SCREW LOCKING 4.0 X 32MM
|
Facility
|
IP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902035
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$120.62 |
Max. Negotiated Rate |
$120.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
|
SCREW LOCKING 4.0 X 34MM
|
Facility
|
IP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902036
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$120.62 |
Max. Negotiated Rate |
$120.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
|
SCREW LOCKING 4.0 X 34MM
|
Facility
|
IP
|
$212.80
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$106.40 |
Max. Negotiated Rate |
$106.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$106.40
|
|
SCREW LOCKING 4.0 X 34MM
|
Facility
|
OP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902036
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$84.44 |
Max. Negotiated Rate |
$253.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.69
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$144.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.72
|
Rate for Payer: EmblemHealth Commercial |
$120.62
|
Rate for Payer: Fidelis Medicare Advantage |
$253.31
|
Rate for Payer: Group Health Inc Commercial |
$120.62
|
Rate for Payer: Group Health Inc Medicare |
$84.44
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.81
|
|
SCREW LOCKING 4.0 X 34MM
|
Facility
|
OP
|
$212.80
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$74.48 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.04
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Brighton Health Commercial |
$127.68
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.36
|
Rate for Payer: EmblemHealth Commercial |
$106.40
|
Rate for Payer: Fidelis Medicare Advantage |
$223.44
|
Rate for Payer: Group Health Inc Commercial |
$106.40
|
Rate for Payer: Group Health Inc Medicare |
$74.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$106.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.32
|
|
SCREW LOCKING 4.0 X 36MM
|
Facility
|
IP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902037
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$120.62 |
Max. Negotiated Rate |
$120.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
|
SCREW LOCKING 4.0 X 36MM
|
Facility
|
OP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902037
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$84.44 |
Max. Negotiated Rate |
$253.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.69
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$144.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.72
|
Rate for Payer: EmblemHealth Commercial |
$120.62
|
Rate for Payer: Fidelis Medicare Advantage |
$253.31
|
Rate for Payer: Group Health Inc Commercial |
$120.62
|
Rate for Payer: Group Health Inc Medicare |
$84.44
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.81
|
|
SCREW LOCKING 4.0 X 38MM A
|
Facility
|
IP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902034
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$120.62 |
Max. Negotiated Rate |
$120.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
|
SCREW LOCKING 4.0 X 38MM A
|
Facility
|
OP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902034
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$84.44 |
Max. Negotiated Rate |
$253.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.69
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$144.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.72
|
Rate for Payer: EmblemHealth Commercial |
$120.62
|
Rate for Payer: Fidelis Medicare Advantage |
$253.31
|
Rate for Payer: Group Health Inc Commercial |
$120.62
|
Rate for Payer: Group Health Inc Medicare |
$84.44
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.81
|
|
SCREW LOCKING 4.0 X 4.0
|
Facility
|
OP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904204
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$527.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$301.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$251.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.65
|
Rate for Payer: EmblemHealth Commercial |
$251.00
|
Rate for Payer: Fidelis Medicare Advantage |
$527.10
|
Rate for Payer: Group Health Inc Commercial |
$251.00
|
Rate for Payer: Group Health Inc Medicare |
$175.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.30
|
|
SCREW LOCKING 4.0 X 4.0
|
Facility
|
IP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904204
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$251.00 |
Max. Negotiated Rate |
$251.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
|
SCREW LOCKING 4.0 X 40MM
|
Facility
|
OP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902094
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$84.44 |
Max. Negotiated Rate |
$253.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.69
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$144.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.72
|
Rate for Payer: EmblemHealth Commercial |
$120.62
|
Rate for Payer: Fidelis Medicare Advantage |
$253.31
|
Rate for Payer: Group Health Inc Commercial |
$120.62
|
Rate for Payer: Group Health Inc Medicare |
$84.44
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.81
|
|
SCREW LOCKING 4.0 X 40MM
|
Facility
|
IP
|
$214.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202408
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$107.00 |
Max. Negotiated Rate |
$107.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$107.00
|
|
SCREW LOCKING 4.0 X 40MM
|
Facility
|
IP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902094
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$120.62 |
Max. Negotiated Rate |
$120.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
|
SCREW LOCKING 4.0 X 40MM
|
Facility
|
OP
|
$214.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202408
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$74.90 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Brighton Health Commercial |
$128.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$107.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$123.05
|
Rate for Payer: EmblemHealth Commercial |
$107.00
|
Rate for Payer: Fidelis Medicare Advantage |
$224.70
|
Rate for Payer: Group Health Inc Commercial |
$107.00
|
Rate for Payer: Group Health Inc Medicare |
$74.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$107.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.10
|
|
SCREW LOCKING 4.0 X 44MM
|
Facility
|
OP
|
$213.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202407
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$74.55 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.15
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Brighton Health Commercial |
$127.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.48
|
Rate for Payer: EmblemHealth Commercial |
$106.50
|
Rate for Payer: Fidelis Medicare Advantage |
$223.65
|
Rate for Payer: Group Health Inc Commercial |
$106.50
|
Rate for Payer: Group Health Inc Medicare |
$74.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$106.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.45
|
|
SCREW LOCKING 4.0 X 44MM
|
Facility
|
OP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902064
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$84.44 |
Max. Negotiated Rate |
$253.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.69
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$144.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.72
|
Rate for Payer: EmblemHealth Commercial |
$120.62
|
Rate for Payer: Fidelis Medicare Advantage |
$253.31
|
Rate for Payer: Group Health Inc Commercial |
$120.62
|
Rate for Payer: Group Health Inc Medicare |
$84.44
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.81
|
|
SCREW LOCKING 4.0 X 44MM
|
Facility
|
IP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902064
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$120.62 |
Max. Negotiated Rate |
$120.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
|
SCREW LOCKING 4.0 X 44MM
|
Facility
|
IP
|
$213.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202407
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$106.50 |
Max. Negotiated Rate |
$106.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$106.50
|
|
SCREW LOCKING 4.0 X 46MM
|
Facility
|
IP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902096
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$120.62 |
Max. Negotiated Rate |
$120.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
|
SCREW LOCKING 4.0 X 46MM
|
Facility
|
OP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902096
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$84.44 |
Max. Negotiated Rate |
$253.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.69
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$144.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.72
|
Rate for Payer: EmblemHealth Commercial |
$120.62
|
Rate for Payer: Fidelis Medicare Advantage |
$253.31
|
Rate for Payer: Group Health Inc Commercial |
$120.62
|
Rate for Payer: Group Health Inc Medicare |
$84.44
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.81
|
|
SCREW LOCKING 4.0 X 5.0
|
Facility
|
OP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904206
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$527.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$301.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$251.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.65
|
Rate for Payer: EmblemHealth Commercial |
$251.00
|
Rate for Payer: Fidelis Medicare Advantage |
$527.10
|
Rate for Payer: Group Health Inc Commercial |
$251.00
|
Rate for Payer: Group Health Inc Medicare |
$175.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.30
|
|
SCREW LOCKING 4.0 X 5.0
|
Facility
|
IP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904206
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$251.00 |
Max. Negotiated Rate |
$251.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
|
SCREW LOCKING 4.0 X 50MM
|
Facility
|
IP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902065
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$120.62 |
Max. Negotiated Rate |
$120.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
|
SCREW LOCKING 4.0 X 50MM
|
Facility
|
OP
|
$241.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902065
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$84.44 |
Max. Negotiated Rate |
$253.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.69
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$144.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.72
|
Rate for Payer: EmblemHealth Commercial |
$120.62
|
Rate for Payer: Fidelis Medicare Advantage |
$253.31
|
Rate for Payer: Group Health Inc Commercial |
$120.62
|
Rate for Payer: Group Health Inc Medicare |
$84.44
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.81
|
|