SYNTHES JOINT UNIVERSAL FOR TWO T
|
Facility
OP
|
$1,172.00
|
|
Hospital Charge Code |
40009329
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$410.20 |
Max. Negotiated Rate |
$937.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$644.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$586.00
|
Rate for Payer: Aetna Government |
$586.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$937.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$796.96
|
Rate for Payer: Group Health Inc Commercial |
$586.00
|
Rate for Payer: Group Health Inc Medicare |
$410.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$586.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$586.00
|
|
SYNTHES K-WIRE 1.25MM
|
Facility
OP
|
$146.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40205216
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$153.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.95
|
Rate for Payer: Fidelis Medicare Advantage |
$153.30
|
Rate for Payer: Group Health Inc Commercial |
$73.00
|
Rate for Payer: Group Health Inc Medicare |
$51.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.90
|
|
SYNTHES K-WIRE 1.25MM
|
Facility
IP
|
$146.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40205216
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$73.00 |
Max. Negotiated Rate |
$73.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.00
|
|
SYNTHES LCKNG SCREW 7.3MMX85MM
|
Facility
IP
|
$528.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205772
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$264.00 |
Max. Negotiated Rate |
$264.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$264.00
|
|
SYNTHES LCKNG SCREW 7.3MMX85MM
|
Facility
OP
|
$528.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205772
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$554.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.40
|
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 |
$264.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$303.60
|
Rate for Payer: Fidelis Medicare Advantage |
$554.40
|
Rate for Payer: Group Health Inc Commercial |
$264.00
|
Rate for Payer: Group Health Inc Medicare |
$184.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$264.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$343.20
|
|
SYNTHES LOCKIG SCREW 2.0MMX 10-12
|
Facility
OP
|
$268.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206333
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$93.80 |
Max. Negotiated Rate |
$281.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.40
|
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 |
$134.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$154.10
|
Rate for Payer: Fidelis Medicare Advantage |
$281.40
|
Rate for Payer: Group Health Inc Commercial |
$134.00
|
Rate for Payer: Group Health Inc Medicare |
$93.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$134.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.20
|
|
SYNTHES LOCKIG SCREW 2.0MMX 10-12
|
Facility
IP
|
$268.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206333
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.00 |
Max. Negotiated Rate |
$134.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$134.00
|
|
SYNTHES LOCKING SCREW
|
Facility
IP
|
$304.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208149
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$152.10 |
Max. Negotiated Rate |
$152.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$152.10
|
|
SYNTHES LOCKING SCREW
|
Facility
OP
|
$304.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208149
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$106.47 |
Max. Negotiated Rate |
$319.41 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$167.31
|
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 |
$152.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$174.92
|
Rate for Payer: Fidelis Medicare Advantage |
$319.41
|
Rate for Payer: Group Health Inc Commercial |
$152.10
|
Rate for Payer: Group Health Inc Medicare |
$106.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$152.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.73
|
|
SYNTHES LOCKING SCREW 2.0
|
Facility
IP
|
$254.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205810
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$127.00 |
Max. Negotiated Rate |
$127.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$127.00
|
|
SYNTHES LOCKING SCREW 2.0
|
Facility
OP
|
$254.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205810
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$88.90 |
Max. Negotiated Rate |
$266.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.70
|
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 |
$127.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.05
|
Rate for Payer: Fidelis Medicare Advantage |
$266.70
|
Rate for Payer: Group Health Inc Commercial |
$127.00
|
Rate for Payer: Group Health Inc Medicare |
$88.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$127.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.10
|
|
SYNTHES LOCKING SCREW 2.7X
|
Facility
IP
|
$297.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200716
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$148.50 |
Max. Negotiated Rate |
$148.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$148.50
|
|
SYNTHES LOCKING SCREW 2.7X
|
Facility
OP
|
$297.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200716
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$103.95 |
Max. Negotiated Rate |
$311.85 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.35
|
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 |
$148.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.78
|
Rate for Payer: Fidelis Medicare Advantage |
$311.85
|
Rate for Payer: Group Health Inc Commercial |
$148.50
|
Rate for Payer: Group Health Inc Medicare |
$103.95
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$148.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.05
|
|
SYNTHES LOCKING SCREW 4.0 X
|
Facility
IP
|
$148.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205700
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$74.25 |
Max. Negotiated Rate |
$74.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$74.25
|
|
SYNTHES LOCKING SCREW 4.0 X
|
Facility
OP
|
$148.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205700
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.98 |
Max. Negotiated Rate |
$155.92 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.68
|
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 |
$74.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.39
|
Rate for Payer: Fidelis Medicare Advantage |
$155.92
|
Rate for Payer: Group Health Inc Commercial |
$74.25
|
Rate for Payer: Group Health Inc Medicare |
$51.98
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$74.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.52
|
|
SYNTHES LOCKING SCREW 5.0 X 54MM
|
Facility
OP
|
$388.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206245
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$407.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.40
|
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 |
$194.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$223.10
|
Rate for Payer: Fidelis Medicare Advantage |
$407.40
|
Rate for Payer: Group Health Inc Commercial |
$194.00
|
Rate for Payer: Group Health Inc Medicare |
$135.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$194.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.20
|
|
SYNTHES LOCKING SCREW 5.0 X 54MM
|
Facility
IP
|
$388.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206245
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$194.00 |
Max. Negotiated Rate |
$194.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$194.00
|
|
SYNTHES L/S 2.7MM X
|
Facility
IP
|
$297.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205793
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$148.50 |
Max. Negotiated Rate |
$148.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$148.50
|
|
SYNTHES L/S 2.7MM X
|
Facility
OP
|
$297.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205793
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$103.95 |
Max. Negotiated Rate |
$311.85 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.35
|
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 |
$148.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.78
|
Rate for Payer: Fidelis Medicare Advantage |
$311.85
|
Rate for Payer: Group Health Inc Commercial |
$148.50
|
Rate for Payer: Group Health Inc Medicare |
$103.95
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$148.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.05
|
|
SYNTHES L/S 5.0X
|
Facility
OP
|
$464.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205946
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$487.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$255.20
|
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 |
$232.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$266.80
|
Rate for Payer: Fidelis Medicare Advantage |
$487.20
|
Rate for Payer: Group Health Inc Commercial |
$232.00
|
Rate for Payer: Group Health Inc Medicare |
$162.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$232.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$301.60
|
|
SYNTHES L/S 5.0X
|
Facility
IP
|
$464.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205946
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$232.00 |
Max. Negotiated Rate |
$232.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$232.00
|
|
SYNTHES L/S 5.0 X 26-38MM
|
Facility
IP
|
$478.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209600
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$239.40 |
Max. Negotiated Rate |
$239.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$239.40
|
|
SYNTHES L/S 5.0 X 26-38MM
|
Facility
OP
|
$478.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209600
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$502.74 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$263.34
|
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 |
$239.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$275.31
|
Rate for Payer: Fidelis Medicare Advantage |
$502.74
|
Rate for Payer: Group Health Inc Commercial |
$239.40
|
Rate for Payer: Group Health Inc Medicare |
$167.58
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$239.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$311.22
|
|
SYNTHES MATRIX HOLE BOARD PLATE
|
Facility
OP
|
$970.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206064
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,018.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$533.50
|
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 |
$485.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$557.75
|
Rate for Payer: Fidelis Medicare Advantage |
$1,018.50
|
Rate for Payer: Group Health Inc Commercial |
$485.00
|
Rate for Payer: Group Health Inc Medicare |
$339.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$485.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$630.50
|
|
SYNTHES MATRIX HOLE BOARD PLATE
|
Facility
IP
|
$970.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206064
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$485.00 |
Max. Negotiated Rate |
$485.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$485.00
|
|