|
5.0MMX34MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX36MM MOTIONLOC SCREW TI
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX36MM MOTIONLOC SCREW TI
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX36MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX36MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX38MM MOTIONLOC SCREW TI
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX38MM MOTIONLOC SCREW TI
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX38MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX38MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX40MM MOTIONLOC SCREW TI
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX40MM MOTIONLOC SCREW TI
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX40MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX40MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX42MM MOTIONLOC SCREW TI
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX42MM MOTIONLOC SCREW TI
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX42MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX42MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX42MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX42MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX44MM MOTIONLOC SCREW TI
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX44MM MOTIONLOC SCREW TI
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX46MM MOTIONLOC SCREW TI
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX46MM MOTIONLOC SCREW TI
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
|
5.0MMX46MM MOTIONLOC SCR TI STRL
|
Facility
IP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.24 |
| Max. Negotiated Rate |
$200.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
|
|
5.0MMX46MM MOTIONLOC SCR TI STRL
|
Facility
OP
|
$400.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.26
|
| 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 |
$200.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.50
|
| Rate for Payer: Group Health Inc Commercial |
$200.24
|
| Rate for Payer: Group Health Inc Medicare |
$140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.31
|
|
