BONE SCREW T8 FT 2.4MM / L28MM
|
Facility
IP
|
$387.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904988
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$193.75 |
Max. Negotiated Rate |
$193.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.75
|
|
BONE SCREW T8 FT 2.4MM / L28MM
|
Facility
OP
|
$387.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904988
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$406.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.12
|
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 |
$193.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$222.81
|
Rate for Payer: Fidelis Medicare Advantage |
$406.88
|
Rate for Payer: Group Health Inc Commercial |
$193.75
|
Rate for Payer: Group Health Inc Medicare |
$135.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.88
|
|
BONE SCREW T8 FT 2.7MM / L10MM
|
Facility
IP
|
$387.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904421
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$193.75 |
Max. Negotiated Rate |
$193.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.75
|
|
BONE SCREW T8 FT 2.7MM / L10MM
|
Facility
OP
|
$387.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904421
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$406.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.12
|
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 |
$193.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$222.81
|
Rate for Payer: Fidelis Medicare Advantage |
$406.88
|
Rate for Payer: Group Health Inc Commercial |
$193.75
|
Rate for Payer: Group Health Inc Medicare |
$135.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.88
|
|
BONE SCREW T8 FT 2.7MM / L12MM
|
Facility
IP
|
$375.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904409
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$187.50 |
Max. Negotiated Rate |
$187.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$187.50
|
|
BONE SCREW T8 FT 2.7MM / L12MM
|
Facility
OP
|
$375.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904409
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$131.25 |
Max. Negotiated Rate |
$393.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.25
|
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 |
$187.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$215.62
|
Rate for Payer: Fidelis Medicare Advantage |
$393.75
|
Rate for Payer: Group Health Inc Commercial |
$187.50
|
Rate for Payer: Group Health Inc Medicare |
$131.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$187.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.75
|
|
BONE SCREW T8 FT 2.7MM / L14MM
|
Facility
OP
|
$375.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904407
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$131.25 |
Max. Negotiated Rate |
$393.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.25
|
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 |
$187.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$215.62
|
Rate for Payer: Fidelis Medicare Advantage |
$393.75
|
Rate for Payer: Group Health Inc Commercial |
$187.50
|
Rate for Payer: Group Health Inc Medicare |
$131.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$187.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.75
|
|
BONE SCREW T8 FT 2.7MM / L14MM
|
Facility
IP
|
$375.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904407
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$187.50 |
Max. Negotiated Rate |
$187.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$187.50
|
|
BONE SCREW T8 FT 2.7MM / L16MM
|
Facility
IP
|
$329.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904519
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$164.69 |
Max. Negotiated Rate |
$164.69 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$164.69
|
|
BONE SCREW T8 FT 2.7MM / L16MM
|
Facility
OP
|
$329.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904519
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$115.28 |
Max. Negotiated Rate |
$345.85 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.16
|
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 |
$164.69
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$189.39
|
Rate for Payer: Fidelis Medicare Advantage |
$345.85
|
Rate for Payer: Group Health Inc Commercial |
$164.69
|
Rate for Payer: Group Health Inc Medicare |
$115.28
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$164.69
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.10
|
|
BONE SCREW T8 FT 2.7MM / L18MM
|
Facility
OP
|
$329.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904796
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$115.28 |
Max. Negotiated Rate |
$345.85 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.16
|
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 |
$164.69
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$189.39
|
Rate for Payer: Fidelis Medicare Advantage |
$345.85
|
Rate for Payer: Group Health Inc Commercial |
$164.69
|
Rate for Payer: Group Health Inc Medicare |
$115.28
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$164.69
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.10
|
|
BONE SCREW T8 FT 2.7MM / L18MM
|
Facility
IP
|
$329.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904796
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$164.69 |
Max. Negotiated Rate |
$164.69 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$164.69
|
|
BONE SCREW T8 FT 2.7MM / L20MM
|
Facility
OP
|
$387.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904628
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$406.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.12
|
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 |
$193.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$222.81
|
Rate for Payer: Fidelis Medicare Advantage |
$406.88
|
Rate for Payer: Group Health Inc Commercial |
$193.75
|
Rate for Payer: Group Health Inc Medicare |
$135.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.88
|
|
BONE SCREW T8 FT 2.7MM / L20MM
|
Facility
IP
|
$387.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904628
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$193.75 |
Max. Negotiated Rate |
$193.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.75
|
|
BONE SCREW T8 FT 2.7MM / L22MM
|
Facility
OP
|
$329.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904630
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$115.28 |
Max. Negotiated Rate |
$345.85 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.16
|
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 |
$164.69
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$189.39
|
Rate for Payer: Fidelis Medicare Advantage |
$345.85
|
Rate for Payer: Group Health Inc Commercial |
$164.69
|
Rate for Payer: Group Health Inc Medicare |
$115.28
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$164.69
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.10
|
|
BONE SCREW T8 FT 2.7MM / L22MM
|
Facility
IP
|
$329.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64904630
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$164.69 |
Max. Negotiated Rate |
$164.69 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$164.69
|
|
BONE SUBSTITUTE
|
Facility
OP
|
$6,300.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40009115
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$6,615.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,465.00
|
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 |
$3,150.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,622.50
|
Rate for Payer: Fidelis Medicare Advantage |
$6,615.00
|
Rate for Payer: Group Health Inc Commercial |
$3,150.00
|
Rate for Payer: Group Health Inc Medicare |
$2,205.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,150.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,150.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,095.00
|
|
BONE SUBSTITUTE
|
Facility
IP
|
$6,300.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40009115
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,150.00 |
Max. Negotiated Rate |
$3,150.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,150.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,150.00
|
|
BONE SUBSTITUTE
|
Facility
IP
|
$822.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203151
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$411.30 |
Max. Negotiated Rate |
$411.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$411.30
|
|
BONE SUBSTITUTE
|
Facility
OP
|
$822.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203151
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$863.73 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$452.43
|
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 |
$411.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$473.00
|
Rate for Payer: Fidelis Medicare Advantage |
$863.73
|
Rate for Payer: Group Health Inc Commercial |
$411.30
|
Rate for Payer: Group Health Inc Medicare |
$287.91
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$411.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$534.69
|
|
BONE VOID FILLER
|
Facility
IP
|
$2,076.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200072
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,038.00 |
Max. Negotiated Rate |
$1,038.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.00
|
|
BONE VOID FILLER
|
Facility
OP
|
$2,076.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200072
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,179.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,141.80
|
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 |
$1,038.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,193.70
|
Rate for Payer: Fidelis Medicare Advantage |
$2,179.80
|
Rate for Payer: Group Health Inc Commercial |
$1,038.00
|
Rate for Payer: Group Health Inc Medicare |
$726.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,349.40
|
|
BONNEY TISSUE FORCEP
|
Facility
OP
|
$50.28
|
|
Hospital Charge Code |
64903644
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$17.60 |
Max. Negotiated Rate |
$40.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.14
|
Rate for Payer: Aetna Government |
$25.14
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.19
|
Rate for Payer: Group Health Inc Commercial |
$25.14
|
Rate for Payer: Group Health Inc Medicare |
$17.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.14
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$25.14
|
|
BONSTON SCI ACCOLADE EL DR L321
|
Facility
OP
|
$13,300.00
|
|
Service Code
|
HCPCS C1785
|
Hospital Charge Code |
66572892
|
Hospital Revenue Code
|
275
|
Min. Negotiated Rate |
$275.42 |
Max. Negotiated Rate |
$13,965.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,315.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
Rate for Payer: Aetna Government |
$275.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,650.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,647.50
|
Rate for Payer: Fidelis Medicare Advantage |
$13,965.00
|
Rate for Payer: Group Health Inc Commercial |
$6,650.00
|
Rate for Payer: Group Health Inc Medicare |
$4,655.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,650.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6,650.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,645.00
|
|
BOOTS BUCKS TRACTION FULL
|
Facility
OP
|
$47.17
|
|
Hospital Charge Code |
64901795
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$16.51 |
Max. Negotiated Rate |
$37.74 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.94
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.58
|
Rate for Payer: Aetna Government |
$23.58
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.74
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.08
|
Rate for Payer: Group Health Inc Commercial |
$23.58
|
Rate for Payer: Group Health Inc Medicare |
$16.51
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.58
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$23.58
|
|