STEM PRESSFIT 16MM X 120MM
|
Facility
IP
|
$3,840.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903975
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,920.00 |
Max. Negotiated Rate |
$1,920.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,920.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,920.00
|
|
STEM PSN REV
|
Facility
IP
|
$8,450.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64907168
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,225.00 |
Max. Negotiated Rate |
$4,225.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,225.00
|
|
STEM PSN REV
|
Facility
OP
|
$8,450.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64907168
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$8,872.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,647.50
|
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 |
$4,225.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,858.75
|
Rate for Payer: Fidelis Medicare Advantage |
$8,872.50
|
Rate for Payer: Group Health Inc Commercial |
$4,225.00
|
Rate for Payer: Group Health Inc Medicare |
$2,957.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,225.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,225.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,492.50
|
|
STEM RADIAL SZ 2
|
Facility
OP
|
$7,570.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905300
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$7,948.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,163.50
|
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 |
$3,785.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,352.75
|
Rate for Payer: Fidelis Medicare Advantage |
$7,948.50
|
Rate for Payer: Group Health Inc Commercial |
$3,785.00
|
Rate for Payer: Group Health Inc Medicare |
$2,649.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,785.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,785.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,920.50
|
|
STEM RADIAL SZ 2
|
Facility
IP
|
$7,570.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905300
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,785.00 |
Max. Negotiated Rate |
$3,785.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,785.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,785.00
|
|
STEM RADIAL SZ 3
|
Facility
IP
|
$4,602.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905298
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,301.25 |
Max. Negotiated Rate |
$2,301.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,301.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,301.25
|
|
STEM RADIAL SZ 3
|
Facility
OP
|
$4,602.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905298
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,832.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,531.38
|
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 |
$2,301.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,646.44
|
Rate for Payer: Fidelis Medicare Advantage |
$4,832.62
|
Rate for Payer: Group Health Inc Commercial |
$2,301.25
|
Rate for Payer: Group Health Inc Medicare |
$1,610.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,301.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,301.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,991.62
|
|
STEM REV ECHELON 12X190
|
Facility
OP
|
$15,682.13
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64903546
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$16,466.24 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,625.17
|
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 |
$7,841.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,017.22
|
Rate for Payer: Fidelis Medicare Advantage |
$16,466.24
|
Rate for Payer: Group Health Inc Commercial |
$7,841.06
|
Rate for Payer: Group Health Inc Medicare |
$5,488.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,841.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7,841.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10,193.38
|
|
STEM REV ECHELON 12X190
|
Facility
IP
|
$15,682.13
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64903546
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$7,841.06 |
Max. Negotiated Rate |
$7,841.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,841.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7,841.06
|
|
STEM REV EXT FLTD 9MM 130MM
|
Facility
IP
|
$5,824.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906413
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,912.00 |
Max. Negotiated Rate |
$2,912.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,912.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,912.00
|
|
STEM REV EXT FLTD 9MM 130MM
|
Facility
OP
|
$5,824.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906413
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$6,115.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,203.20
|
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 |
$2,912.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,348.80
|
Rate for Payer: Fidelis Medicare Advantage |
$6,115.20
|
Rate for Payer: Group Health Inc Commercial |
$2,912.00
|
Rate for Payer: Group Health Inc Medicare |
$2,038.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,912.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,912.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,785.60
|
|
STEM SECR-FX MAX NECK ANG HIP
|
Facility
OP
|
$16,301.25
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64901784
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$17,116.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,965.69
|
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 |
$8,150.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,373.22
|
Rate for Payer: Fidelis Medicare Advantage |
$17,116.31
|
Rate for Payer: Group Health Inc Commercial |
$8,150.62
|
Rate for Payer: Group Health Inc Medicare |
$5,705.44
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,150.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$8,150.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10,595.81
|
|
STEM SECR-FX MAX NECK ANG HIP
|
Facility
IP
|
$16,301.25
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64901784
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,150.62 |
Max. Negotiated Rate |
$8,150.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,150.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$8,150.62
|
|
STEM SHOULDER PRIMARY 7 X 122MM
|
Facility
IP
|
$8,500.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906972
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,250.00 |
Max. Negotiated Rate |
$4,250.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,250.00
|
|
STEM SHOULDER PRIMARY 7 X 122MM
|
Facility
OP
|
$8,500.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906972
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$8,925.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,675.00
|
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 |
$4,250.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,887.50
|
Rate for Payer: Fidelis Medicare Advantage |
$8,925.00
|
Rate for Payer: Group Health Inc Commercial |
$4,250.00
|
Rate for Payer: Group Health Inc Medicare |
$2,975.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,250.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,525.00
|
|
STEM SIZE 5 ACCOLA II 132 DEG
|
Facility
OP
|
$17,115.75
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64905740
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$17,971.54 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,413.66
|
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 |
$8,557.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,841.56
|
Rate for Payer: Fidelis Medicare Advantage |
$17,971.54
|
Rate for Payer: Group Health Inc Commercial |
$8,557.88
|
Rate for Payer: Group Health Inc Medicare |
$5,990.51
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,557.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$8,557.88
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11,125.24
|
|
STEM SIZE 5 ACCOLA II 132 DEG
|
Facility
IP
|
$17,115.75
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64905740
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,557.88 |
Max. Negotiated Rate |
$8,557.88 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,557.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$8,557.88
|
|
STEM STD 12 ECH
|
Facility
OP
|
$9,999.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903640
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$10,499.21 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,499.59
|
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 |
$4,999.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,749.57
|
Rate for Payer: Fidelis Medicare Advantage |
$10,499.21
|
Rate for Payer: Group Health Inc Commercial |
$4,999.62
|
Rate for Payer: Group Health Inc Medicare |
$3,499.74
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,999.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,999.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,499.51
|
|
STEM STD 12 ECH
|
Facility
IP
|
$9,999.25
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903640
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,999.62 |
Max. Negotiated Rate |
$4,999.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,999.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,999.62
|
|
STEM_STD AVENIR NULR 12/14-010601
|
Facility
IP
|
$4,668.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906408
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,334.00 |
Max. Negotiated Rate |
$2,334.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,334.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,334.00
|
|
STEM_STD AVENIR NULR 12/14-010601
|
Facility
OP
|
$4,668.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906408
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$4,901.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,567.40
|
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 |
$2,334.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,684.10
|
Rate for Payer: Fidelis Medicare Advantage |
$4,901.40
|
Rate for Payer: Group Health Inc Commercial |
$2,334.00
|
Rate for Payer: Group Health Inc Medicare |
$1,633.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,334.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,334.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,034.20
|
|
STEM STRGT 15DIA 145MM 100
|
Facility
IP
|
$4,460.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905888
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,230.00 |
Max. Negotiated Rate |
$2,230.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,230.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,230.00
|
|
STEM STRGT 15DIA 145MM 100
|
Facility
OP
|
$4,460.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905888
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,683.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,453.00
|
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 |
$2,230.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,564.50
|
Rate for Payer: Fidelis Medicare Advantage |
$4,683.00
|
Rate for Payer: Group Health Inc Commercial |
$2,230.00
|
Rate for Payer: Group Health Inc Medicare |
$1,561.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,230.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,230.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,899.00
|
|
STEM STS ARCOS W-SCW DIST
|
Facility
OP
|
$9,952.00
|
|
Hospital Charge Code |
64906707
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$3,483.20 |
Max. Negotiated Rate |
$7,961.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,473.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,976.00
|
Rate for Payer: Aetna Government |
$4,976.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7,961.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,767.36
|
Rate for Payer: Group Health Inc Commercial |
$4,976.00
|
Rate for Payer: Group Health Inc Medicare |
$3,483.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,976.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,976.00
|
|
STEM STS DISTAL
|
Facility
OP
|
$12,440.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64907130
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$13,062.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,842.00
|
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 |
$6,220.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,153.00
|
Rate for Payer: Fidelis Medicare Advantage |
$13,062.00
|
Rate for Payer: Group Health Inc Commercial |
$6,220.00
|
Rate for Payer: Group Health Inc Medicare |
$4,354.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,220.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6,220.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,086.00
|
|