|
STRYKER 2.7X14MM LOCKING SCREW
|
Facility
IP
|
$203.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$101.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.50
|
|
|
STRYKER 2.7X16MM BONE SCREW
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205607
|
|
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 2.7X16MM BONE SCREW
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205607
|
|
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 HOLE DOGBONE PLATE W/O
|
Facility
OP
|
$268.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.84
|
| 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 |
$134.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$154.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.24
|
| Rate for Payer: Group Health Inc Commercial |
$134.40
|
| Rate for Payer: Group Health Inc Medicare |
$94.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.72
|
|
|
STRYKER 2 HOLE DOGBONE PLATE W/O
|
Facility
IP
|
$268.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.40
|
|
|
STRYKER 30 DEGREE ANGLED POST
|
Facility
OP
|
$257.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.22 |
| Max. Negotiated Rate |
$270.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$141.77
|
| 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 |
$128.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$148.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.65
|
| Rate for Payer: Group Health Inc Commercial |
$128.88
|
| Rate for Payer: Group Health Inc Medicare |
$90.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.54
|
|
|
STRYKER 30 DEGREE ANGLED POST
|
Facility
IP
|
$257.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.88 |
| Max. Negotiated Rate |
$128.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.88
|
|
|
STRYKER 30 DGREE ANGLED POST
|
Facility
IP
|
$242.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$121.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.10
|
|
|
STRYKER 30 DGREE ANGLED POST
|
Facility
OP
|
$242.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$254.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.21
|
| 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 |
$121.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$139.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$254.31
|
| Rate for Payer: Group Health Inc Commercial |
$121.10
|
| Rate for Payer: Group Health Inc Medicare |
$84.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.43
|
|
|
STRYKER 32MM FEM HEAD
|
Facility
OP
|
$3,596.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40029620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,775.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,977.80
|
| 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 |
$1,798.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,067.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,775.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,798.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,258.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,798.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,798.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,337.40
|
|
|
STRYKER 32MM FEM HEAD
|
Facility
IP
|
$3,596.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40029620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,798.00 |
| Max. Negotiated Rate |
$1,798.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,798.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,798.00
|
|
|
STRYKER 3.2MMX22MM TWIN FIX SCRW
|
Facility
OP
|
$606.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$636.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$333.41
|
| 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 |
$303.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$348.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$636.51
|
| Rate for Payer: Group Health Inc Commercial |
$303.10
|
| Rate for Payer: Group Health Inc Medicare |
$212.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$394.03
|
|
|
STRYKER 3.2MMX22MM TWIN FIX SCRW
|
Facility
IP
|
$606.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$303.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.10
|
|
|
STRYKER 3.5MM SZ 1 RECTGLR PLATE
|
Facility
IP
|
$1,056.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.00 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$528.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$528.00
|
|
|
STRYKER 3.5MM SZ 1 RECTGLR PLATE
|
Facility
OP
|
$1,056.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,108.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$580.80
|
| 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 |
$528.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$607.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,108.80
|
| Rate for Payer: Group Health Inc Commercial |
$528.00
|
| Rate for Payer: Group Health Inc Medicare |
$369.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$528.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$528.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$686.40
|
|
|
STRYKER 3.5 NL X75
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40201059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
|
|
STRYKER 3.5 NL X75
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40201059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| 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 |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.60
|
| Rate for Payer: Group Health Inc Commercial |
$16.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.80
|
|
|
STRYKER 3.5X12MM LOCKING SCREW
|
Facility
OP
|
$501.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$526.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.82
|
| 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 |
$250.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$526.58
|
| Rate for Payer: Group Health Inc Commercial |
$250.75
|
| Rate for Payer: Group Health Inc Medicare |
$175.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$325.98
|
|
|
STRYKER 3.5X12MM LOCKING SCREW
|
Facility
IP
|
$501.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.75 |
| Max. Negotiated Rate |
$250.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.75
|
|
|
STRYKER 3.5X14 NON BIASED SCREW
|
Facility
IP
|
$3,004.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.32 |
| Max. Negotiated Rate |
$1,502.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,502.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,502.32
|
|
|
STRYKER 3.5X14 NON BIASED SCREW
|
Facility
OP
|
$3,004.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,154.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,652.55
|
| 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 |
$1,502.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,727.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,154.87
|
| Rate for Payer: Group Health Inc Commercial |
$1,502.32
|
| Rate for Payer: Group Health Inc Medicare |
$1,051.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,502.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,502.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,953.02
|
|
|
STRYKER 3.5X16 NON BIASED SCREW
|
Facility
OP
|
$3,004.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,154.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,652.55
|
| 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 |
$1,502.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,727.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,154.87
|
| Rate for Payer: Group Health Inc Commercial |
$1,502.32
|
| Rate for Payer: Group Health Inc Medicare |
$1,051.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,502.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,502.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,953.02
|
|
|
STRYKER 3.5X16 NON BIASED SCREW
|
Facility
IP
|
$3,004.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.32 |
| Max. Negotiated Rate |
$1,502.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,502.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,502.32
|
|
|
STRYKER 3.5X24 MEDIAL BIAS SCREW
|
Facility
OP
|
$3,004.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,154.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,652.55
|
| 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 |
$1,502.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,727.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,154.87
|
| Rate for Payer: Group Health Inc Commercial |
$1,502.32
|
| Rate for Payer: Group Health Inc Medicare |
$1,051.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,502.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,502.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,953.02
|
|
|
STRYKER 3.5X24 MEDIAL BIAS SCREW
|
Facility
IP
|
$3,004.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.32 |
| Max. Negotiated Rate |
$1,502.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,502.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,502.32
|
|
