|
BONE SCREW NONLOCKING 2.7X38MM
|
Facility
IP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
|
|
BONE SCREW NONLOCKING 2.7X38MM
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.00
|
| Rate for Payer: Group Health Inc Commercial |
$200.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.00
|
|
|
BONE SCREW NONLOCKING 3.5X38 B
|
Facility
IP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
|
|
BONE SCREW NONLOCKING 3.5X38 B
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.00
|
| Rate for Payer: Group Health Inc Commercial |
$200.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.00
|
|
|
BONE SCREW NONLOCKING 3.5X46
|
Facility
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905172
|
|
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
|
|
|
BONE SCREW NONLOCKING 3.5X46
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905172
|
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$170.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
| 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
|
|
|
BONE SCREW T10 3.5MM/L12MM
|
Facility
OP
|
$272.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$149.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.60
|
| Rate for Payer: Group Health Inc Commercial |
$136.00
|
| Rate for Payer: Group Health Inc Medicare |
$95.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.80
|
|
|
BONE SCREW T10 3.5MM/L12MM
|
Facility
IP
|
$272.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.00
|
|
|
BONE SCREW T10 3.5MM/L16MM
|
Facility
OP
|
$272.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$149.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.60
|
| Rate for Payer: Group Health Inc Commercial |
$136.00
|
| Rate for Payer: Group Health Inc Medicare |
$95.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.80
|
|
|
BONE SCREW T10 3.5MM/L16MM
|
Facility
IP
|
$272.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.00
|
|
|
BONE SCREW T10 FL THRD 2.7X24MML
|
Facility
IP
|
$247.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.76 |
| Max. Negotiated Rate |
$123.76 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.76
|
|
|
BONE SCREW T10 FL THRD 2.7X24MML
|
Facility
OP
|
$247.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.63 |
| Max. Negotiated Rate |
$259.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$123.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.90
|
| Rate for Payer: Group Health Inc Commercial |
$123.76
|
| Rate for Payer: Group Health Inc Medicare |
$86.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.89
|
|
|
BONE SCREW T10 FT 2.7MM / L32MM
|
Facility
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904670
|
|
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
|
|
|
BONE SCREW T10 FT 2.7MM / L32MM
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904670
|
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$170.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
| 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
|
|
|
BONE SCREW T10 FT 3.5MM/L10MM
|
Facility
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905194
|
|
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
|
|
|
BONE SCREW T10 FT 3.5MM/L10MM
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905194
|
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$170.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
| 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
|
|
|
BONE SCREW T10 FT 3.5MM / L12MM
|
Facility
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904663
|
|
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
|
|
|
BONE SCREW T10 FT 3.5MM / L12MM
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904663
|
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$170.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
| 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
|
|
|
BONE SCREW T10 FT 3.5MM / L18MM
|
Facility
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904555
|
|
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
|
|
|
BONE SCREW T10 FT 3.5MM / L18MM
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904555
|
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$170.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
| 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
|
|
|
BONE SCREW T10 FT 3.5MM / L20MM
|
Facility
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904787
|
|
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
|
|
|
BONE SCREW T10 FT 3.5MM / L20MM
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904787
|
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$170.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
| 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
|
|
|
BONE SCREW T10 FT 3.5MM / L22MM
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904683
|
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$170.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
| 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
|
|
|
BONE SCREW T10 FT 3.5MM / L22MM
|
Facility
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904683
|
|
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
|
|
|
BONE SCREW T10 FT 3.5MM / L24MM
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.00
|
| Rate for Payer: Group Health Inc Commercial |
$200.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.00
|
|
