SCREW BONE 1.7 X 18
|
Facility
|
OP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904527
|
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: Brighton Health Commercial |
$107.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.78
|
Rate for Payer: EmblemHealth Commercial |
$89.38
|
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 BONE 1.7 X 4MM
|
Facility
|
OP
|
$113.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903218
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$39.66 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.32
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$67.98
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.65
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.15
|
Rate for Payer: EmblemHealth Commercial |
$56.65
|
Rate for Payer: Fidelis Medicare Advantage |
$118.96
|
Rate for Payer: Group Health Inc Commercial |
$56.65
|
Rate for Payer: Group Health Inc Medicare |
$39.66
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.65
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$56.65
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.64
|
|
SCREW BONE 1.7 X 4MM
|
Facility
|
IP
|
$113.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903218
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$56.65 |
Max. Negotiated Rate |
$56.65 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.65
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$56.65
|
|
SCREW BONE 1.7X6MM LOCKING
|
Facility
|
IP
|
$229.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905787
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$114.56 |
Max. Negotiated Rate |
$114.56 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$114.56
|
|
SCREW BONE 1.7X6MM LOCKING
|
Facility
|
OP
|
$229.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905787
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$80.20 |
Max. Negotiated Rate |
$240.59 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.02
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$137.48
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$114.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$131.75
|
Rate for Payer: EmblemHealth Commercial |
$114.56
|
Rate for Payer: Fidelis Medicare Advantage |
$240.59
|
Rate for Payer: Group Health Inc Commercial |
$114.56
|
Rate for Payer: Group Health Inc Medicare |
$80.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$114.56
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.93
|
|
SCREW BONE 2.0 12MM
|
Facility
|
IP
|
$107.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903208
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$53.55 |
Max. Negotiated Rate |
$53.55 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.55
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$53.55
|
|
SCREW BONE 2.0 12MM
|
Facility
|
OP
|
$107.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903208
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$37.48 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$64.26
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.55
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.58
|
Rate for Payer: EmblemHealth Commercial |
$53.55
|
Rate for Payer: Fidelis Medicare Advantage |
$112.46
|
Rate for Payer: Group Health Inc Commercial |
$53.55
|
Rate for Payer: Group Health Inc Medicare |
$37.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.55
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$53.55
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.62
|
|
SCREW BONE 2.0 6MM
|
Facility
|
IP
|
$107.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903205
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$53.55 |
Max. Negotiated Rate |
$53.55 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.55
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$53.55
|
|
SCREW BONE 2.0 6MM
|
Facility
|
OP
|
$107.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903205
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$37.48 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$64.26
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.55
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.58
|
Rate for Payer: EmblemHealth Commercial |
$53.55
|
Rate for Payer: Fidelis Medicare Advantage |
$112.46
|
Rate for Payer: Group Health Inc Commercial |
$53.55
|
Rate for Payer: Group Health Inc Medicare |
$37.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.55
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$53.55
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.62
|
|
SCREW BONE 2.0 DIA 6MM SD A
|
Facility
|
OP
|
$315.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902784
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$110.25 |
Max. Negotiated Rate |
$330.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$189.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$181.12
|
Rate for Payer: EmblemHealth Commercial |
$157.50
|
Rate for Payer: Fidelis Medicare Advantage |
$330.75
|
Rate for Payer: Group Health Inc Commercial |
$157.50
|
Rate for Payer: Group Health Inc Medicare |
$110.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$157.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.75
|
|
SCREW BONE 2.0 DIA 6MM SD A
|
Facility
|
IP
|
$315.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902784
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$157.50 |
Max. Negotiated Rate |
$157.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$157.50
|
|
SCREW BONE 2.0 DIA 8MM SD
|
Facility
|
OP
|
$315.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902823
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$110.25 |
Max. Negotiated Rate |
$330.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$189.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$181.12
|
Rate for Payer: EmblemHealth Commercial |
$157.50
|
Rate for Payer: Fidelis Medicare Advantage |
$330.75
|
Rate for Payer: Group Health Inc Commercial |
$157.50
|
Rate for Payer: Group Health Inc Medicare |
$110.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$157.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.75
|
|
SCREW BONE 2.0 DIA 8MM SD
|
Facility
|
IP
|
$315.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902823
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$157.50 |
Max. Negotiated Rate |
$157.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$157.50
|
|
SCREW BONE 2.0X5MM MP CRSS PIN
|
Facility
|
OP
|
$128.78
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901847
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$45.07 |
Max. Negotiated Rate |
$135.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.83
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$77.27
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.39
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.05
|
Rate for Payer: EmblemHealth Commercial |
$64.39
|
Rate for Payer: Fidelis Medicare Advantage |
$135.22
|
Rate for Payer: Group Health Inc Commercial |
$64.39
|
Rate for Payer: Group Health Inc Medicare |
$45.07
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.39
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$64.39
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.71
|
|
SCREW BONE 2.0X5MM MP CRSS PIN
|
Facility
|
IP
|
$128.78
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901847
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$64.39 |
Max. Negotiated Rate |
$64.39 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.39
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$64.39
|
|
SCREW BONE 23MM 26MML
|
Facility
|
OP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905462
|
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: Brighton Health Commercial |
$107.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.78
|
Rate for Payer: EmblemHealth Commercial |
$89.38
|
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 BONE 23MM 26MML
|
Facility
|
IP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905462
|
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 BONE 2.3MM DIA 10MML TT
|
Facility
|
IP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901983
|
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 BONE 2.3MM DIA 10MML TT
|
Facility
|
OP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901983
|
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: Brighton Health Commercial |
$107.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.78
|
Rate for Payer: EmblemHealth Commercial |
$89.38
|
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 BONE 2.3MM DIA 14MML TT
|
Facility
|
IP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904987
|
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 BONE 2.3MM DIA 14MML TT
|
Facility
|
OP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904987
|
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: Brighton Health Commercial |
$107.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.78
|
Rate for Payer: EmblemHealth Commercial |
$89.38
|
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 BONE 2.3MM DIA 20MML TT
|
Facility
|
IP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901985
|
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 BONE 2.3MM DIA 20MML TT
|
Facility
|
OP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901985
|
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: Brighton Health Commercial |
$107.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.78
|
Rate for Payer: EmblemHealth Commercial |
$89.38
|
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 BONE 2.3MM DIA 8MML TTA
|
Facility
|
IP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904083
|
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 BONE 2.3MM DIA 8MML TTA
|
Facility
|
OP
|
$178.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904083
|
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: Brighton Health Commercial |
$107.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.78
|
Rate for Payer: EmblemHealth Commercial |
$89.38
|
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
|
|