SCREW VIRAGE 3.5X14MM
|
Facility
IP
|
$1,399.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906472
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$699.50 |
Max. Negotiated Rate |
$699.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$699.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$699.50
|
|
SCREW VIRAGE 3.5X14MM
|
Facility
OP
|
$1,399.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906472
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,468.95 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$769.45
|
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 |
$699.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$804.42
|
Rate for Payer: Fidelis Medicare Advantage |
$1,468.95
|
Rate for Payer: Group Health Inc Commercial |
$699.50
|
Rate for Payer: Group Health Inc Medicare |
$489.65
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$699.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$699.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$909.35
|
|
SCREW VOYAGER 6.5X40MM
|
Facility
OP
|
$2,500.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905861
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,625.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,375.00
|
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 |
$1,250.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,437.50
|
Rate for Payer: Fidelis Medicare Advantage |
$2,625.00
|
Rate for Payer: Group Health Inc Commercial |
$1,250.00
|
Rate for Payer: Group Health Inc Medicare |
$875.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,625.00
|
|
SCREW VOYAGER 6.5X40MM
|
Facility
IP
|
$2,500.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905861
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,250.00 |
Max. Negotiated Rate |
$1,250.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
|
SCREW VOYAGER 6.5X45MM
|
Facility
IP
|
$2,500.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905863
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,250.00 |
Max. Negotiated Rate |
$1,250.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
|
SCREW VOYAGER 6.5X45MM
|
Facility
OP
|
$2,500.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905863
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,625.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,375.00
|
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 |
$1,250.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,437.50
|
Rate for Payer: Fidelis Medicare Advantage |
$2,625.00
|
Rate for Payer: Group Health Inc Commercial |
$1,250.00
|
Rate for Payer: Group Health Inc Medicare |
$875.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,625.00
|
|
SCREW VOYAGER SET
|
Facility
OP
|
$212.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905865
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$74.38 |
Max. Negotiated Rate |
$223.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.88
|
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 |
$106.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.19
|
Rate for Payer: Fidelis Medicare Advantage |
$223.12
|
Rate for Payer: Group Health Inc Commercial |
$106.25
|
Rate for Payer: Group Health Inc Medicare |
$74.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$106.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.12
|
|
SCREW VOYAGER SET
|
Facility
IP
|
$212.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905865
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$106.25 |
Max. Negotiated Rate |
$106.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$106.25
|
|
SCREW VUEP2 3.5X14MM
|
Facility
IP
|
$3,350.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903805
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,675.00 |
Max. Negotiated Rate |
$1,675.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,675.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,675.00
|
|
SCREW VUEP2 3.5X14MM
|
Facility
OP
|
$3,350.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903805
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,517.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,842.50
|
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 |
$1,675.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,926.25
|
Rate for Payer: Fidelis Medicare Advantage |
$3,517.50
|
Rate for Payer: Group Health Inc Commercial |
$1,675.00
|
Rate for Payer: Group Health Inc Medicare |
$1,172.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,675.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,675.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,177.50
|
|
SCREW VUEP2 4.5X30MM
|
Facility
OP
|
$3,550.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903807
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,727.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,952.50
|
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 |
$1,775.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,041.25
|
Rate for Payer: Fidelis Medicare Advantage |
$3,727.50
|
Rate for Payer: Group Health Inc Commercial |
$1,775.00
|
Rate for Payer: Group Health Inc Medicare |
$1,242.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,775.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,775.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,307.50
|
|
SCREW VUEP2 4.5X30MM
|
Facility
IP
|
$3,550.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903807
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,775.00 |
Max. Negotiated Rate |
$1,775.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,775.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,775.00
|
|
SCREW VUEP2 4.5X34MM
|
Facility
OP
|
$3,550.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903809
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,727.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,952.50
|
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 |
$1,775.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,041.25
|
Rate for Payer: Fidelis Medicare Advantage |
$3,727.50
|
Rate for Payer: Group Health Inc Commercial |
$1,775.00
|
Rate for Payer: Group Health Inc Medicare |
$1,242.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,775.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,775.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,307.50
|
|
SCREW VUEP2 4.5X34MM
|
Facility
IP
|
$3,550.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903809
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,775.00 |
Max. Negotiated Rate |
$1,775.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,775.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,775.00
|
|
SCREW VUEP2 4.5X36MM
|
Facility
IP
|
$3,550.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903811
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,775.00 |
Max. Negotiated Rate |
$1,775.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,775.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,775.00
|
|
SCREW VUEP2 4.5X36MM
|
Facility
OP
|
$3,550.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903811
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,727.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,952.50
|
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 |
$1,775.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,041.25
|
Rate for Payer: Fidelis Medicare Advantage |
$3,727.50
|
Rate for Payer: Group Health Inc Commercial |
$1,775.00
|
Rate for Payer: Group Health Inc Medicare |
$1,242.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,775.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,775.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,307.50
|
|
SCREW WASHR T8 & T10 2.4/2.7/3.5
|
Facility
OP
|
$150.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906677
|
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 WASHR T8 & T10 2.4/2.7/3.5
|
Facility
IP
|
$150.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906677
|
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 WASTED 5.5 X 50
|
Facility
IP
|
$4,754.35
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905111
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,377.18 |
Max. Negotiated Rate |
$2,377.18 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,377.18
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,377.18
|
|
SCREW WASTED 5.5 X 50
|
Facility
OP
|
$4,754.35
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905111
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,992.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,614.89
|
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 |
$2,377.18
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,733.75
|
Rate for Payer: Fidelis Medicare Advantage |
$4,992.07
|
Rate for Payer: Group Health Inc Commercial |
$2,377.18
|
Rate for Payer: Group Health Inc Medicare |
$1,664.02
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,377.18
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,377.18
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,090.33
|
|
SCREW, X-CORE MINI LOCK, ENDCAP
|
Facility
IP
|
$1,310.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905583
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$655.00 |
Max. Negotiated Rate |
$655.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$655.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$655.00
|
|
SCREW, X-CORE MINI LOCK, ENDCAP
|
Facility
OP
|
$1,310.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905583
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,375.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$720.50
|
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 |
$655.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$753.25
|
Rate for Payer: Fidelis Medicare Advantage |
$1,375.50
|
Rate for Payer: Group Health Inc Commercial |
$655.00
|
Rate for Payer: Group Health Inc Medicare |
$458.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$655.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$655.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$851.50
|
|
SCREW XIA3 5.0 X 40
|
Facility
OP
|
$4,557.18
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903941
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,785.04 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,506.45
|
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 |
$2,278.59
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,620.38
|
Rate for Payer: Fidelis Medicare Advantage |
$4,785.04
|
Rate for Payer: Group Health Inc Commercial |
$2,278.59
|
Rate for Payer: Group Health Inc Medicare |
$1,595.01
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,278.59
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,278.59
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,962.17
|
|
SCREW XIA3 5.0 X 40
|
Facility
IP
|
$4,557.18
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903941
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,278.59 |
Max. Negotiated Rate |
$2,278.59 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,278.59
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,278.59
|
|
SCREW XIA3 PA 5.5MM X 40MM
|
Facility
OP
|
$4,754.35
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902283
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,992.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,614.89
|
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 |
$2,377.18
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,733.75
|
Rate for Payer: Fidelis Medicare Advantage |
$4,992.07
|
Rate for Payer: Group Health Inc Commercial |
$2,377.18
|
Rate for Payer: Group Health Inc Medicare |
$1,664.02
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,377.18
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,377.18
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,090.33
|
|