STRYKER 18X0 DEG END CAPS
|
Facility
OP
|
$576.56
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205238
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$201.80 |
Max. Negotiated Rate |
$605.39 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$317.11
|
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 |
$288.28
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$331.52
|
Rate for Payer: Fidelis Medicare Advantage |
$605.39
|
Rate for Payer: Group Health Inc Commercial |
$288.28
|
Rate for Payer: Group Health Inc Medicare |
$201.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.28
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$288.28
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.76
|
|
STRYKER 18X0 DEG END CAPS
|
Facility
IP
|
$576.56
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205238
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$288.28 |
Max. Negotiated Rate |
$288.28 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.28
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$288.28
|
|
STRYKER 2.0 K-WIRE
|
Facility
OP
|
$164.00
|
|
Hospital Charge Code |
40005300
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$57.40 |
Max. Negotiated Rate |
$131.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$82.00
|
Rate for Payer: Aetna Government |
$82.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$131.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$111.52
|
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
|
|
STRYKER 2.0 OLIVE WIRES
|
Facility
IP
|
$90.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008261
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$45.00 |
Max. Negotiated Rate |
$45.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
|
STRYKER 2.0 OLIVE WIRES
|
Facility
OP
|
$90.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008261
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$31.50 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
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 |
$45.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.75
|
Rate for Payer: Fidelis Medicare Advantage |
$94.50
|
Rate for Payer: Group Health Inc Commercial |
$45.00
|
Rate for Payer: Group Health Inc Medicare |
$31.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.50
|
|
STRYKER 2.0X5MM BONE SCR CRSS PIN
|
Facility
OP
|
$85.68
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204671
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.99 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.12
|
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 |
$42.84
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.27
|
Rate for Payer: Fidelis Medicare Advantage |
$89.96
|
Rate for Payer: Group Health Inc Commercial |
$42.84
|
Rate for Payer: Group Health Inc Medicare |
$29.99
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.84
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.69
|
|
STRYKER 2.0X5MM BONE SCR CRSS PIN
|
Facility
IP
|
$85.68
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204671
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$42.84 |
Max. Negotiated Rate |
$42.84 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.84
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
|
STRYKER 2.0X8MM BONE SCR CRSS PIN
|
Facility
IP
|
$85.68
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204672
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$42.84 |
Max. Negotiated Rate |
$42.84 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.84
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
|
STRYKER 2.0X8MM BONE SCR CRSS PIN
|
Facility
OP
|
$85.68
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204672
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.99 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.12
|
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 |
$42.84
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.27
|
Rate for Payer: Fidelis Medicare Advantage |
$89.96
|
Rate for Payer: Group Health Inc Commercial |
$42.84
|
Rate for Payer: Group Health Inc Medicare |
$29.99
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.84
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.69
|
|
STRYKER 2.3X6MM BONE SCREW CROSS
|
Facility
OP
|
$104.94
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203411
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$36.73 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.72
|
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 |
$52.47
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.34
|
Rate for Payer: Fidelis Medicare Advantage |
$110.19
|
Rate for Payer: Group Health Inc Commercial |
$52.47
|
Rate for Payer: Group Health Inc Medicare |
$36.73
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.47
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$52.47
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.21
|
|
STRYKER 2.3X6MM BONE SCREW CROSS
|
Facility
IP
|
$104.94
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203411
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$52.47 |
Max. Negotiated Rate |
$52.47 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.47
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$52.47
|
|
STRYKER 2.5 DRILL BIT
|
Facility
OP
|
$816.00
|
|
Hospital Charge Code |
40005301
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$285.60 |
Max. Negotiated Rate |
$652.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$448.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$408.00
|
Rate for Payer: Aetna Government |
$408.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$652.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$554.88
|
Rate for Payer: Group Health Inc Commercial |
$408.00
|
Rate for Payer: Group Health Inc Medicare |
$285.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$408.00
|
|
STRYKER 26MM C TAPER FEM HEAD
|
Facility
IP
|
$1,801.60
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029616
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$900.80 |
Max. Negotiated Rate |
$900.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$900.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$900.80
|
|
STRYKER 26MM C TAPER FEM HEAD
|
Facility
OP
|
$1,801.60
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029616
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,891.68 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$990.88
|
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 |
$900.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,035.92
|
Rate for Payer: Fidelis Medicare Advantage |
$1,891.68
|
Rate for Payer: Group Health Inc Commercial |
$900.80
|
Rate for Payer: Group Health Inc Medicare |
$630.56
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$900.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$900.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,171.04
|
|
STRYKER 2.7 LOCKING SCREW
|
Facility
OP
|
$219.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205605
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$76.65 |
Max. Negotiated Rate |
$229.95 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$120.45
|
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 |
$109.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.92
|
Rate for Payer: Fidelis Medicare Advantage |
$229.95
|
Rate for Payer: Group Health Inc Commercial |
$109.50
|
Rate for Payer: Group Health Inc Medicare |
$76.65
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$109.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.35
|
|
STRYKER 2.7 LOCKING SCREW
|
Facility
IP
|
$219.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205605
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$109.50 |
Max. Negotiated Rate |
$109.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$109.50
|
|
STRYKER 2.7MM BONE SCREW
|
Facility
IP
|
$165.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205646
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$82.50 |
Max. Negotiated Rate |
$82.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
|
STRYKER 2.7MM BONE SCREW
|
Facility
OP
|
$165.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205646
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$57.75 |
Max. Negotiated Rate |
$173.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.75
|
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 |
$82.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$94.88
|
Rate for Payer: Fidelis Medicare Advantage |
$173.25
|
Rate for Payer: Group Health Inc Commercial |
$82.50
|
Rate for Payer: Group Health Inc Medicare |
$57.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.25
|
|
STRYKER 2.7MM DRILL
|
Facility
IP
|
$401.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205542
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$200.50 |
Max. Negotiated Rate |
$200.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$200.50
|
|
STRYKER 2.7MM DRILL
|
Facility
OP
|
$401.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205542
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$421.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.55
|
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 |
$200.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.58
|
Rate for Payer: Fidelis Medicare Advantage |
$421.05
|
Rate for Payer: Group Health Inc Commercial |
$200.50
|
Rate for Payer: Group Health Inc Medicare |
$140.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$200.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.65
|
|
STRYKER 2.7 NON LCKNG
|
Facility
IP
|
$175.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205952
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$87.50 |
Max. Negotiated Rate |
$87.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
|
STRYKER 2.7 NON LCKNG
|
Facility
OP
|
$175.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205952
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$61.25 |
Max. Negotiated Rate |
$183.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
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 |
$87.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.62
|
Rate for Payer: Fidelis Medicare Advantage |
$183.75
|
Rate for Payer: Group Health Inc Commercial |
$87.50
|
Rate for Payer: Group Health Inc Medicare |
$61.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.75
|
|
STRYKER 2.7 X 12 H XXL VOLAR PLT
|
Facility
IP
|
$2,688.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205563
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,344.00 |
Max. Negotiated Rate |
$1,344.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,344.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,344.00
|
|
STRYKER 2.7 X 12 H XXL VOLAR PLT
|
Facility
OP
|
$2,688.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205563
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,822.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,478.40
|
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 |
$1,344.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,545.60
|
Rate for Payer: Fidelis Medicare Advantage |
$2,822.40
|
Rate for Payer: Group Health Inc Commercial |
$1,344.00
|
Rate for Payer: Group Health Inc Medicare |
$940.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,344.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,344.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,747.20
|
|
STRYKER 2.7X14MM LOCKING SCREW
|
Facility
OP
|
$203.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205215
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$71.05 |
Max. Negotiated Rate |
$213.15 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$111.65
|
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 |
$101.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.72
|
Rate for Payer: Fidelis Medicare Advantage |
$213.15
|
Rate for Payer: Group Health Inc Commercial |
$101.50
|
Rate for Payer: Group Health Inc Medicare |
$71.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$101.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.95
|
|