BIOMET TIBIAL COMPONENT
|
Facility
OP
|
$4,876.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40024009
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$5,120.01 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,681.91
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,438.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,803.82
|
Rate for Payer: Fidelis Medicare Advantage |
$5,120.01
|
Rate for Payer: Group Health Inc Commercial |
$2,438.10
|
Rate for Payer: Group Health Inc Medicare |
$1,706.67
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,438.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,438.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,169.53
|
|
BIOMET TIBIAL COMPONENT
|
Facility
IP
|
$4,876.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40024009
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,438.10 |
Max. Negotiated Rate |
$2,438.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,438.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,438.10
|
|
BIOMET TIBIAL POLY
|
Facility
IP
|
$2,679.08
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40024010
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,339.54 |
Max. Negotiated Rate |
$1,339.54 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,339.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,339.54
|
|
BIOMET TIBIAL POLY
|
Facility
OP
|
$2,679.08
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40024010
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,813.03 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,473.49
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,339.54
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,540.47
|
Rate for Payer: Fidelis Medicare Advantage |
$2,813.03
|
Rate for Payer: Group Health Inc Commercial |
$1,339.54
|
Rate for Payer: Group Health Inc Medicare |
$937.68
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,339.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,339.54
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,741.40
|
|
BIOMET TRI CORTICAL BLCK
|
Facility
IP
|
$1,544.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205756
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$772.00 |
Max. Negotiated Rate |
$772.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$772.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$772.00
|
|
BIOMET TRI CORTICAL BLCK
|
Facility
OP
|
$1,544.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205756
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,621.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$849.20
|
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 |
$772.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$887.80
|
Rate for Payer: Fidelis Medicare Advantage |
$1,621.20
|
Rate for Payer: Group Health Inc Commercial |
$772.00
|
Rate for Payer: Group Health Inc Medicare |
$540.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$772.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$772.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,003.60
|
|
BIOMET UNIPLATE 13MM
|
Facility
OP
|
$2,920.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208109
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,066.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,606.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,460.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,679.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,066.00
|
Rate for Payer: Group Health Inc Commercial |
$1,460.00
|
Rate for Payer: Group Health Inc Medicare |
$1,022.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,460.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,460.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,898.00
|
|
BIOMET UNIPLATE 13MM
|
Facility
IP
|
$2,920.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208109
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,460.00 |
Max. Negotiated Rate |
$1,460.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,460.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,460.00
|
|
BIOMET UNIV B/P HEAD COMP 54X26MM
|
Facility
OP
|
$3,010.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206255
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,160.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,655.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,505.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,730.75
|
Rate for Payer: Fidelis Medicare Advantage |
$3,160.50
|
Rate for Payer: Group Health Inc Commercial |
$1,505.00
|
Rate for Payer: Group Health Inc Medicare |
$1,053.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,956.50
|
|
BIOMET UNIV B/P HEAD COMP 54X26MM
|
Facility
IP
|
$3,010.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206255
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,505.00 |
Max. Negotiated Rate |
$1,505.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.00
|
|
BIOMET VAN CR FEM 67.5MM IN/LK
|
Facility
IP
|
$6,898.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202217
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,449.00 |
Max. Negotiated Rate |
$3,449.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,449.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,449.00
|
|
BIOMET VAN CR FEM 67.5MM IN/LK
|
Facility
OP
|
$6,898.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202217
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$7,242.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,793.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,449.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,966.35
|
Rate for Payer: Fidelis Medicare Advantage |
$7,242.90
|
Rate for Payer: Group Health Inc Commercial |
$3,449.00
|
Rate for Payer: Group Health Inc Medicare |
$2,414.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,449.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,449.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,483.70
|
|
BIOMET VAN CRFEM 70MM RGHT IN/LK
|
Facility
OP
|
$6,140.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205576
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$6,447.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,377.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,070.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,530.50
|
Rate for Payer: Fidelis Medicare Advantage |
$6,447.00
|
Rate for Payer: Group Health Inc Commercial |
$3,070.00
|
Rate for Payer: Group Health Inc Medicare |
$2,149.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,070.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,070.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,991.00
|
|
BIOMET VAN CRFEM 70MM RGHT IN/LK
|
Facility
IP
|
$6,140.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205576
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,070.00 |
Max. Negotiated Rate |
$3,070.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,070.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,070.00
|
|
BIOMET VAN TM CR FEM 65MM LFT I/L
|
Facility
IP
|
$6,570.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205450
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,285.00 |
Max. Negotiated Rate |
$3,285.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,285.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.00
|
|
BIOMET VAN TM CR FEM 65MM LFT I/L
|
Facility
OP
|
$6,570.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205450
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$6,898.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,613.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,285.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,777.75
|
Rate for Payer: Fidelis Medicare Advantage |
$6,898.50
|
Rate for Payer: Group Health Inc Commercial |
$3,285.00
|
Rate for Payer: Group Health Inc Medicare |
$2,299.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,285.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,270.50
|
|
BIOMET VAN TM CR FEM 65MM R IN/LK
|
Facility
IP
|
$6,570.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205358
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,285.00 |
Max. Negotiated Rate |
$3,285.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,285.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.00
|
|
BIOMET VAN TM CR FEM 65MM R IN/LK
|
Facility
OP
|
$6,570.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205358
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$6,898.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,613.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,285.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,777.75
|
Rate for Payer: Fidelis Medicare Advantage |
$6,898.50
|
Rate for Payer: Group Health Inc Commercial |
$3,285.00
|
Rate for Payer: Group Health Inc Medicare |
$2,299.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,285.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,270.50
|
|
BIOMET V B/S CARRIAGE
|
Facility
OP
|
$1,700.00
|
|
Hospital Charge Code |
40205831
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$595.00 |
Max. Negotiated Rate |
$1,360.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$935.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$850.00
|
Rate for Payer: Aetna Government |
$850.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,360.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,156.00
|
Rate for Payer: Group Health Inc Commercial |
$850.00
|
Rate for Payer: Group Health Inc Medicare |
$595.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$850.00
|
|
BIOMET VHS LAG SCREW 60MM
|
Facility
OP
|
$1,498.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205836
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,572.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$823.90
|
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 |
$749.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$861.35
|
Rate for Payer: Fidelis Medicare Advantage |
$1,572.90
|
Rate for Payer: Group Health Inc Commercial |
$749.00
|
Rate for Payer: Group Health Inc Medicare |
$524.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$749.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$749.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$973.70
|
|
BIOMET VHS LAG SCREW 60MM
|
Facility
IP
|
$1,498.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205836
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$749.00 |
Max. Negotiated Rate |
$749.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$749.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$749.00
|
|
BIOMET VHS PEDIATRIC PLATE 8 HOLE
|
Facility
OP
|
$2,130.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205837
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,236.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,171.50
|
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 |
$1,065.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,224.75
|
Rate for Payer: Fidelis Medicare Advantage |
$2,236.50
|
Rate for Payer: Group Health Inc Commercial |
$1,065.00
|
Rate for Payer: Group Health Inc Medicare |
$745.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,065.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,065.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,384.50
|
|
BIOMET VHS PEDIATRIC PLATE 8 HOLE
|
Facility
IP
|
$2,130.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205837
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,065.00 |
Max. Negotiated Rate |
$1,065.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,065.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,065.00
|
|
BIOMET VNGRD CR FEM 60MM R INLK
|
Facility
OP
|
$6,570.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208081
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$6,898.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,613.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,285.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,777.75
|
Rate for Payer: Fidelis Medicare Advantage |
$6,898.50
|
Rate for Payer: Group Health Inc Commercial |
$3,285.00
|
Rate for Payer: Group Health Inc Medicare |
$2,299.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,285.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,270.50
|
|
BIOMET VNGRD CR FEM 60MM R INLK
|
Facility
IP
|
$6,570.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208081
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,285.00 |
Max. Negotiated Rate |
$3,285.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,285.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.00
|
|