STR SCR/2.0X8MM LCK CROSS PIN
|
Facility
|
IP
|
$156.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204450
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$78.19 |
Max. Negotiated Rate |
$78.19 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.19
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.19
|
|
STR SCR/2.0X8MM LCK CR PIN
|
Facility
|
OP
|
$156.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204456
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$54.73 |
Max. Negotiated Rate |
$164.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.01
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$93.83
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.19
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$89.92
|
Rate for Payer: EmblemHealth Commercial |
$78.19
|
Rate for Payer: Fidelis Medicare Advantage |
$164.20
|
Rate for Payer: Group Health Inc Commercial |
$78.19
|
Rate for Payer: Group Health Inc Medicare |
$54.73
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.19
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.19
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.65
|
|
STR SCR/2.0X8MM LCK CR PIN
|
Facility
|
IP
|
$156.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204456
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$78.19 |
Max. Negotiated Rate |
$78.19 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.19
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.19
|
|
STR SCR/2.3X6MM LCK CR PIN
|
Facility
|
OP
|
$180.18
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204457
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$63.06 |
Max. Negotiated Rate |
$189.19 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$108.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.09
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.60
|
Rate for Payer: EmblemHealth Commercial |
$90.09
|
Rate for Payer: Fidelis Medicare Advantage |
$189.19
|
Rate for Payer: Group Health Inc Commercial |
$90.09
|
Rate for Payer: Group Health Inc Medicare |
$63.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.09
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.09
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.12
|
|
STR SCR/2.3X6MM LCK CR PIN
|
Facility
|
IP
|
$180.18
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204457
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$90.09 |
Max. Negotiated Rate |
$90.09 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.09
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.09
|
|
STR SCR/2.3X8MM LCKNG CROSS PIN
|
Facility
|
OP
|
$180.18
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204451
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$63.06 |
Max. Negotiated Rate |
$189.19 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$108.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.09
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.60
|
Rate for Payer: EmblemHealth Commercial |
$90.09
|
Rate for Payer: Fidelis Medicare Advantage |
$189.19
|
Rate for Payer: Group Health Inc Commercial |
$90.09
|
Rate for Payer: Group Health Inc Medicare |
$63.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.09
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.09
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.12
|
|
STR SCR/2.3X8MM LCKNG CROSS PIN
|
Facility
|
IP
|
$180.18
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204451
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$90.09 |
Max. Negotiated Rate |
$90.09 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.09
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.09
|
|
STR T2 REC NAIL R1.5 TI LT 11X380
|
Facility
|
OP
|
$3,803.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204663
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,993.99 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,092.09
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$2,282.28
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,901.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,187.18
|
Rate for Payer: EmblemHealth Commercial |
$1,901.90
|
Rate for Payer: Fidelis Medicare Advantage |
$3,993.99
|
Rate for Payer: Group Health Inc Commercial |
$1,901.90
|
Rate for Payer: Group Health Inc Medicare |
$1,331.33
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,901.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,901.90
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,472.47
|
|
STR T2 REC NAIL R1.5 TI LT 11X380
|
Facility
|
IP
|
$3,803.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204663
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,901.90 |
Max. Negotiated Rate |
$1,901.90 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,901.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,901.90
|
|
STRUT FAST FIX MED FOR TSF
|
Facility
|
OP
|
$3,349.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901935
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,516.98 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,842.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$2,009.70
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,674.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,925.96
|
Rate for Payer: EmblemHealth Commercial |
$1,674.75
|
Rate for Payer: Fidelis Medicare Advantage |
$3,516.98
|
Rate for Payer: Group Health Inc Commercial |
$1,674.75
|
Rate for Payer: Group Health Inc Medicare |
$1,172.32
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,674.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,177.18
|
|
STRUT FAST FIX MED FOR TSF
|
Facility
|
IP
|
$3,349.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901935
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,674.75 |
Max. Negotiated Rate |
$1,674.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,674.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.75
|
|
STRUT FAST FIX SHORT FOR TSF
|
Facility
|
OP
|
$3,349.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901936
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,516.98 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,842.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$2,009.70
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,674.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,925.96
|
Rate for Payer: EmblemHealth Commercial |
$1,674.75
|
Rate for Payer: Fidelis Medicare Advantage |
$3,516.98
|
Rate for Payer: Group Health Inc Commercial |
$1,674.75
|
Rate for Payer: Group Health Inc Medicare |
$1,172.32
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,674.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,177.18
|
|
STRUT FAST FIX SHORT FOR TSF
|
Facility
|
IP
|
$3,349.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901936
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,674.75 |
Max. Negotiated Rate |
$1,674.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,674.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.75
|
|
STRUT FEMORAL CORTICAL (CS1)
|
Facility
|
OP
|
$1,168.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906330
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,226.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$642.40
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Brighton Health Commercial |
$700.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$584.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$671.60
|
Rate for Payer: EmblemHealth Commercial |
$584.00
|
Rate for Payer: Fidelis Medicare Advantage |
$1,226.40
|
Rate for Payer: Group Health Inc Commercial |
$584.00
|
Rate for Payer: Group Health Inc Medicare |
$408.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$584.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$759.20
|
|
STRUT FEMORAL CORTICAL (CS1)
|
Facility
|
IP
|
$1,168.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906330
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$584.00 |
Max. Negotiated Rate |
$584.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$584.00
|
|
STRUT HEXAPOD
|
Facility
|
OP
|
$5,172.50
|
|
Hospital Charge Code |
64907390
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,810.38 |
Max. Negotiated Rate |
$4,138.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,844.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,586.25
|
Rate for Payer: Aetna Government |
$2,586.25
|
Rate for Payer: Brighton Health Commercial |
$3,879.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,138.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,517.30
|
Rate for Payer: Group Health Inc Commercial |
$2,586.25
|
Rate for Payer: Group Health Inc Medicare |
$1,810.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,586.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,586.25
|
|
STRUT HEXAPOD MD
|
Facility
|
IP
|
$9,667.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907404
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,833.75 |
Max. Negotiated Rate |
$4,833.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,833.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,833.75
|
|
STRUT HEXAPOD MD
|
Facility
|
OP
|
$9,667.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907404
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$10,150.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,317.12
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$5,800.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,833.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,558.81
|
Rate for Payer: EmblemHealth Commercial |
$4,833.75
|
Rate for Payer: Fidelis Medicare Advantage |
$10,150.88
|
Rate for Payer: Group Health Inc Commercial |
$4,833.75
|
Rate for Payer: Group Health Inc Medicare |
$3,383.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,833.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,833.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,283.88
|
|
STRUT STATIC MD
|
Facility
|
OP
|
$140.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907401
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$49.17 |
Max. Negotiated Rate |
$147.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.26
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$84.29
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.24
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$80.78
|
Rate for Payer: EmblemHealth Commercial |
$70.24
|
Rate for Payer: Fidelis Medicare Advantage |
$147.50
|
Rate for Payer: Group Health Inc Commercial |
$70.24
|
Rate for Payer: Group Health Inc Medicare |
$49.17
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$70.24
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.31
|
|
STRUT STATIC MD
|
Facility
|
IP
|
$140.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907401
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$70.24 |
Max. Negotiated Rate |
$70.24 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$70.24
|
|
STR XIA TITAN BLOCKER
|
Facility
|
OP
|
$317.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40001659
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$110.95 |
Max. Negotiated Rate |
$332.85 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$190.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$158.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$182.28
|
Rate for Payer: EmblemHealth Commercial |
$158.50
|
Rate for Payer: Fidelis Medicare Advantage |
$332.85
|
Rate for Payer: Group Health Inc Commercial |
$158.50
|
Rate for Payer: Group Health Inc Medicare |
$110.95
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$158.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.05
|
|
STR XIA TITAN BLOCKER
|
Facility
|
IP
|
$317.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40001659
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$158.50 |
Max. Negotiated Rate |
$158.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$158.50
|
|
STRY 10 HOLE CURVED PLATE MIDFACE
|
Facility
|
IP
|
$428.16
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203415
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$214.08 |
Max. Negotiated Rate |
$214.08 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$214.08
|
|
STRY 10 HOLE CURVED PLATE MIDFACE
|
Facility
|
OP
|
$428.16
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203415
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$449.57 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$235.49
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$256.90
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$214.08
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$246.19
|
Rate for Payer: EmblemHealth Commercial |
$214.08
|
Rate for Payer: Fidelis Medicare Advantage |
$449.57
|
Rate for Payer: Group Health Inc Commercial |
$214.08
|
Rate for Payer: Group Health Inc Medicare |
$149.86
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$214.08
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.30
|
|
STRY 12 HOLE PLATE
|
Facility
|
IP
|
$903.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40004609
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$451.75 |
Max. Negotiated Rate |
$451.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$451.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$451.75
|
|