|
SCREW SET HEX-FIX
|
Facility
IP
|
$36.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$18.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.26
|
|
|
SCREW SET YUKNO 10001
|
Facility
IP
|
$544.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$272.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.00
|
|
|
SCREW SET YUKNO 10001
|
Facility
OP
|
$544.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$299.20
|
| 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 |
$272.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$312.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$571.20
|
| Rate for Payer: Group Health Inc Commercial |
$272.00
|
| Rate for Payer: Group Health Inc Medicare |
$190.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$272.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.60
|
|
|
SCREW SH 5.5 X 35
|
Facility
IP
|
$8,552.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904932
|
|
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 SH 5.5 X 35
|
Facility
OP
|
$8,552.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904932
|
|
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 SIZE 1.2MM X 6MM
|
Facility
OP
|
$145.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.03 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.19
|
| 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 |
$72.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.09
|
| Rate for Payer: Group Health Inc Commercial |
$72.90
|
| Rate for Payer: Group Health Inc Medicare |
$51.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.77
|
|
|
SCREW SIZE 1.2MM X 6MM
|
Facility
IP
|
$145.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.90 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.90
|
|
|
SCREW SLF DRILL 14MM 48335314
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$440.00
|
| 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 |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$460.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$840.00
|
| Rate for Payer: Group Health Inc Commercial |
$400.00
|
| Rate for Payer: Group Health Inc Medicare |
$280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.00
|
|
|
SCREW SLF DRILL 14MM 48335314
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
|
|
SCREW SLF DRL ANCHR-C 3.5X12MM
|
Facility
OP
|
$656.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$688.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$360.90
|
| 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 |
$328.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$377.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$688.99
|
| Rate for Payer: Group Health Inc Commercial |
$328.09
|
| Rate for Payer: Group Health Inc Medicare |
$229.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$426.52
|
|
|
SCREW SLF DRL ANCHR-C 3.5X12MM
|
Facility
IP
|
$656.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.09 |
| Max. Negotiated Rate |
$328.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.09
|
|
|
SCREW SLF START VARI 14
|
Facility
IP
|
$1,248.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$624.00
|
|
|
SCREW SLF START VARI 14
|
Facility
OP
|
$1,248.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,310.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$686.40
|
| 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 |
$624.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$717.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,310.40
|
| Rate for Payer: Group Health Inc Commercial |
$624.00
|
| Rate for Payer: Group Health Inc Medicare |
$436.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$624.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$811.20
|
|
|
SCREW SLF TAP LOW PROFILE
|
Facility
IP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.50
|
|
|
SCREW SLF TAP LOW PROFILE
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$425.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$222.75
|
| 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 |
$202.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$232.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$425.25
|
| Rate for Payer: Group Health Inc Commercial |
$202.50
|
| Rate for Payer: Group Health Inc Medicare |
$141.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$263.25
|
|
|
SCREW SLF TP ANCHOR-C 3.5X10MM
|
Facility
IP
|
$656.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.09 |
| Max. Negotiated Rate |
$328.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.09
|
|
|
SCREW SLF TP ANCHOR-C 3.5X10MM
|
Facility
OP
|
$656.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$688.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$360.90
|
| 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 |
$328.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$377.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$688.99
|
| Rate for Payer: Group Health Inc Commercial |
$328.09
|
| Rate for Payer: Group Health Inc Medicare |
$229.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$426.52
|
|
|
SCREW SNAP OFF 2.0 X 15
|
Facility
OP
|
$1,307.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,372.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$719.12
|
| 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 |
$653.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$751.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,372.88
|
| Rate for Payer: Group Health Inc Commercial |
$653.75
|
| Rate for Payer: Group Health Inc Medicare |
$457.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$653.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$653.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$849.88
|
|
|
SCREW SNAP OFF 2.0 X 15
|
Facility
IP
|
$1,307.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.75 |
| Max. Negotiated Rate |
$653.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$653.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$653.75
|
|
|
SCREW SP 9MM X 25X8
|
Facility
IP
|
$15,237.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,618.68 |
| Max. Negotiated Rate |
$7,618.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,618.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,618.68
|
|
|
SCREW SP 9MM X 25X8
|
Facility
OP
|
$15,237.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$15,999.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,380.54
|
| 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 |
$7,618.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,761.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,999.22
|
| Rate for Payer: Group Health Inc Commercial |
$7,618.68
|
| Rate for Payer: Group Health Inc Medicare |
$5,333.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,618.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,618.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,904.28
|
|
|
SCREW SPINAL 5.5X45 -15545
|
Facility
OP
|
$4,665.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,898.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,566.07
|
| 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 |
$2,332.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,682.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,898.86
|
| Rate for Payer: Group Health Inc Commercial |
$2,332.79
|
| Rate for Payer: Group Health Inc Medicare |
$1,632.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,332.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,332.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,032.63
|
|
|
SCREW SPINAL 5.5X45 -15545
|
Facility
IP
|
$4,665.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,332.79 |
| Max. Negotiated Rate |
$2,332.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,332.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,332.79
|
|
|
SCREW SPINAL CANNULATED 6.5M
|
Facility
OP
|
$8,552.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904798
|
|
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 SPINAL CANNULATED 6.5M
|
Facility
IP
|
$8,552.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904798
|
|
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
|
|
