SCREW MM 4.0 X 12
|
Facility
|
OP
|
$1,112.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904957
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,168.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$611.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$667.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$556.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$639.69
|
Rate for Payer: EmblemHealth Commercial |
$556.25
|
Rate for Payer: Fidelis Medicare Advantage |
$1,168.12
|
Rate for Payer: Group Health Inc Commercial |
$556.25
|
Rate for Payer: Group Health Inc Medicare |
$389.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$556.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$556.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$723.12
|
|
SCREW MMF 8MM 4/PK
|
Facility
|
IP
|
$172.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201318
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$86.00 |
Max. Negotiated Rate |
$86.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$86.00
|
|
SCREW MMF 8MM 4/PK
|
Facility
|
OP
|
$172.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201318
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$60.20 |
Max. Negotiated Rate |
$180.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$103.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$86.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.90
|
Rate for Payer: EmblemHealth Commercial |
$86.00
|
Rate for Payer: Fidelis Medicare Advantage |
$180.60
|
Rate for Payer: Group Health Inc Commercial |
$86.00
|
Rate for Payer: Group Health Inc Medicare |
$60.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$86.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.80
|
|
SCREW MM W NEW TH 1.7 X 5
|
Facility
|
OP
|
$127.33
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904565
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.57 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.03
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$76.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.66
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.21
|
Rate for Payer: EmblemHealth Commercial |
$63.66
|
Rate for Payer: Fidelis Medicare Advantage |
$133.70
|
Rate for Payer: Group Health Inc Commercial |
$63.66
|
Rate for Payer: Group Health Inc Medicare |
$44.57
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.66
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$63.66
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.76
|
|
SCREW MM W NEW TH 1.7 X 5
|
Facility
|
IP
|
$127.33
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904565
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$63.66 |
Max. Negotiated Rate |
$63.66 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.66
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$63.66
|
|
SCREW MULTI DIRECT 2.7X12
|
Facility
|
IP
|
$507.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903759
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$253.75 |
Max. Negotiated Rate |
$253.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$253.75
|
|
SCREW MULTI DIRECT 2.7X12
|
Facility
|
OP
|
$507.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903759
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$532.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$279.12
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$304.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$253.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$291.81
|
Rate for Payer: EmblemHealth Commercial |
$253.75
|
Rate for Payer: Fidelis Medicare Advantage |
$532.88
|
Rate for Payer: Group Health Inc Commercial |
$253.75
|
Rate for Payer: Group Health Inc Medicare |
$177.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$253.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$329.88
|
|
SCREW NCB CORT 4.0 X 26MM
|
Facility
|
OP
|
$278.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905619
|
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 NCB CORT 4.0 X 26MM
|
Facility
|
IP
|
$278.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905619
|
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 NCB CORT 4.0X26MM SELF-TAP
|
Facility
|
OP
|
$222.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40007545
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$77.87 |
Max. Negotiated Rate |
$233.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.36
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$133.49
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$111.24
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.93
|
Rate for Payer: EmblemHealth Commercial |
$111.24
|
Rate for Payer: Fidelis Medicare Advantage |
$233.60
|
Rate for Payer: Group Health Inc Commercial |
$111.24
|
Rate for Payer: Group Health Inc Medicare |
$77.87
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.24
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.61
|
|
SCREW NCB CORT 4.0X26MM SELF-TAP
|
Facility
|
IP
|
$222.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204626
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$111.24 |
Max. Negotiated Rate |
$111.24 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.24
|
|
SCREW NCB CORT 4.0X26MM SELF-TAP
|
Facility
|
IP
|
$222.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40007545
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$111.24 |
Max. Negotiated Rate |
$111.24 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.24
|
|
SCREW NCB CORT 4.0X26MM SELF-TAP
|
Facility
|
OP
|
$222.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204626
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$77.87 |
Max. Negotiated Rate |
$233.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.36
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$133.49
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$111.24
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.93
|
Rate for Payer: EmblemHealth Commercial |
$111.24
|
Rate for Payer: Fidelis Medicare Advantage |
$233.60
|
Rate for Payer: Group Health Inc Commercial |
$111.24
|
Rate for Payer: Group Health Inc Medicare |
$77.87
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.24
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.61
|
|
SCREW NCB CORT 4.0X30MM SELF-TAP
|
Facility
|
OP
|
$222.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40007538
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$77.87 |
Max. Negotiated Rate |
$233.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.36
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$133.49
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$111.24
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.93
|
Rate for Payer: EmblemHealth Commercial |
$111.24
|
Rate for Payer: Fidelis Medicare Advantage |
$233.60
|
Rate for Payer: Group Health Inc Commercial |
$111.24
|
Rate for Payer: Group Health Inc Medicare |
$77.87
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.24
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.61
|
|
SCREW NCB CORT 4.0X30MM SELF-TAP
|
Facility
|
IP
|
$222.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204619
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$111.24 |
Max. Negotiated Rate |
$111.24 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.24
|
|
SCREW NCB CORT 4.0X30MM SELF-TAP
|
Facility
|
IP
|
$222.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40007538
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$111.24 |
Max. Negotiated Rate |
$111.24 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.24
|
|
SCREW NCB CORT 4.0X30MM SELF-TAP
|
Facility
|
OP
|
$222.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204619
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$77.87 |
Max. Negotiated Rate |
$233.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.36
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$133.49
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$111.24
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.93
|
Rate for Payer: EmblemHealth Commercial |
$111.24
|
Rate for Payer: Fidelis Medicare Advantage |
$233.60
|
Rate for Payer: Group Health Inc Commercial |
$111.24
|
Rate for Payer: Group Health Inc Medicare |
$77.87
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.24
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.61
|
|
SCREW NCB CORT 4.0 X 30MM ST
|
Facility
|
IP
|
$278.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905600
|
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 NCB CORT 4.0 X 30MM ST
|
Facility
|
OP
|
$278.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905600
|
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 NCB CORT 4.0 X 32MM
|
Facility
|
OP
|
$278.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905484
|
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 NCB CORT 4.0 X 32MM
|
Facility
|
IP
|
$278.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905484
|
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 NCB CORT 4.0X32MM SELF-TAP
|
Facility
|
OP
|
$358.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204575
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$125.30 |
Max. Negotiated Rate |
$375.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$214.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$179.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$205.85
|
Rate for Payer: EmblemHealth Commercial |
$179.00
|
Rate for Payer: Fidelis Medicare Advantage |
$375.90
|
Rate for Payer: Group Health Inc Commercial |
$179.00
|
Rate for Payer: Group Health Inc Medicare |
$125.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.70
|
|
SCREW NCB CORT 4.0X32MM SELF-TAP
|
Facility
|
IP
|
$358.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204575
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$179.00 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
|
SCREW, NCB CORT 4.0X32MM SELF-TAP
|
Facility
|
IP
|
$222.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40006601
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$111.24 |
Max. Negotiated Rate |
$111.24 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.24
|
|
SCREW, NCB CORT 4.0X32MM SELF-TAP
|
Facility
|
OP
|
$222.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40006601
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$77.87 |
Max. Negotiated Rate |
$233.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.36
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$133.49
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$111.24
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.93
|
Rate for Payer: EmblemHealth Commercial |
$111.24
|
Rate for Payer: Fidelis Medicare Advantage |
$233.60
|
Rate for Payer: Group Health Inc Commercial |
$111.24
|
Rate for Payer: Group Health Inc Medicare |
$77.87
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.24
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.61
|
|