SCREW HMMF 2.0 X 6MM B
|
Facility
|
IP
|
$315.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905465
|
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 HMMF 2.0 X 6MM B
|
Facility
|
OP
|
$315.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905465
|
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 IMF 12MM
|
Facility
|
OP
|
$253.45
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901373
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$88.71 |
Max. Negotiated Rate |
$266.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.40
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$152.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$126.72
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$145.73
|
Rate for Payer: EmblemHealth Commercial |
$126.72
|
Rate for Payer: Fidelis Medicare Advantage |
$266.12
|
Rate for Payer: Group Health Inc Commercial |
$126.72
|
Rate for Payer: Group Health Inc Medicare |
$88.71
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.72
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.74
|
|
SCREW IMF 12MM
|
Facility
|
IP
|
$253.45
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901373
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$126.72 |
Max. Negotiated Rate |
$126.72 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.72
|
|
SCREW IMF 8MM
|
Facility
|
IP
|
$253.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901371
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$126.50 |
Max. Negotiated Rate |
$126.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.50
|
|
SCREW IMF 8MM
|
Facility
|
OP
|
$253.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901371
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$88.55 |
Max. Negotiated Rate |
$265.65 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.15
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$151.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$126.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$145.48
|
Rate for Payer: EmblemHealth Commercial |
$126.50
|
Rate for Payer: Fidelis Medicare Advantage |
$265.65
|
Rate for Payer: Group Health Inc Commercial |
$126.50
|
Rate for Payer: Group Health Inc Medicare |
$88.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.45
|
|
SCREW KLS 2.7MM REG#12
|
Facility
|
OP
|
$160.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200392
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$56.00 |
Max. Negotiated Rate |
$168.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$96.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$92.00
|
Rate for Payer: EmblemHealth Commercial |
$80.00
|
Rate for Payer: Fidelis Medicare Advantage |
$168.00
|
Rate for Payer: Group Health Inc Commercial |
$80.00
|
Rate for Payer: Group Health Inc Medicare |
$56.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.00
|
|
SCREW KLS 2.7MM REG#12
|
Facility
|
IP
|
$160.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200392
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$80.00 |
Max. Negotiated Rate |
$80.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
|
SCREW KOTOFIX 2.0 X 14MM
|
Facility
|
IP
|
$487.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901624
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$243.75 |
Max. Negotiated Rate |
$243.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$243.75
|
|
SCREW KOTOFIX 2.0 X 14MM
|
Facility
|
OP
|
$487.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901624
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$511.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$268.12
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$292.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$243.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.31
|
Rate for Payer: EmblemHealth Commercial |
$243.75
|
Rate for Payer: Fidelis Medicare Advantage |
$511.88
|
Rate for Payer: Group Health Inc Commercial |
$243.75
|
Rate for Payer: Group Health Inc Medicare |
$170.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$243.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$316.88
|
|
SCREW LAG
|
Facility
|
OP
|
$477.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901158
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$501.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$262.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$286.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$238.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$274.56
|
Rate for Payer: EmblemHealth Commercial |
$238.75
|
Rate for Payer: Fidelis Medicare Advantage |
$501.38
|
Rate for Payer: Group Health Inc Commercial |
$238.75
|
Rate for Payer: Group Health Inc Medicare |
$167.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$238.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.38
|
|
SCREW LAG
|
Facility
|
IP
|
$477.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901158
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$238.75 |
Max. Negotiated Rate |
$238.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$238.75
|
|
SCREW LAG 10.5 115MM
|
Facility
|
OP
|
$1,282.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901739
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,346.24 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$705.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$769.28
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$641.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$737.22
|
Rate for Payer: EmblemHealth Commercial |
$641.06
|
Rate for Payer: Fidelis Medicare Advantage |
$1,346.24
|
Rate for Payer: Group Health Inc Commercial |
$641.06
|
Rate for Payer: Group Health Inc Medicare |
$448.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$833.38
|
|
SCREW LAG 10.5 115MM
|
Facility
|
IP
|
$1,282.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901739
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$641.06 |
Max. Negotiated Rate |
$641.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.06
|
|
SCREW LAG 10.5 MM X 100MM
|
Facility
|
IP
|
$1,477.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901773
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$738.50 |
Max. Negotiated Rate |
$738.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$738.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$738.50
|
|
SCREW LAG 10.5 MM X 100MM
|
Facility
|
OP
|
$1,477.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901773
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,550.85 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$812.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$886.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$738.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$849.28
|
Rate for Payer: EmblemHealth Commercial |
$738.50
|
Rate for Payer: Fidelis Medicare Advantage |
$1,550.85
|
Rate for Payer: Group Health Inc Commercial |
$738.50
|
Rate for Payer: Group Health Inc Medicare |
$516.95
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$738.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$738.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$960.05
|
|
SCREW LAG 10.5 X 100MM
|
Facility
|
IP
|
$1,282.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901650
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$641.06 |
Max. Negotiated Rate |
$641.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.06
|
|
SCREW LAG 10.5 X 100MM
|
Facility
|
OP
|
$1,282.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901650
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,346.24 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$705.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$769.28
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$641.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$737.22
|
Rate for Payer: EmblemHealth Commercial |
$641.06
|
Rate for Payer: Fidelis Medicare Advantage |
$1,346.24
|
Rate for Payer: Group Health Inc Commercial |
$641.06
|
Rate for Payer: Group Health Inc Medicare |
$448.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$833.38
|
|
SCREW LAG 10.5 X 110MM
|
Facility
|
IP
|
$1,282.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901999
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$641.06 |
Max. Negotiated Rate |
$641.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.06
|
|
SCREW LAG 10.5 X 110MM
|
Facility
|
OP
|
$1,282.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901999
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,346.24 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$705.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$769.28
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$641.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$737.22
|
Rate for Payer: EmblemHealth Commercial |
$641.06
|
Rate for Payer: Fidelis Medicare Advantage |
$1,346.24
|
Rate for Payer: Group Health Inc Commercial |
$641.06
|
Rate for Payer: Group Health Inc Medicare |
$448.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$833.38
|
|
SCREW LAG 10.5 X 150MM
|
Facility
|
OP
|
$1,282.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901854
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,346.24 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$705.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$769.28
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$641.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$737.22
|
Rate for Payer: EmblemHealth Commercial |
$641.06
|
Rate for Payer: Fidelis Medicare Advantage |
$1,346.24
|
Rate for Payer: Group Health Inc Commercial |
$641.06
|
Rate for Payer: Group Health Inc Medicare |
$448.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$833.38
|
|
SCREW LAG 10.5 X 150MM
|
Facility
|
IP
|
$1,282.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901854
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$641.06 |
Max. Negotiated Rate |
$641.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.06
|
|
SCREW LAG 10.5X90MM GAM3
|
Facility
|
OP
|
$908.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205081
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$954.03 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$499.73
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$545.16
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$454.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$522.44
|
Rate for Payer: EmblemHealth Commercial |
$454.30
|
Rate for Payer: Fidelis Medicare Advantage |
$954.03
|
Rate for Payer: Group Health Inc Commercial |
$454.30
|
Rate for Payer: Group Health Inc Medicare |
$318.01
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$454.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$454.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$590.59
|
|
SCREW LAG 10.5X90MM GAM3
|
Facility
|
OP
|
$1,282.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901446
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,346.24 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$705.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$769.28
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$641.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$737.22
|
Rate for Payer: EmblemHealth Commercial |
$641.06
|
Rate for Payer: Fidelis Medicare Advantage |
$1,346.24
|
Rate for Payer: Group Health Inc Commercial |
$641.06
|
Rate for Payer: Group Health Inc Medicare |
$448.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$833.38
|
|
SCREW LAG 10.5X90MM GAM3
|
Facility
|
IP
|
$1,282.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901446
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$641.06 |
Max. Negotiated Rate |
$641.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$641.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$641.06
|
|