1.2 BURR H COVER PLATE 10MM
|
Facility
IP
|
$346.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209752
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$173.00 |
Max. Negotiated Rate |
$173.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$173.00
|
|
1.2 BURR H COVER PLATE 14MM
|
Facility
OP
|
$346.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209753
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$69.35 |
Max. Negotiated Rate |
$363.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$190.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
Rate for Payer: Aetna Government |
$69.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$198.95
|
Rate for Payer: Fidelis Medicare Advantage |
$363.30
|
Rate for Payer: Group Health Inc Commercial |
$173.00
|
Rate for Payer: Group Health Inc Medicare |
$121.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$173.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.90
|
|
1.2 BURR H COVER PLATE 14MM
|
Facility
IP
|
$346.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209753
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$173.00 |
Max. Negotiated Rate |
$173.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$173.00
|
|
1.2 BURR H COVER PLATE 7MM
|
Facility
OP
|
$346.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209754
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$69.35 |
Max. Negotiated Rate |
$363.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$190.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
Rate for Payer: Aetna Government |
$69.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$198.95
|
Rate for Payer: Fidelis Medicare Advantage |
$363.30
|
Rate for Payer: Group Health Inc Commercial |
$173.00
|
Rate for Payer: Group Health Inc Medicare |
$121.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$173.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.90
|
|
1.2 BURR H COVER PLATE 7MM
|
Facility
IP
|
$346.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209754
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$173.00 |
Max. Negotiated Rate |
$173.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$173.00
|
|
12H CURVED PLT, 75 PROFILE
|
Facility
OP
|
$582.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209809
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$611.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$320.10
|
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 |
$291.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$334.65
|
Rate for Payer: Fidelis Medicare Advantage |
$611.10
|
Rate for Payer: Group Health Inc Commercial |
$291.00
|
Rate for Payer: Group Health Inc Medicare |
$203.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$291.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.30
|
|
12H CURVED PLT, 75 PROFILE
|
Facility
IP
|
$582.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209809
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$291.00 |
Max. Negotiated Rate |
$291.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$291.00
|
|
12 H DISTAL FEMUR LCKNG PLATE
|
Facility
OP
|
$1,942.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205276
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,039.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,068.10
|
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 |
$971.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,116.65
|
Rate for Payer: Fidelis Medicare Advantage |
$2,039.10
|
Rate for Payer: Group Health Inc Commercial |
$971.00
|
Rate for Payer: Group Health Inc Medicare |
$679.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$971.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$971.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,262.30
|
|
12 H DISTAL FEMUR LCKNG PLATE
|
Facility
IP
|
$1,942.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205276
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$971.00 |
Max. Negotiated Rate |
$971.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$971.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$971.00
|
|
12 HOLE CURVED PLATE
|
Facility
OP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209394
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$119.00 |
Max. Negotiated Rate |
$357.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$187.00
|
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 |
$170.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
Rate for Payer: Fidelis Medicare Advantage |
$357.00
|
Rate for Payer: Group Health Inc Commercial |
$170.00
|
Rate for Payer: Group Health Inc Medicare |
$119.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$170.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.00
|
|
12 HOLE CURVED PLATE
|
Facility
IP
|
$340.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209394
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$170.00 |
Max. Negotiated Rate |
$170.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$170.00
|
|
1.2 MLBL BURR H COVER 10MM
|
Facility
IP
|
$387.08
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209756
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$193.54 |
Max. Negotiated Rate |
$193.54 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.54
|
|
1.2 MLBL BURR H COVER 10MM
|
Facility
OP
|
$387.08
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209756
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$69.35 |
Max. Negotiated Rate |
$406.43 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$212.89
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
Rate for Payer: Aetna Government |
$69.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.54
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$222.57
|
Rate for Payer: Fidelis Medicare Advantage |
$406.43
|
Rate for Payer: Group Health Inc Commercial |
$193.54
|
Rate for Payer: Group Health Inc Medicare |
$135.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.54
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.60
|
|
1.2 MLBL BURR H COVER 20MM
|
Facility
IP
|
$387.08
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209757
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$193.54 |
Max. Negotiated Rate |
$193.54 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.54
|
|
1.2 MLBL BURR H COVER 20MM
|
Facility
OP
|
$387.08
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209757
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$69.35 |
Max. Negotiated Rate |
$406.43 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$212.89
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
Rate for Payer: Aetna Government |
$69.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.54
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$222.57
|
Rate for Payer: Fidelis Medicare Advantage |
$406.43
|
Rate for Payer: Group Health Inc Commercial |
$193.54
|
Rate for Payer: Group Health Inc Medicare |
$135.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.54
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.60
|
|
1.2 MLBL BURR H COVER 7MM
|
Facility
OP
|
$387.08
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209758
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$69.35 |
Max. Negotiated Rate |
$406.43 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$212.89
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
Rate for Payer: Aetna Government |
$69.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.54
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$222.57
|
Rate for Payer: Fidelis Medicare Advantage |
$406.43
|
Rate for Payer: Group Health Inc Commercial |
$193.54
|
Rate for Payer: Group Health Inc Medicare |
$135.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.54
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.60
|
|
1.2 MLBL BURR H COVER 7MM
|
Facility
IP
|
$387.08
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209758
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$193.54 |
Max. Negotiated Rate |
$193.54 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.54
|
|
1.2 MLBL BURR HOLE COVER 14MM
|
Facility
IP
|
$432.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201234
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$216.00 |
Max. Negotiated Rate |
$216.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$216.00
|
|
1.2 MLBL BURR HOLE COVER 14MM
|
Facility
OP
|
$432.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201234
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$453.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$237.60
|
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 |
$216.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$248.40
|
Rate for Payer: Fidelis Medicare Advantage |
$453.60
|
Rate for Payer: Group Health Inc Commercial |
$216.00
|
Rate for Payer: Group Health Inc Medicare |
$151.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$216.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.80
|
|
1.2 MLBL BURR HOLE CVR 10MM
|
Facility
OP
|
$388.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202315
|
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
|
|
1.2 MLBL BURR HOLE CVR 10MM
|
Facility
IP
|
$388.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202315
|
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
|
|
12 MM LARGE ROUND ENDCAP
|
Facility
OP
|
$383.00
|
|
Hospital Charge Code |
40001656
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$134.05 |
Max. Negotiated Rate |
$306.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.50
|
Rate for Payer: Aetna Government |
$191.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.44
|
Rate for Payer: Group Health Inc Commercial |
$191.50
|
Rate for Payer: Group Health Inc Medicare |
$134.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$191.50
|
|
1.2MM ORBITAL FL PLT,BSC,MED,3MM
|
Facility
OP
|
$1,424.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209759
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$69.35 |
Max. Negotiated Rate |
$1,495.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$783.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
Rate for Payer: Aetna Government |
$69.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$712.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$818.80
|
Rate for Payer: Fidelis Medicare Advantage |
$1,495.20
|
Rate for Payer: Group Health Inc Commercial |
$712.00
|
Rate for Payer: Group Health Inc Medicare |
$498.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$712.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$712.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$925.60
|
|
1.2MM ORBITAL FL PLT,BSC,MED,3MM
|
Facility
IP
|
$1,424.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209759
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$712.00 |
Max. Negotiated Rate |
$712.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$712.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$712.00
|
|
1.2MM ORBITAL FL PLT,BSC,MED 4MM
|
Facility
IP
|
$1,424.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209760
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$712.00 |
Max. Negotiated Rate |
$712.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$712.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$712.00
|
|