STRY SCREW NON-LCK 2.7X34MM
|
Facility
|
IP
|
$320.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008285
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$160.00 |
Max. Negotiated Rate |
$160.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
|
STRY SCREW NON-LCK 3.5X40MM
|
Facility
|
IP
|
$320.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008260
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$160.00 |
Max. Negotiated Rate |
$160.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
|
STRY SCREW NON-LCK 3.5X40MM
|
Facility
|
OP
|
$320.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008260
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$112.00 |
Max. Negotiated Rate |
$336.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$192.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.00
|
Rate for Payer: EmblemHealth Commercial |
$160.00
|
Rate for Payer: Fidelis Medicare Advantage |
$336.00
|
Rate for Payer: Group Health Inc Commercial |
$160.00
|
Rate for Payer: Group Health Inc Medicare |
$112.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.00
|
|
STRY SCR LCK 2.7 X 20MM
|
Facility
|
OP
|
$450.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204247
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$270.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.75
|
Rate for Payer: EmblemHealth Commercial |
$225.00
|
Rate for Payer: Fidelis Medicare Advantage |
$472.50
|
Rate for Payer: Group Health Inc Commercial |
$225.00
|
Rate for Payer: Group Health Inc Medicare |
$157.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
STRY SCR LCK 2.7 X 20MM
|
Facility
|
IP
|
$450.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204247
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.00 |
Max. Negotiated Rate |
$225.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
|
STRY SCR LCK 2.7 X 22MM
|
Facility
|
IP
|
$450.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204248
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.00 |
Max. Negotiated Rate |
$225.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
|
STRY SCR LCK 2.7 X 22MM
|
Facility
|
OP
|
$450.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204248
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$270.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.75
|
Rate for Payer: EmblemHealth Commercial |
$225.00
|
Rate for Payer: Fidelis Medicare Advantage |
$472.50
|
Rate for Payer: Group Health Inc Commercial |
$225.00
|
Rate for Payer: Group Health Inc Medicare |
$157.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
STRY SCR LCK 2.7 X 24MM
|
Facility
|
OP
|
$450.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204249
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$270.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.75
|
Rate for Payer: EmblemHealth Commercial |
$225.00
|
Rate for Payer: Fidelis Medicare Advantage |
$472.50
|
Rate for Payer: Group Health Inc Commercial |
$225.00
|
Rate for Payer: Group Health Inc Medicare |
$157.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
STRY SCR LCK 2.7 X 24MM
|
Facility
|
IP
|
$450.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204249
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.00 |
Max. Negotiated Rate |
$225.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
|
STRY SCR LCK 2.7 X 44MM
|
Facility
|
IP
|
$450.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204246
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$225.00 |
Max. Negotiated Rate |
$225.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
|
STRY SCR LCK 2.7 X 44MM
|
Facility
|
OP
|
$450.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204246
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$472.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$270.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.75
|
Rate for Payer: EmblemHealth Commercial |
$225.00
|
Rate for Payer: Fidelis Medicare Advantage |
$472.50
|
Rate for Payer: Group Health Inc Commercial |
$225.00
|
Rate for Payer: Group Health Inc Medicare |
$157.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
STRY SCR LG 6.5X70MM
|
Facility
|
IP
|
$4,665.58
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008317
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,332.79 |
Max. Negotiated Rate |
$2,332.79 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,332.79
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,332.79
|
|
STRY SCR LG 6.5X70MM
|
Facility
|
OP
|
$4,665.58
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008317
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,898.86 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,566.07
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$2,799.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,332.79
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,682.71
|
Rate for Payer: EmblemHealth Commercial |
$2,332.79
|
Rate for Payer: Fidelis Medicare Advantage |
$4,898.86
|
Rate for Payer: Group Health Inc Commercial |
$2,332.79
|
Rate for Payer: Group Health Inc Medicare |
$1,632.95
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,332.79
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,332.79
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,032.63
|
|
STRY SCR UN III AXS SCREW 1.5X5MM
|
Facility
|
OP
|
$164.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203408
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$57.40 |
Max. Negotiated Rate |
$172.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$98.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$94.30
|
Rate for Payer: EmblemHealth Commercial |
$82.00
|
Rate for Payer: Fidelis Medicare Advantage |
$172.20
|
Rate for Payer: Group Health Inc Commercial |
$82.00
|
Rate for Payer: Group Health Inc Medicare |
$57.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$82.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.60
|
|
STRY SCR UN III AXS SCREW 1.5X5MM
|
Facility
|
IP
|
$164.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203408
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$82.00 |
Max. Negotiated Rate |
$82.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$82.00
|
|
STRY SCRW ASNIS MICR 3.0X16MM CAN
|
Facility
|
IP
|
$399.84
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204263
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$199.92 |
Max. Negotiated Rate |
$199.92 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.92
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$199.92
|
|
STRY SCRW ASNIS MICR 3.0X16MM CAN
|
Facility
|
OP
|
$399.84
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204263
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$419.83 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.91
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$239.90
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$199.92
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$229.91
|
Rate for Payer: EmblemHealth Commercial |
$199.92
|
Rate for Payer: Fidelis Medicare Advantage |
$419.83
|
Rate for Payer: Group Health Inc Commercial |
$199.92
|
Rate for Payer: Group Health Inc Medicare |
$139.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.92
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$199.92
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.90
|
|
STRY SCRW BONE 3.5 X 14MM
|
Facility
|
OP
|
$104.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208007
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$36.40 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Brighton Health Commercial |
$62.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.80
|
Rate for Payer: EmblemHealth Commercial |
$52.00
|
Rate for Payer: Fidelis Medicare Advantage |
$109.20
|
Rate for Payer: Group Health Inc Commercial |
$52.00
|
Rate for Payer: Group Health Inc Medicare |
$36.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$52.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.60
|
|
STRY SCRW BONE 3.5 X 14MM
|
Facility
|
IP
|
$104.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208007
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$52.00 |
Max. Negotiated Rate |
$52.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$52.00
|
|
STRY SCRW BONE 3.5 X16MM
|
Facility
|
OP
|
$104.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208008
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$36.40 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Brighton Health Commercial |
$62.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.80
|
Rate for Payer: EmblemHealth Commercial |
$52.00
|
Rate for Payer: Fidelis Medicare Advantage |
$109.20
|
Rate for Payer: Group Health Inc Commercial |
$52.00
|
Rate for Payer: Group Health Inc Medicare |
$36.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$52.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.60
|
|
STRY SCRW BONE 3.5 X16MM
|
Facility
|
IP
|
$104.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208008
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$52.00 |
Max. Negotiated Rate |
$52.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$52.00
|
|
STRY SELF-DRILL HALF PIN 5X50 MM
|
Facility
|
OP
|
$370.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204221
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$129.50 |
Max. Negotiated Rate |
$388.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$203.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$222.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$185.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$212.75
|
Rate for Payer: EmblemHealth Commercial |
$185.00
|
Rate for Payer: Fidelis Medicare Advantage |
$388.50
|
Rate for Payer: Group Health Inc Commercial |
$185.00
|
Rate for Payer: Group Health Inc Medicare |
$129.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$185.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$240.50
|
|
STRY SELF-DRILL HALF PIN 5X50 MM
|
Facility
|
IP
|
$370.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204221
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$185.00 |
Max. Negotiated Rate |
$185.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$185.00
|
|
STRY SER POLYAX 6.5X30MM
|
Facility
|
OP
|
$4,665.58
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008316
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,898.86 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,566.07
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$2,799.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,332.79
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,682.71
|
Rate for Payer: EmblemHealth Commercial |
$2,332.79
|
Rate for Payer: Fidelis Medicare Advantage |
$4,898.86
|
Rate for Payer: Group Health Inc Commercial |
$2,332.79
|
Rate for Payer: Group Health Inc Medicare |
$1,632.95
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,332.79
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,332.79
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,032.63
|
|
STRY SER POLYAX 6.5X30MM
|
Facility
|
IP
|
$4,665.58
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008316
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,332.79 |
Max. Negotiated Rate |
$2,332.79 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,332.79
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,332.79
|
|