1.2MM ORBITAL FL PLT,BSC,MED 4MM
|
Facility
OP
|
$1,424.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209760
|
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,CMPLX,L 3MM
|
Facility
OP
|
$1,144.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209761
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$69.35 |
Max. Negotiated Rate |
$1,201.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$629.20
|
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 |
$572.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$657.80
|
Rate for Payer: Fidelis Medicare Advantage |
$1,201.20
|
Rate for Payer: Group Health Inc Commercial |
$572.00
|
Rate for Payer: Group Health Inc Medicare |
$400.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$572.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$743.60
|
|
1.2MM ORBITAL FL PLT,CMPLX,L 3MM
|
Facility
IP
|
$1,144.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209761
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$572.00 |
Max. Negotiated Rate |
$572.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$572.00
|
|
1.2MM ORBITAL FL PLT,CMPLX,L 4MM
|
Facility
IP
|
$1,144.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209762
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$572.00 |
Max. Negotiated Rate |
$572.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$572.00
|
|
1.2MM ORBITAL FL PLT,CMPLX,L 4MM
|
Facility
OP
|
$1,144.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209762
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$69.35 |
Max. Negotiated Rate |
$1,201.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$629.20
|
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 |
$572.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$657.80
|
Rate for Payer: Fidelis Medicare Advantage |
$1,201.20
|
Rate for Payer: Group Health Inc Commercial |
$572.00
|
Rate for Payer: Group Health Inc Medicare |
$400.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$572.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$743.60
|
|
1.2MM ORBITAL FL PLT,ISLTD,SM 3MM
|
Facility
OP
|
$1,024.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209763
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$69.35 |
Max. Negotiated Rate |
$1,075.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$563.20
|
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 |
$512.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$588.80
|
Rate for Payer: Fidelis Medicare Advantage |
$1,075.20
|
Rate for Payer: Group Health Inc Commercial |
$512.00
|
Rate for Payer: Group Health Inc Medicare |
$358.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$512.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$512.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$665.60
|
|
1.2MM ORBITAL FL PLT,ISLTD,SM 3MM
|
Facility
IP
|
$1,024.00
|
|
Service Code
|
HCPCS C1781
|
Hospital Charge Code |
40209763
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$512.00 |
Max. Negotiated Rate |
$512.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$512.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$512.00
|
|
12 MM SMALL ROUND ENDCAP
|
Facility
OP
|
$383.00
|
|
Hospital Charge Code |
40001657
|
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
|
|
1.2 ORBITAL FLOOR PLATE
|
Facility
OP
|
$324.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202313
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$113.40 |
Max. Negotiated Rate |
$340.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.20
|
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 |
$162.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$186.30
|
Rate for Payer: Fidelis Medicare Advantage |
$340.20
|
Rate for Payer: Group Health Inc Commercial |
$162.00
|
Rate for Payer: Group Health Inc Medicare |
$113.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$162.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.60
|
|
1.2 ORBITAL FLOOR PLATE
|
Facility
IP
|
$324.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201237
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$162.00 |
Max. Negotiated Rate |
$162.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$162.00
|
|
1.2 ORBITAL FLOOR PLATE
|
Facility
IP
|
$324.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202313
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$162.00 |
Max. Negotiated Rate |
$162.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$162.00
|
|
1.2 ORBITAL FLOOR PLATE
|
Facility
OP
|
$324.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201237
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$113.40 |
Max. Negotiated Rate |
$340.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.20
|
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 |
$162.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$186.30
|
Rate for Payer: Fidelis Medicare Advantage |
$340.20
|
Rate for Payer: Group Health Inc Commercial |
$162.00
|
Rate for Payer: Group Health Inc Medicare |
$113.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$162.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.60
|
|
12X285 T2 TIBIAL NAIL, STANDARD
|
Facility
OP
|
$2,350.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200582
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,467.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,292.50
|
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 |
$1,175.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,351.25
|
Rate for Payer: Fidelis Medicare Advantage |
$2,467.50
|
Rate for Payer: Group Health Inc Commercial |
$1,175.00
|
Rate for Payer: Group Health Inc Medicare |
$822.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,175.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,175.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,527.50
|
|
12X285 T2 TIBIAL NAIL, STANDARD
|
Facility
IP
|
$2,350.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200582
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,175.00 |
Max. Negotiated Rate |
$1,175.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,175.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,175.00
|
|
12X360MM T2 TIBIAL NAIL, STANDARD
|
Facility
OP
|
$2,360.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200583
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,478.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.00
|
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 |
$1,180.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,357.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,478.00
|
Rate for Payer: Group Health Inc Commercial |
$1,180.00
|
Rate for Payer: Group Health Inc Medicare |
$826.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,534.00
|
|
12X360MM T2 TIBIAL NAIL, STANDARD
|
Facility
IP
|
$2,360.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200583
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,180.00 |
Max. Negotiated Rate |
$1,180.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
|
12X390MM T2 TIBIAL NAIL, STANDARD
|
Facility
OP
|
$2,364.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200584
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,482.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,300.20
|
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 |
$1,182.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,359.30
|
Rate for Payer: Fidelis Medicare Advantage |
$2,482.20
|
Rate for Payer: Group Health Inc Commercial |
$1,182.00
|
Rate for Payer: Group Health Inc Medicare |
$827.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,182.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,182.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,536.60
|
|
12X390MM T2 TIBIAL NAIL, STANDARD
|
Facility
IP
|
$2,364.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200584
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,182.00 |
Max. Negotiated Rate |
$1,182.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,182.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,182.00
|
|
1.2 X3MM BONE SCREW
|
Facility
IP
|
$126.70
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005304
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$63.35 |
Max. Negotiated Rate |
$63.35 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$63.35
|
|
1.2 X3MM BONE SCREW
|
Facility
OP
|
$126.70
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005304
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.34 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.68
|
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 |
$63.35
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.85
|
Rate for Payer: Fidelis Medicare Advantage |
$133.04
|
Rate for Payer: Group Health Inc Commercial |
$63.35
|
Rate for Payer: Group Health Inc Medicare |
$44.34
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$63.35
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.36
|
|
1.35 5MM TWIST DRILL
|
Facility
OP
|
$221.62
|
|
Hospital Charge Code |
40005305
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$77.57 |
Max. Negotiated Rate |
$177.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.89
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.81
|
Rate for Payer: Aetna Government |
$110.81
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$150.70
|
Rate for Payer: Group Health Inc Commercial |
$110.81
|
Rate for Payer: Group Health Inc Medicare |
$77.57
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.81
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$110.81
|
|
13 HOLE NARROW Z-PLT
|
Facility
IP
|
$845.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203443
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$422.50 |
Max. Negotiated Rate |
$422.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$422.50
|
|
13 HOLE NARROW Z-PLT
|
Facility
OP
|
$845.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203443
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$887.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$464.75
|
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 |
$422.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$485.88
|
Rate for Payer: Fidelis Medicare Advantage |
$887.25
|
Rate for Payer: Group Health Inc Commercial |
$422.50
|
Rate for Payer: Group Health Inc Medicare |
$295.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$422.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$549.25
|
|
13_HOLE NARROW Z-PLT
|
Facility
OP
|
$845.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204725
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$887.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$464.75
|
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 |
$422.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$485.88
|
Rate for Payer: Fidelis Medicare Advantage |
$887.25
|
Rate for Payer: Group Health Inc Commercial |
$422.50
|
Rate for Payer: Group Health Inc Medicare |
$295.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$422.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$549.25
|
|
13_HOLE NARROW Z-PLT
|
Facility
IP
|
$845.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204725
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$422.50 |
Max. Negotiated Rate |
$422.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$422.50
|
|