|
SYNTHES M/F 26 H ADAPTION PLATE
|
Facility
IP
|
$708.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40207057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.00 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.00
|
|
|
SYNTHES M/F 26 H ADAPTION PLATE
|
Facility
OP
|
$708.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40207057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$389.40
|
| 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 |
$354.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$407.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$743.40
|
| Rate for Payer: Group Health Inc Commercial |
$354.00
|
| Rate for Payer: Group Health Inc Medicare |
$247.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$460.20
|
|
|
SYNTHES M/F OBLIQUE L 2X3 H PLT
|
Facility
OP
|
$638.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40207058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$669.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$350.90
|
| 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 |
$319.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$366.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.90
|
| Rate for Payer: Group Health Inc Commercial |
$319.00
|
| Rate for Payer: Group Health Inc Medicare |
$223.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$414.70
|
|
|
SYNTHES M/F OBLIQUE L 2X3 H PLT
|
Facility
IP
|
$638.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40207058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.00 |
| Max. Negotiated Rate |
$319.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.00
|
|
|
SYNTHES M/F S/D SCREW
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40206072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.00
|
|
|
SYNTHES M/F S/D SCREW
|
Facility
OP
|
$176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40206072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$184.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.80
|
| 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 |
$88.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$101.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.80
|
| Rate for Payer: Group Health Inc Commercial |
$88.00
|
| Rate for Payer: Group Health Inc Medicare |
$61.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.40
|
|
|
SYNTHES MINI FRAGMENT PLT 442.62
|
Facility
IP
|
$694.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$347.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$347.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$347.40
|
|
|
SYNTHES MINI FRAGMENT PLT 442.62
|
Facility
OP
|
$694.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$729.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$382.14
|
| 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 |
$347.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$399.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$729.54
|
| Rate for Payer: Group Health Inc Commercial |
$347.40
|
| Rate for Payer: Group Health Inc Medicare |
$243.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$347.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$347.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$451.62
|
|
|
SYNTHES MINI FRAGMENT PLT 443.23
|
Facility
OP
|
$444.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$466.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$244.53
|
| 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 |
$222.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$466.83
|
| Rate for Payer: Group Health Inc Commercial |
$222.30
|
| Rate for Payer: Group Health Inc Medicare |
$155.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$222.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.99
|
|
|
SYNTHES MINI FRAGMENT PLT 443.23
|
Facility
IP
|
$444.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$222.30
|
|
|
SYNTHES NAIL
|
Facility
OP
|
$529.79
|
|
| Hospital Charge Code |
40207034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$185.43 |
| Max. Negotiated Rate |
$423.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$264.90
|
| Rate for Payer: Aetna Government |
$264.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$423.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.26
|
| Rate for Payer: Group Health Inc Commercial |
$264.90
|
| Rate for Payer: Group Health Inc Medicare |
$185.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.90
|
|
|
SYNTHES NL TRCH FIX 11MM/130D/380
|
Facility
OP
|
$3,036.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,187.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,669.80
|
| 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 |
$1,518.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,745.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,187.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,518.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,062.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,518.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,518.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,973.40
|
|
|
SYNTHES NL TRCH FIX 11MM/130D/380
|
Facility
IP
|
$3,036.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,518.00 |
| Max. Negotiated Rate |
$1,518.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,518.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,518.00
|
|
|
SYNTHES OBLIQUE L 5 H RIGID PLT
|
Facility
IP
|
$572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$286.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.00
|
|
|
SYNTHES OBLIQUE L 5 H RIGID PLT
|
Facility
OP
|
$572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205305
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$600.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$314.60
|
| 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 |
$286.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$328.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$600.60
|
| Rate for Payer: Group Health Inc Commercial |
$286.00
|
| Rate for Payer: Group Health Inc Medicare |
$200.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.80
|
|
|
SYNTHES PLATE
|
Facility
IP
|
$397.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40207033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.63 |
| Max. Negotiated Rate |
$198.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.63
|
|
|
SYNTHES PLATE
|
Facility
OP
|
$397.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40207033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$417.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$218.49
|
| 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 |
$198.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$228.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$417.12
|
| Rate for Payer: Group Health Inc Commercial |
$198.63
|
| Rate for Payer: Group Health Inc Medicare |
$139.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$258.22
|
|
|
SYNTHES PLATE 7HOLE LCP
|
Facility
OP
|
$1,796.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,885.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$987.80
|
| 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 |
$898.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,032.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,885.80
|
| Rate for Payer: Group Health Inc Commercial |
$898.00
|
| Rate for Payer: Group Health Inc Medicare |
$628.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$898.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$898.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,167.40
|
|
|
SYNTHES PLATE 7HOLE LCP
|
Facility
IP
|
$1,796.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.00 |
| Max. Negotiated Rate |
$898.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$898.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$898.00
|
|
|
SYNTHES PLATE 8 HOLE
|
Facility
IP
|
$682.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.10 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.10
|
|
|
SYNTHES PLATE 8 HOLE
|
Facility
OP
|
$682.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$716.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$375.21
|
| 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 |
$341.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$392.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$716.31
|
| Rate for Payer: Group Health Inc Commercial |
$341.10
|
| Rate for Payer: Group Health Inc Medicare |
$238.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$443.43
|
|
|
SYNTHES PLATE 8HOLE 3.5X11MM
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.25
|
| 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 |
$67.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.75
|
| Rate for Payer: Group Health Inc Commercial |
$67.50
|
| Rate for Payer: Group Health Inc Medicare |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.75
|
|
|
SYNTHES PLATE 8HOLE 3.5X11MM
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
|
|
SYNTHES PLATE L/CALANEAL RGHT
|
Facility
OP
|
$1,333.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,400.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$733.59
|
| 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 |
$666.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$766.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,400.49
|
| Rate for Payer: Group Health Inc Commercial |
$666.90
|
| Rate for Payer: Group Health Inc Medicare |
$466.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$666.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$666.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$866.97
|
|
|
SYNTHES PLATE L/CALANEAL RGHT
|
Facility
IP
|
$1,333.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.90 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$666.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$666.90
|
|
