STRYKER 10.5 X 115MM LAG SCREW
|
Facility
OP
|
$682.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205342
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$716.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$375.10
|
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 |
$341.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$392.15
|
Rate for Payer: Fidelis Medicare Advantage |
$716.10
|
Rate for Payer: Group Health Inc Commercial |
$341.00
|
Rate for Payer: Group Health Inc Medicare |
$238.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$341.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$443.30
|
|
STRYKER 10.5 X 95MM LAG SCREW
|
Facility
OP
|
$963.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205399
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,011.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$529.76
|
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 |
$481.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$553.84
|
Rate for Payer: Fidelis Medicare Advantage |
$1,011.36
|
Rate for Payer: Group Health Inc Commercial |
$481.60
|
Rate for Payer: Group Health Inc Medicare |
$337.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$481.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$626.08
|
|
STRYKER 10.5 X 95MM LAG SCREW
|
Facility
IP
|
$963.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205399
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$481.60 |
Max. Negotiated Rate |
$481.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$481.60
|
|
STRYKER 10H CURVED PLT MIDFACE
|
Facility
OP
|
$1,750.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209949
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,837.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$962.50
|
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 |
$875.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,006.25
|
Rate for Payer: Fidelis Medicare Advantage |
$1,837.50
|
Rate for Payer: Group Health Inc Commercial |
$875.00
|
Rate for Payer: Group Health Inc Medicare |
$612.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$875.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,137.50
|
|
STRYKER 10H CURVED PLT MIDFACE
|
Facility
IP
|
$1,750.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209949
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$875.00 |
Max. Negotiated Rate |
$875.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$875.00
|
|
STRYKER 10 HOLE COMPRESSION PLT
|
Facility
IP
|
$928.90
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208515
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$464.45 |
Max. Negotiated Rate |
$464.45 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$464.45
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$464.45
|
|
STRYKER 10 HOLE COMPRESSION PLT
|
Facility
OP
|
$928.90
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208515
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$975.34 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$510.90
|
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 |
$464.45
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$534.12
|
Rate for Payer: Fidelis Medicare Advantage |
$975.34
|
Rate for Payer: Group Health Inc Commercial |
$464.45
|
Rate for Payer: Group Health Inc Medicare |
$325.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$464.45
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$464.45
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$603.78
|
|
STRYKER 10 H RGHT LATERAL TIB PLT
|
Facility
OP
|
$350.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40200710
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$122.50 |
Max. Negotiated Rate |
$367.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
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 |
$175.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.25
|
Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
Rate for Payer: Group Health Inc Commercial |
$175.00
|
Rate for Payer: Group Health Inc Medicare |
$122.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
STRYKER 10 H RGHT LATERAL TIB PLT
|
Facility
IP
|
$350.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40200710
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$175.00 |
Max. Negotiated Rate |
$175.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
|
STRYKER 10MM REMER
|
Facility
OP
|
$773.00
|
|
Hospital Charge Code |
40208012
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$270.55 |
Max. Negotiated Rate |
$618.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$425.15
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$386.50
|
Rate for Payer: Aetna Government |
$386.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$618.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$525.64
|
Rate for Payer: Group Health Inc Commercial |
$386.50
|
Rate for Payer: Group Health Inc Medicare |
$270.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$386.50
|
|
STRYKER 10X170X125MM TROCH N/KIT
|
Facility
IP
|
$3,395.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206262
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,697.50 |
Max. Negotiated Rate |
$1,697.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,697.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,697.50
|
|
STRYKER 10X170X125MM TROCH N/KIT
|
Facility
OP
|
$3,395.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206262
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,564.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,867.25
|
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 |
$1,697.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,952.12
|
Rate for Payer: Fidelis Medicare Advantage |
$3,564.75
|
Rate for Payer: Group Health Inc Commercial |
$1,697.50
|
Rate for Payer: Group Health Inc Medicare |
$1,188.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,697.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,697.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,206.75
|
|
STRYKER 10X340MM LFT LG NAIL
|
Facility
IP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205628
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,116.10 |
Max. Negotiated Rate |
$2,116.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
|
STRYKER 10X340MM LFT LG NAIL
|
Facility
OP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205628
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,443.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,327.71
|
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 |
$2,116.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,433.52
|
Rate for Payer: Fidelis Medicare Advantage |
$4,443.81
|
Rate for Payer: Group Health Inc Commercial |
$2,116.10
|
Rate for Payer: Group Health Inc Medicare |
$1,481.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,750.93
|
|
STRYKER 10X340 RIGHT LONG NAIL
|
Facility
IP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205724
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,116.10 |
Max. Negotiated Rate |
$2,116.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
|
STRYKER 10X340 RIGHT LONG NAIL
|
Facility
OP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205724
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,443.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,327.71
|
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 |
$2,116.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,433.52
|
Rate for Payer: Fidelis Medicare Advantage |
$4,443.81
|
Rate for Payer: Group Health Inc Commercial |
$2,116.10
|
Rate for Payer: Group Health Inc Medicare |
$1,481.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,750.93
|
|
STRYKER 10X360X125 LNG NAIL RGHT
|
Facility
OP
|
$4,232.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205781
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,443.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,327.60
|
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 |
$2,116.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,433.40
|
Rate for Payer: Fidelis Medicare Advantage |
$4,443.60
|
Rate for Payer: Group Health Inc Commercial |
$2,116.00
|
Rate for Payer: Group Health Inc Medicare |
$1,481.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,750.80
|
|
STRYKER 10X360X125 LNG NAIL RGHT
|
Facility
IP
|
$4,232.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205781
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,116.00 |
Max. Negotiated Rate |
$2,116.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.00
|
|
STRYKER 10X375MM T2 TN ST
|
Facility
OP
|
$2,529.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208175
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,656.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,391.39
|
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 |
$1,264.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,454.64
|
Rate for Payer: Fidelis Medicare Advantage |
$2,656.29
|
Rate for Payer: Group Health Inc Commercial |
$1,264.90
|
Rate for Payer: Group Health Inc Medicare |
$885.43
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,264.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,264.90
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,644.37
|
|
STRYKER 10X375MM T2 TN ST
|
Facility
IP
|
$2,529.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208175
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,264.90 |
Max. Negotiated Rate |
$1,264.90 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,264.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,264.90
|
|
STRYKER 10X380X125 R LONG NAIL
|
Facility
IP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205668
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,116.10 |
Max. Negotiated Rate |
$2,116.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
|
STRYKER 10X380X125 R LONG NAIL
|
Facility
OP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205668
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,443.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,327.71
|
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 |
$2,116.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,433.52
|
Rate for Payer: Fidelis Medicare Advantage |
$4,443.81
|
Rate for Payer: Group Health Inc Commercial |
$2,116.10
|
Rate for Payer: Group Health Inc Medicare |
$1,481.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,750.93
|
|
STRYKER 10X400 LEFT LONG NAIL
|
Facility
OP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205727
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,443.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,327.71
|
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 |
$2,116.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,433.52
|
Rate for Payer: Fidelis Medicare Advantage |
$4,443.81
|
Rate for Payer: Group Health Inc Commercial |
$2,116.10
|
Rate for Payer: Group Health Inc Medicare |
$1,481.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,750.93
|
|
STRYKER 10X400 LEFT LONG NAIL
|
Facility
IP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205727
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,116.10 |
Max. Negotiated Rate |
$2,116.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
|
STRYKER 10X400MMX130DEG LONG NAIL
|
Facility
IP
|
$4,529.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205790
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,264.50 |
Max. Negotiated Rate |
$2,264.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,264.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,264.50
|
|