|
6HOLE RIGHT PROX LOCKING PLATE
|
Facility
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$875.00
|
|
|
6HOLE RIGHT PROX LOCKING PLATE
|
Facility
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$962.50
|
| 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 |
$875.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,006.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,837.50
|
| Rate for Payer: Group Health Inc Commercial |
$875.00
|
| Rate for Payer: Group Health Inc Medicare |
$612.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$875.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,137.50
|
|
|
6 HOLE SAGITTAL SPLIT PLATE
|
Facility
IP
|
$532.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.31 |
| Max. Negotiated Rate |
$266.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$266.31
|
|
|
6 HOLE SAGITTAL SPLIT PLATE
|
Facility
OP
|
$532.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$559.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$292.94
|
| 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 |
$266.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$559.25
|
| Rate for Payer: Group Health Inc Commercial |
$266.31
|
| Rate for Payer: Group Health Inc Medicare |
$186.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$266.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$346.20
|
|
|
6HOLE START PLTE W/BAR,MAND,LOCK
|
Facility
OP
|
$418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$229.90
|
| 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 |
$209.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$240.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$438.90
|
| Rate for Payer: Group Health Inc Commercial |
$209.00
|
| Rate for Payer: Group Health Inc Medicare |
$146.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.70
|
|
|
6HOLE START PLTE W/BAR,MAND,LOCK
|
Facility
IP
|
$418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.00
|
|
|
6H PLATE
|
Facility
OP
|
$1,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,062.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,080.20
|
| 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 |
$982.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,129.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,062.20
|
| Rate for Payer: Group Health Inc Commercial |
$982.00
|
| Rate for Payer: Group Health Inc Medicare |
$687.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$982.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$982.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,276.60
|
|
|
6H PLATE
|
Facility
IP
|
$1,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.00 |
| Max. Negotiated Rate |
$982.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$982.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$982.00
|
|
|
6-MINUTE WALK
|
Facility
OP
|
$88.03
|
|
|
Service Code
|
HCPCS 97116
|
| Hospital Charge Code |
41701001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.96
|
| Rate for Payer: Aetna Government |
$16.96
|
| Rate for Payer: Amida Care Medicaid |
$47.88
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,788.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.27
|
| Rate for Payer: Group Health Inc Commercial |
$44.02
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Healthfirst Essential Plan |
$107.73
|
| Rate for Payer: Healthfirst QHP |
$47.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.88
|
| Rate for Payer: SOMOS Essential |
$107.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
6 MIN WALK TEST
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 94618 TC
|
| Hospital Charge Code |
30301329
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Government |
$165.12
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.28
|
| Rate for Payer: Group Health Inc Commercial |
$165.12
|
| Rate for Payer: Group Health Inc Medicare |
$115.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.75
|
|
|
6MM PRE-DRILLING ASSEMBLY-LONG
|
Facility
IP
|
$304.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.00
|
|
|
6MM PRE-DRILLING ASSEMBLY-LONG
|
Facility
OP
|
$304.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$167.20
|
| 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 |
$152.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$174.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.20
|
| Rate for Payer: Group Health Inc Commercial |
$152.00
|
| Rate for Payer: Group Health Inc Medicare |
$106.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.60
|
|
|
6X2H 3D PLATE UPPER FC MALLEABLE
|
Facility
IP
|
$676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.00
|
|
|
6X2H 3D PLATE UPPER FC MALLEABLE
|
Facility
OP
|
$676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$709.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$371.80
|
| 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 |
$338.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$388.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$709.80
|
| Rate for Payer: Group Health Inc Commercial |
$338.00
|
| Rate for Payer: Group Health Inc Medicare |
$236.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$439.40
|
|
|
6X2 HOLE 3D PLTE UPPERFACE
|
Facility
OP
|
$636.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$667.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.80
|
| 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 |
$318.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$365.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$667.80
|
| Rate for Payer: Group Health Inc Commercial |
$318.00
|
| Rate for Payer: Group Health Inc Medicare |
$222.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.40
|
|
|
6X2 HOLE 3D PLTE UPPERFACE
|
Facility
IP
|
$636.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.00
|
|
|
6X2 HOLE 3D PLT UPPERFACE
|
Facility
OP
|
$636.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$667.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.80
|
| 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 |
$318.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$365.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$667.80
|
| Rate for Payer: Group Health Inc Commercial |
$318.00
|
| Rate for Payer: Group Health Inc Medicare |
$222.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.40
|
|
|
6X2 HOLE 3D PLT UPPERFACE
|
Facility
IP
|
$636.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.00
|
|
|
6X2 HOLE 3D PLT UPPER FC MALLBL
|
Facility
IP
|
$1,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$780.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$780.00
|
|
|
6X2 HOLE 3D PLT UPPER FC MALLBL
|
Facility
OP
|
$1,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$858.00
|
| 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 |
$780.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$897.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,638.00
|
| Rate for Payer: Group Health Inc Commercial |
$780.00
|
| Rate for Payer: Group Health Inc Medicare |
$546.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$780.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$780.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,014.00
|
|
|
6X6H 3D PLATE UPPER FC MALLEABLE
|
Facility
IP
|
$676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.00
|
|
|
6X6H 3D PLATE UPPER FC MALLEABLE
|
Facility
OP
|
$676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$709.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$371.80
|
| 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 |
$338.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$388.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$709.80
|
| Rate for Payer: Group Health Inc Commercial |
$338.00
|
| Rate for Payer: Group Health Inc Medicare |
$236.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$439.40
|
|
|
6X6 HOLE 3D PLTE UPPERFACE
|
Facility
OP
|
$1,508.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,583.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$829.40
|
| 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 |
$754.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$867.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,583.40
|
| Rate for Payer: Group Health Inc Commercial |
$754.00
|
| Rate for Payer: Group Health Inc Medicare |
$527.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$754.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$754.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$980.20
|
|
|
6X6 HOLE 3D PLTE UPPERFACE
|
Facility
IP
|
$1,508.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$754.00 |
| Max. Negotiated Rate |
$754.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$754.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$754.00
|
|
|
6X6HOLE 3D PLT UPPERFACE
|
Facility
IP
|
$1,508.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$754.00 |
| Max. Negotiated Rate |
$754.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$754.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$754.00
|
|
