STRY EASYCLP CMPR STPL 15X15X15MM
|
Facility
OP
|
$4,620.00
|
|
Hospital Charge Code |
40008268
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$1,617.00 |
Max. Negotiated Rate |
$3,696.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,541.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,310.00
|
Rate for Payer: Aetna Government |
$2,310.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,696.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,141.60
|
Rate for Payer: Group Health Inc Commercial |
$2,310.00
|
Rate for Payer: Group Health Inc Medicare |
$1,617.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,310.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,310.00
|
|
STRY FEM DIS FIX PEG
|
Facility
OP
|
$1,226.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206081
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,287.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$674.30
|
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 |
$613.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$704.95
|
Rate for Payer: Fidelis Medicare Advantage |
$1,287.30
|
Rate for Payer: Group Health Inc Commercial |
$613.00
|
Rate for Payer: Group Health Inc Medicare |
$429.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$613.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$613.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$796.90
|
|
STRY FEM DIS FIX PEG
|
Facility
IP
|
$1,226.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206081
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$613.00 |
Max. Negotiated Rate |
$613.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$613.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$613.00
|
|
STRY FRACTURE PLT, 4 HOLES W/BAR
|
Facility
IP
|
$591.36
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203425
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$295.68 |
Max. Negotiated Rate |
$295.68 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$295.68
|
|
STRY FRACTURE PLT, 4 HOLES W/BAR
|
Facility
OP
|
$591.36
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203425
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$620.93 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$325.25
|
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 |
$295.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.03
|
Rate for Payer: Fidelis Medicare Advantage |
$620.93
|
Rate for Payer: Group Health Inc Commercial |
$295.68
|
Rate for Payer: Group Health Inc Medicare |
$206.98
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$295.68
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$384.38
|
|
STRY GUIDEWIRE W/CALIBRA 3.2X300
|
Facility
OP
|
$100.45
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40203696
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$105.47 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.76
|
Rate for Payer: Fidelis Medicare Advantage |
$105.47
|
Rate for Payer: Group Health Inc Commercial |
$50.22
|
Rate for Payer: Group Health Inc Medicare |
$35.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.22
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.22
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.29
|
|
STRY GUIDEWIRE W/CALIBRA 3.2X300
|
Facility
IP
|
$100.45
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40203696
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$50.22 |
Max. Negotiated Rate |
$50.22 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.22
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.22
|
|
STRY HERL SCR NON-LCK 2.7X18MM
|
Facility
IP
|
$500.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204244
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$250.00 |
Max. Negotiated Rate |
$250.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
STRY HERL SCR NON-LCK 2.7X18MM
|
Facility
OP
|
$500.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204244
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$525.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
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 |
$250.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$287.50
|
Rate for Payer: Fidelis Medicare Advantage |
$525.00
|
Rate for Payer: Group Health Inc Commercial |
$250.00
|
Rate for Payer: Group Health Inc Medicare |
$175.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$325.00
|
|
STRY HOLE BLRANON PLA PLA
|
Facility
IP
|
$2,140.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40009286
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,070.00 |
Max. Negotiated Rate |
$1,070.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,070.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,070.00
|
|
STRY HOLE BLRANON PLA PLA
|
Facility
OP
|
$2,140.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40009286
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,247.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,177.00
|
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 |
$1,070.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,230.50
|
Rate for Payer: Fidelis Medicare Advantage |
$2,247.00
|
Rate for Payer: Group Health Inc Commercial |
$1,070.00
|
Rate for Payer: Group Health Inc Medicare |
$749.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,070.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,070.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,391.00
|
|
STRY HYDROSET BLJECTABLE CE
|
Facility
OP
|
$5,212.00
|
|
Hospital Charge Code |
40009734
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,824.20 |
Max. Negotiated Rate |
$4,169.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,866.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,606.00
|
Rate for Payer: Aetna Government |
$2,606.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,169.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,544.16
|
Rate for Payer: Group Health Inc Commercial |
$2,606.00
|
Rate for Payer: Group Health Inc Medicare |
$1,824.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,606.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,606.00
|
|
STRY INTERM SHORT PLT RT
|
Facility
IP
|
$2,888.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203437
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,444.00 |
Max. Negotiated Rate |
$1,444.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,444.00
|
|
STRY INTERM SHORT PLT RT
|
Facility
OP
|
$2,888.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203437
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,032.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,588.40
|
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 |
$1,444.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,660.60
|
Rate for Payer: Fidelis Medicare Advantage |
$3,032.40
|
Rate for Payer: Group Health Inc Commercial |
$1,444.00
|
Rate for Payer: Group Health Inc Medicare |
$1,010.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,444.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,877.20
|
|
STRY INTERM STAND PLT LT
|
Facility
OP
|
$2,781.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204208
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,920.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,529.55
|
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 |
$1,390.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,599.08
|
Rate for Payer: Fidelis Medicare Advantage |
$2,920.05
|
Rate for Payer: Group Health Inc Commercial |
$1,390.50
|
Rate for Payer: Group Health Inc Medicare |
$973.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,390.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,390.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,807.65
|
|
STRY INTERM STAND PLT LT
|
Facility
IP
|
$2,781.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204208
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,390.50 |
Max. Negotiated Rate |
$1,390.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,390.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,390.50
|
|
STRYK 12 HOLE TIBIAL PLT
|
Facility
IP
|
$4,894.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008271
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,447.15 |
Max. Negotiated Rate |
$2,447.15 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,447.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,447.15
|
|
STRYK 12 HOLE TIBIAL PLT
|
Facility
OP
|
$4,894.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008271
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$5,139.02 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,691.86
|
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 |
$2,447.15
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,814.22
|
Rate for Payer: Fidelis Medicare Advantage |
$5,139.02
|
Rate for Payer: Group Health Inc Commercial |
$2,447.15
|
Rate for Payer: Group Health Inc Medicare |
$1,713.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,447.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,447.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,181.30
|
|
STRYK ANK SOL TRY 4.0X40 CANN SCR
|
Facility
OP
|
$312.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204472
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$156.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$179.40
|
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
|
|
STRYK ANK SOL TRY 4.0X40 CANN SCR
|
Facility
IP
|
$312.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204472
|
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
|
|
STRYK AXOS III 3.5X38MM LOCK SCRW
|
Facility
IP
|
$64.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204704
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$32.00 |
Max. Negotiated Rate |
$32.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$32.00
|
|
STRYK AXOS III 3.5X38MM LOCK SCRW
|
Facility
OP
|
$64.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204704
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$22.40 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.20
|
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 |
$32.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.80
|
Rate for Payer: Fidelis Medicare Advantage |
$67.20
|
Rate for Payer: Group Health Inc Commercial |
$32.00
|
Rate for Payer: Group Health Inc Medicare |
$22.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$32.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.60
|
|
STRYKE APEX PIN 6X150
|
Facility
OP
|
$267.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202745
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$93.59 |
Max. Negotiated Rate |
$280.77 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.07
|
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 |
$133.70
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$153.76
|
Rate for Payer: Fidelis Medicare Advantage |
$280.77
|
Rate for Payer: Group Health Inc Commercial |
$133.70
|
Rate for Payer: Group Health Inc Medicare |
$93.59
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$133.70
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.81
|
|
STRYKE APEX PIN 6X150
|
Facility
IP
|
$267.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202745
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$133.70 |
Max. Negotiated Rate |
$133.70 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$133.70
|
|
STRYKER 10.5 X 115MM LAG SCREW
|
Facility
IP
|
$682.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205342
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$341.00 |
Max. Negotiated Rate |
$341.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$341.00
|
|