3 X 13MM
|
Facility
OP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901980
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$62.56 |
Max. Negotiated Rate |
$187.69 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$98.31
|
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 |
$89.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.78
|
Rate for Payer: Fidelis Medicare Advantage |
$187.69
|
Rate for Payer: Group Health Inc Commercial |
$89.38
|
Rate for Payer: Group Health Inc Medicare |
$62.56
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$89.38
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.19
|
|
SCREW NON-LOCK 2.3 X 22MM
|
Facility
OP
|
$140.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901987
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$49.00 |
Max. Negotiated Rate |
$147.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
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 |
$70.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$80.50
|
Rate for Payer: Fidelis Medicare Advantage |
$147.00
|
Rate for Payer: Group Health Inc Commercial |
$70.00
|
Rate for Payer: Group Health Inc Medicare |
$49.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.00
|
|
SCREW NON-LOCK 2.3 X 22MM
|
Facility
IP
|
$140.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901987
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$70.00 |
Max. Negotiated Rate |
$70.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
|
SCREW NONLOCK 2.3 X 22MM
|
Facility
OP
|
$216.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906841
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$75.60 |
Max. Negotiated Rate |
$226.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$118.80
|
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 |
$108.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.20
|
Rate for Payer: Fidelis Medicare Advantage |
$226.80
|
Rate for Payer: Group Health Inc Commercial |
$108.00
|
Rate for Payer: Group Health Inc Medicare |
$75.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$108.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.40
|
|
SCREW NONLOCK 2.3 X 22MM
|
Facility
IP
|
$216.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906841
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$108.00 |
Max. Negotiated Rate |
$108.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$108.00
|
|
SCREW NONLOCK 2.4 STRY
|
Facility
IP
|
$462.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907021
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$231.25 |
Max. Negotiated Rate |
$231.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$231.25
|
|
SCREW NONLOCK 2.4 STRY
|
Facility
OP
|
$462.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907021
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$485.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.38
|
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 |
$231.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$265.94
|
Rate for Payer: Fidelis Medicare Advantage |
$485.62
|
Rate for Payer: Group Health Inc Commercial |
$231.25
|
Rate for Payer: Group Health Inc Medicare |
$161.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$231.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.62
|
|
SCREW NONLOCK 2.7 STRY
|
Facility
IP
|
$462.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907027
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$231.25 |
Max. Negotiated Rate |
$231.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$231.25
|
|
SCREW NONLOCK 2.7 STRY
|
Facility
OP
|
$462.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907027
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$485.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.38
|
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 |
$231.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$265.94
|
Rate for Payer: Fidelis Medicare Advantage |
$485.62
|
Rate for Payer: Group Health Inc Commercial |
$231.25
|
Rate for Payer: Group Health Inc Medicare |
$161.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$231.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.62
|
|
SCREW NONLOCK 3.5 X 12MM
|
Facility
OP
|
$180.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906842
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$63.00 |
Max. Negotiated Rate |
$189.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.00
|
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 |
$90.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.50
|
Rate for Payer: Fidelis Medicare Advantage |
$189.00
|
Rate for Payer: Group Health Inc Commercial |
$90.00
|
Rate for Payer: Group Health Inc Medicare |
$63.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.00
|
|
SCREW NONLOCK 3.5 X 12MM
|
Facility
IP
|
$180.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906842
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$90.00 |
Max. Negotiated Rate |
$90.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
|
SCREW NONLOCK 3.5 X 14MM
|
Facility
OP
|
$180.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906839
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$63.00 |
Max. Negotiated Rate |
$189.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.00
|
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 |
$90.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.50
|
Rate for Payer: Fidelis Medicare Advantage |
$189.00
|
Rate for Payer: Group Health Inc Commercial |
$90.00
|
Rate for Payer: Group Health Inc Medicare |
$63.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.00
|
|
SCREW NONLOCK 3.5 X 14MM
|
Facility
IP
|
$180.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906839
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$90.00 |
Max. Negotiated Rate |
$90.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
|
SCREW NON LOCK 3.5X16
|
Facility
OP
|
$525.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902938
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$551.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$288.75
|
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 |
$262.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$301.88
|
Rate for Payer: Fidelis Medicare Advantage |
$551.25
|
Rate for Payer: Group Health Inc Commercial |
$262.50
|
Rate for Payer: Group Health Inc Medicare |
$183.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$262.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.25
|
|
SCREW NON LOCK 3.5X16
|
Facility
IP
|
$525.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902938
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$262.50 |
Max. Negotiated Rate |
$262.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$262.50
|
|
SCREW NON LOCKING 2.7X16
|
Facility
IP
|
$160.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903931
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$80.00 |
Max. Negotiated Rate |
$80.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
|
SCREW NON LOCKING 2.7X16
|
Facility
OP
|
$160.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903931
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$56.00 |
Max. Negotiated Rate |
$168.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.00
|
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 |
$80.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$92.00
|
Rate for Payer: Fidelis Medicare Advantage |
$168.00
|
Rate for Payer: Group Health Inc Commercial |
$80.00
|
Rate for Payer: Group Health Inc Medicare |
$56.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.00
|
|