STRY STEM BLL ACCOLAD MM,
|
Facility
OP
|
$13,041.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009749
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$13,693.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,172.55
|
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 |
$6,520.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,498.58
|
Rate for Payer: Fidelis Medicare Advantage |
$13,693.05
|
Rate for Payer: Group Health Inc Commercial |
$6,520.50
|
Rate for Payer: Group Health Inc Medicare |
$4,564.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,520.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6,520.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,476.65
|
|
STRY STEM BLL ACCOLAD MM,
|
Facility
IP
|
$13,041.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009749
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$6,520.50 |
Max. Negotiated Rate |
$6,520.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,520.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6,520.50
|
|
STRY STRAIT PLATE, 8 HOLE W/O BAR
|
Facility
IP
|
$292.46
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203402
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$146.23 |
Max. Negotiated Rate |
$146.23 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.23
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$146.23
|
|
STRY STRAIT PLATE, 8 HOLE W/O BAR
|
Facility
OP
|
$292.46
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203402
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$102.36 |
Max. Negotiated Rate |
$307.08 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$160.85
|
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 |
$146.23
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$168.16
|
Rate for Payer: Fidelis Medicare Advantage |
$307.08
|
Rate for Payer: Group Health Inc Commercial |
$146.23
|
Rate for Payer: Group Health Inc Medicare |
$102.36
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.23
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$146.23
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$190.10
|
|
STRY T2 SCN 11 X 380MM
|
Facility
IP
|
$3,746.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40009733
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,873.30 |
Max. Negotiated Rate |
$1,873.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,873.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,873.30
|
|
STRY T2 SCN 11 X 380MM
|
Facility
OP
|
$3,746.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40009733
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,933.93 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,060.63
|
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 |
$1,873.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,154.30
|
Rate for Payer: Fidelis Medicare Advantage |
$3,933.93
|
Rate for Payer: Group Health Inc Commercial |
$1,873.30
|
Rate for Payer: Group Health Inc Medicare |
$1,311.31
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,873.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,873.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,435.29
|
|
STRY TAP XIA3 5.0 MM
|
Facility
IP
|
$720.16
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003442
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$360.08 |
Max. Negotiated Rate |
$360.08 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$360.08
|
|
STRY TAP XIA3 5.0 MM
|
Facility
OP
|
$720.16
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003442
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$756.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$396.09
|
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 |
$360.08
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$414.09
|
Rate for Payer: Fidelis Medicare Advantage |
$756.17
|
Rate for Payer: Group Health Inc Commercial |
$360.08
|
Rate for Payer: Group Health Inc Medicare |
$252.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$360.08
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$468.10
|
|
STRY TITAN WASHERS
|
Facility
OP
|
$54.60
|
|
Hospital Charge Code |
40008258
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$19.11 |
Max. Negotiated Rate |
$43.68 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.03
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.30
|
Rate for Payer: Aetna Government |
$27.30
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.13
|
Rate for Payer: Group Health Inc Commercial |
$27.30
|
Rate for Payer: Group Health Inc Medicare |
$19.11
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$27.30
|
|
STRY TIT WASHER FOR 5.0MM SCREW
|
Facility
OP
|
$58.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40004616
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.30 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.90
|
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 |
$29.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.35
|
Rate for Payer: Fidelis Medicare Advantage |
$60.90
|
Rate for Payer: Group Health Inc Commercial |
$29.00
|
Rate for Payer: Group Health Inc Medicare |
$20.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.70
|
|
STRY TIT WASHER FOR 5.0MM SCREW
|
Facility
IP
|
$58.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40004616
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.00 |
Max. Negotiated Rate |
$29.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.00
|
|
STRY TWST DRLL 1.6X58MM WKLG 26MM
|
Facility
IP
|
$218.82
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203423
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$109.41 |
Max. Negotiated Rate |
$109.41 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$109.41
|
|
STRY TWST DRLL 1.6X58MM WKLG 26MM
|
Facility
OP
|
$218.82
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203423
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$76.59 |
Max. Negotiated Rate |
$229.76 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$120.35
|
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 |
$109.41
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.82
|
Rate for Payer: Fidelis Medicare Advantage |
$229.76
|
Rate for Payer: Group Health Inc Commercial |
$109.41
|
Rate for Payer: Group Health Inc Medicare |
$76.59
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$109.41
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.23
|
|
STRY UN3 BOX PLATE
|
Facility
OP
|
$501.82
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204201
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$526.91 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.00
|
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 |
$250.91
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.55
|
Rate for Payer: Fidelis Medicare Advantage |
$526.91
|
Rate for Payer: Group Health Inc Commercial |
$250.91
|
Rate for Payer: Group Health Inc Medicare |
$175.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.91
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.91
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.18
|
|
STRY UN3 BOX PLATE
|
Facility
IP
|
$501.82
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204201
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$250.91 |
Max. Negotiated Rate |
$250.91 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.91
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.91
|
|
STRY UN3 BOX_PLATE
|
Facility
IP
|
$501.82
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204206
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$250.91 |
Max. Negotiated Rate |
$250.91 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.91
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.91
|
|
STRY UN3 BOX_PLATE
|
Facility
OP
|
$501.82
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204206
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$526.91 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.00
|
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 |
$250.91
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.55
|
Rate for Payer: Fidelis Medicare Advantage |
$526.91
|
Rate for Payer: Group Health Inc Commercial |
$250.91
|
Rate for Payer: Group Health Inc Medicare |
$175.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.91
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.91
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.18
|
|
STRY UN3 COVER 20MM W/TAB
|
Facility
IP
|
$448.66
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40001788
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$224.33 |
Max. Negotiated Rate |
$224.33 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.33
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$224.33
|
|
STRY UN3 COVER 20MM W/TAB
|
Facility
OP
|
$448.66
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40001788
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$471.09 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$246.76
|
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 |
$224.33
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$257.98
|
Rate for Payer: Fidelis Medicare Advantage |
$471.09
|
Rate for Payer: Group Health Inc Commercial |
$224.33
|
Rate for Payer: Group Health Inc Medicare |
$157.03
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.33
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$224.33
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.63
|
|
STRY UN3 HOLE PLT W/O TAB 0.6MM
|
Facility
IP
|
$267.44
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40001789
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$133.72 |
Max. Negotiated Rate |
$133.72 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$133.72
|
|
STRY UN3 HOLE PLT W/O TAB 0.6MM
|
Facility
OP
|
$267.44
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40001789
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$93.60 |
Max. Negotiated Rate |
$280.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.09
|
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 |
$133.72
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$153.78
|
Rate for Payer: Fidelis Medicare Advantage |
$280.81
|
Rate for Payer: Group Health Inc Commercial |
$133.72
|
Rate for Payer: Group Health Inc Medicare |
$93.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$133.72
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.84
|
|
STRY UNI BONE REP INST 3.2MM
|
Facility
OP
|
$925.86
|
|
Hospital Charge Code |
40204213
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$324.05 |
Max. Negotiated Rate |
$740.69 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$509.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$462.93
|
Rate for Payer: Aetna Government |
$462.93
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$740.69
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$629.58
|
Rate for Payer: Group Health Inc Commercial |
$462.93
|
Rate for Payer: Group Health Inc Medicare |
$324.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.93
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$462.93
|
|
STRY VARIAX CAN SCREW 3.0MM 12
|
Facility
IP
|
$196.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204262
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$98.00 |
Max. Negotiated Rate |
$98.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$98.00
|
|
STRY VARIAX CAN SCREW 3.0MM 12
|
Facility
OP
|
$196.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204262
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$68.60 |
Max. Negotiated Rate |
$205.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.80
|
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 |
$98.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.70
|
Rate for Payer: Fidelis Medicare Advantage |
$205.80
|
Rate for Payer: Group Health Inc Commercial |
$98.00
|
Rate for Payer: Group Health Inc Medicare |
$68.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$98.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.40
|
|
STRY VITOSS BIM 10CC
|
Facility
OP
|
$7,472.66
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003444
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$7,846.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,109.96
|
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 |
$3,736.33
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,296.78
|
Rate for Payer: Fidelis Medicare Advantage |
$7,846.29
|
Rate for Payer: Group Health Inc Commercial |
$3,736.33
|
Rate for Payer: Group Health Inc Medicare |
$2,615.43
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,736.33
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,736.33
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,857.23
|
|