STRY A LCK SCREW 4.0X65MM
|
Facility
|
OP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008282
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$527.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$301.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$251.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.65
|
Rate for Payer: EmblemHealth Commercial |
$251.00
|
Rate for Payer: Fidelis Medicare Advantage |
$527.10
|
Rate for Payer: Group Health Inc Commercial |
$251.00
|
Rate for Payer: Group Health Inc Medicare |
$175.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.30
|
|
STRY A LCK SCREW 4.0X65MM
|
Facility
|
IP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008282
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$251.00 |
Max. Negotiated Rate |
$251.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
|
STRY ANCHOR C 9X12X144
|
Facility
|
IP
|
$11,250.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906951
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$5,625.00 |
Max. Negotiated Rate |
$5,625.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,625.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5,625.00
|
|
STRY ANCHOR C 9X12X144
|
Facility
|
OP
|
$11,250.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906951
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$11,812.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,187.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$6,750.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,625.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,468.75
|
Rate for Payer: EmblemHealth Commercial |
$5,625.00
|
Rate for Payer: Fidelis Medicare Advantage |
$11,812.50
|
Rate for Payer: Group Health Inc Commercial |
$5,625.00
|
Rate for Payer: Group Health Inc Medicare |
$3,937.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,625.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5,625.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,312.50
|
|
STRY A NON LCK SCREW 3.5X34MM
|
Facility
|
OP
|
$80.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008283
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.00 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$48.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.00
|
Rate for Payer: EmblemHealth Commercial |
$40.00
|
Rate for Payer: Fidelis Medicare Advantage |
$84.00
|
Rate for Payer: Group Health Inc Commercial |
$40.00
|
Rate for Payer: Group Health Inc Medicare |
$28.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
|
STRY A NON LCK SCREW 3.5X34MM
|
Facility
|
IP
|
$80.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008283
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.00 |
Max. Negotiated Rate |
$40.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
|
STRY APEX PIN 6 X 180 MM
|
Facility
|
OP
|
$279.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203452
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$97.82 |
Max. Negotiated Rate |
$293.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$153.72
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$167.70
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$139.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$160.71
|
Rate for Payer: EmblemHealth Commercial |
$139.75
|
Rate for Payer: Fidelis Medicare Advantage |
$293.48
|
Rate for Payer: Group Health Inc Commercial |
$139.75
|
Rate for Payer: Group Health Inc Medicare |
$97.82
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$139.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.68
|
|
STRY APEX PIN 6 X 180 MM
|
Facility
|
IP
|
$279.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203452
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$139.75 |
Max. Negotiated Rate |
$139.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$139.75
|
|
STRY APEX PIN 6 X 180MM
|
Facility
|
IP
|
$279.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204734
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$139.75 |
Max. Negotiated Rate |
$139.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$139.75
|
|
STRY APEX PIN 6 X 180MM
|
Facility
|
OP
|
$279.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204734
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$97.82 |
Max. Negotiated Rate |
$293.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$153.72
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$167.70
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$139.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$160.71
|
Rate for Payer: EmblemHealth Commercial |
$139.75
|
Rate for Payer: Fidelis Medicare Advantage |
$293.48
|
Rate for Payer: Group Health Inc Commercial |
$139.75
|
Rate for Payer: Group Health Inc Medicare |
$97.82
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$139.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.68
|
|
STRY ASNISIII SCREW 4.0X46MM
|
Facility
|
OP
|
$312.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008257
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$109.20 |
Max. Negotiated Rate |
$327.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$187.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$156.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$179.40
|
Rate for Payer: EmblemHealth Commercial |
$156.00
|
Rate for Payer: Fidelis Medicare Advantage |
$327.60
|
Rate for Payer: Group Health Inc Commercial |
$156.00
|
Rate for Payer: Group Health Inc Medicare |
$109.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$156.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.80
|
|
STRY ASNISIII SCREW 4.0X46MM
|
Facility
|
IP
|
$312.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008257
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$156.00 |
Max. Negotiated Rate |
$156.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$156.00
|
|
STRY ASNIS SCR 4.0 X 40MM
|
Facility
|
OP
|
$312.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203450
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$109.20 |
Max. Negotiated Rate |
$327.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$187.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$156.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$179.40
|
Rate for Payer: EmblemHealth Commercial |
$156.00
|
Rate for Payer: Fidelis Medicare Advantage |
$327.60
|
Rate for Payer: Group Health Inc Commercial |
$156.00
|
Rate for Payer: Group Health Inc Medicare |
$109.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$156.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.80
|
|
STRY ASNIS SCR 4.0 X 40MM
|
Facility
|
IP
|
$312.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203450
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$156.00 |
Max. Negotiated Rate |
$156.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$156.00
|
|
STRY ASNIS SCREW 4.0 X 40MM
|
Facility
|
IP
|
$312.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204732
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$156.00 |
Max. Negotiated Rate |
$156.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$156.00
|
|
STRY ASNIS SCREW 4.0 X 40MM
|
Facility
|
OP
|
$312.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204732
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$109.20 |
Max. Negotiated Rate |
$327.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$187.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$156.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$179.40
|
Rate for Payer: EmblemHealth Commercial |
$156.00
|
Rate for Payer: Fidelis Medicare Advantage |
$327.60
|
Rate for Payer: Group Health Inc Commercial |
$156.00
|
Rate for Payer: Group Health Inc Medicare |
$109.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$156.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.80
|
|
STRY AXSOS 8 HL RT TIBL PLT
|
Facility
|
IP
|
$5,248.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204234
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,624.00 |
Max. Negotiated Rate |
$2,624.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.00
|
|
STRY AXSOS 8 HL RT TIBL PLT
|
Facility
|
OP
|
$5,248.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204234
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$5,510.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,886.40
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$3,148.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,624.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,017.60
|
Rate for Payer: EmblemHealth Commercial |
$2,624.00
|
Rate for Payer: Fidelis Medicare Advantage |
$5,510.40
|
Rate for Payer: Group Health Inc Commercial |
$2,624.00
|
Rate for Payer: Group Health Inc Medicare |
$1,836.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,411.20
|
|
STRY AXSOS LCK SCR 4.0 X 30MM
|
Facility
|
OP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204235
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$527.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$301.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$251.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.65
|
Rate for Payer: EmblemHealth Commercial |
$251.00
|
Rate for Payer: Fidelis Medicare Advantage |
$527.10
|
Rate for Payer: Group Health Inc Commercial |
$251.00
|
Rate for Payer: Group Health Inc Medicare |
$175.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.30
|
|
STRY AXSOS LCK SCR 4.0 X 30MM
|
Facility
|
IP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204235
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$251.00 |
Max. Negotiated Rate |
$251.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
|
STRY AXSOS LCK SCR 4.0 X 75MM
|
Facility
|
IP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204236
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$251.00 |
Max. Negotiated Rate |
$251.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
|
STRY AXSOS LCK SCR 4.0 X 75MM
|
Facility
|
OP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204236
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$527.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$301.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$251.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.65
|
Rate for Payer: EmblemHealth Commercial |
$251.00
|
Rate for Payer: Fidelis Medicare Advantage |
$527.10
|
Rate for Payer: Group Health Inc Commercial |
$251.00
|
Rate for Payer: Group Health Inc Medicare |
$175.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.30
|
|
STRY AXSOS LCK SCR 4.0 X 80MM
|
Facility
|
IP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204237
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$251.00 |
Max. Negotiated Rate |
$251.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
|
STRY AXSOS LCK SCR 4.0 X 80MM
|
Facility
|
OP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204237
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$527.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$301.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$251.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.65
|
Rate for Payer: EmblemHealth Commercial |
$251.00
|
Rate for Payer: Fidelis Medicare Advantage |
$527.10
|
Rate for Payer: Group Health Inc Commercial |
$251.00
|
Rate for Payer: Group Health Inc Medicare |
$175.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.30
|
|
STRY AXSOS LCK SCR 4.0 X 85MM
|
Facility
|
OP
|
$502.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204238
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$527.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$301.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$251.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.65
|
Rate for Payer: EmblemHealth Commercial |
$251.00
|
Rate for Payer: Fidelis Medicare Advantage |
$527.10
|
Rate for Payer: Group Health Inc Commercial |
$251.00
|
Rate for Payer: Group Health Inc Medicare |
$175.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$251.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.30
|
|