SCREW BONE 3.5 X 40MM
|
Facility
|
OP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902416
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.76 |
Max. Negotiated Rate |
$155.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$88.73
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
Rate for Payer: EmblemHealth Commercial |
$73.94
|
Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
Rate for Payer: Group Health Inc Commercial |
$73.94
|
Rate for Payer: Group Health Inc Medicare |
$51.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
SCREW BONE 3.5 X 42MM
|
Facility
|
OP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902302
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.76 |
Max. Negotiated Rate |
$155.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$88.73
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
Rate for Payer: EmblemHealth Commercial |
$73.94
|
Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
Rate for Payer: Group Health Inc Commercial |
$73.94
|
Rate for Payer: Group Health Inc Medicare |
$51.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
SCREW BONE 3.5 X 42MM
|
Facility
|
IP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902302
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$73.94 |
Max. Negotiated Rate |
$73.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
SCREW BONE 3.5 X 44MM
|
Facility
|
OP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902432
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.76 |
Max. Negotiated Rate |
$155.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$88.73
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
Rate for Payer: EmblemHealth Commercial |
$73.94
|
Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
Rate for Payer: Group Health Inc Commercial |
$73.94
|
Rate for Payer: Group Health Inc Medicare |
$51.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
SCREW BONE 3.5 X 44MM
|
Facility
|
IP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902432
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$73.94 |
Max. Negotiated Rate |
$73.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
SCREW BONE 3.5 X 48
|
Facility
|
OP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904737
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$119.00 |
Max. Negotiated Rate |
$357.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$187.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$204.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$170.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
Rate for Payer: EmblemHealth Commercial |
$170.00
|
Rate for Payer: Fidelis Medicare Advantage |
$357.00
|
Rate for Payer: Group Health Inc Commercial |
$170.00
|
Rate for Payer: Group Health Inc Medicare |
$119.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$170.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.00
|
|
SCREW BONE 3.5 X 48
|
Facility
|
IP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904737
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$170.00 |
Max. Negotiated Rate |
$170.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$170.00
|
|
SCREW BONE 3.5 X 48MM
|
Facility
|
OP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902277
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.76 |
Max. Negotiated Rate |
$155.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$88.73
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
Rate for Payer: EmblemHealth Commercial |
$73.94
|
Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
Rate for Payer: Group Health Inc Commercial |
$73.94
|
Rate for Payer: Group Health Inc Medicare |
$51.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
SCREW BONE 3.5 X 48MM
|
Facility
|
IP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902277
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$73.94 |
Max. Negotiated Rate |
$73.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
SCREW BONE 3.5 X 50MM
|
Facility
|
IP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902321
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$73.94 |
Max. Negotiated Rate |
$73.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
SCREW BONE 3.5 X 50MM
|
Facility
|
OP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902321
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.76 |
Max. Negotiated Rate |
$155.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$88.73
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
Rate for Payer: EmblemHealth Commercial |
$73.94
|
Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
Rate for Payer: Group Health Inc Commercial |
$73.94
|
Rate for Payer: Group Health Inc Medicare |
$51.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
SCREW BONE 3.5 X 55MM
|
Facility
|
OP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902246
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.76 |
Max. Negotiated Rate |
$155.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$88.73
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
Rate for Payer: EmblemHealth Commercial |
$73.94
|
Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
Rate for Payer: Group Health Inc Commercial |
$73.94
|
Rate for Payer: Group Health Inc Medicare |
$51.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
SCREW BONE 3.5 X 55MM
|
Facility
|
IP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902246
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$73.94 |
Max. Negotiated Rate |
$73.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
SCREW BONE 3.5 X 60
|
Facility
|
IP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904889
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$170.00 |
Max. Negotiated Rate |
$170.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$170.00
|
|
SCREW BONE 3.5 X 60
|
Facility
|
OP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904889
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$119.00 |
Max. Negotiated Rate |
$357.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$187.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$204.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$170.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
Rate for Payer: EmblemHealth Commercial |
$170.00
|
Rate for Payer: Fidelis Medicare Advantage |
$357.00
|
Rate for Payer: Group Health Inc Commercial |
$170.00
|
Rate for Payer: Group Health Inc Medicare |
$119.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$170.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.00
|
|
SCREW BONE 3.5 X 60MM
|
Facility
|
OP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902385
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.76 |
Max. Negotiated Rate |
$155.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$88.73
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
Rate for Payer: EmblemHealth Commercial |
$73.94
|
Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
Rate for Payer: Group Health Inc Commercial |
$73.94
|
Rate for Payer: Group Health Inc Medicare |
$51.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
SCREW BONE 3.5 X 60MM
|
Facility
|
IP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902385
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$73.94 |
Max. Negotiated Rate |
$73.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|
SCREW BONE 36
|
Facility
|
IP
|
$80.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903297
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.00 |
Max. Negotiated Rate |
$40.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
|
SCREW BONE 36
|
Facility
|
OP
|
$80.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903297
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.00 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$48.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.00
|
Rate for Payer: EmblemHealth Commercial |
$40.00
|
Rate for Payer: Fidelis Medicare Advantage |
$84.00
|
Rate for Payer: Group Health Inc Commercial |
$40.00
|
Rate for Payer: Group Health Inc Medicare |
$28.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
|
SCREW BONE 4.0 X 22MM
|
Facility
|
OP
|
$660.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905073
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$693.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$363.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$396.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$379.50
|
Rate for Payer: EmblemHealth Commercial |
$330.00
|
Rate for Payer: Fidelis Medicare Advantage |
$693.00
|
Rate for Payer: Group Health Inc Commercial |
$330.00
|
Rate for Payer: Group Health Inc Medicare |
$231.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$330.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$429.00
|
|
SCREW BONE 4.0 X 22MM
|
Facility
|
IP
|
$660.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905073
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$330.00 |
Max. Negotiated Rate |
$330.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$330.00
|
|
SCREW BONE 4.0 X 28MM SELF
|
Facility
|
OP
|
$278.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905810
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$97.34 |
Max. Negotiated Rate |
$292.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$152.96
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$166.86
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$139.05
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$159.91
|
Rate for Payer: EmblemHealth Commercial |
$139.05
|
Rate for Payer: Fidelis Medicare Advantage |
$292.00
|
Rate for Payer: Group Health Inc Commercial |
$139.05
|
Rate for Payer: Group Health Inc Medicare |
$97.34
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$139.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.76
|
|
SCREW BONE 4.0 X 28MM SELF
|
Facility
|
IP
|
$278.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905810
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$139.05 |
Max. Negotiated Rate |
$139.05 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$139.05
|
|
SCREW BONE 4.0 X 32
|
Facility
|
IP
|
$561.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905201
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$280.50 |
Max. Negotiated Rate |
$280.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$280.50
|
|
SCREW BONE 4.0 X 32
|
Facility
|
OP
|
$561.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905201
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$589.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$308.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$336.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$322.58
|
Rate for Payer: EmblemHealth Commercial |
$280.50
|
Rate for Payer: Fidelis Medicare Advantage |
$589.05
|
Rate for Payer: Group Health Inc Commercial |
$280.50
|
Rate for Payer: Group Health Inc Medicare |
$196.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$280.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$364.65
|
|