STRYKER 4X120X3O S/D S/T
|
Facility
IP
|
$215.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205909
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$107.80 |
Max. Negotiated Rate |
$107.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$107.80
|
|
STRYKER 4X120X3O S/D S/T
|
Facility
OP
|
$215.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205909
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$75.46 |
Max. Negotiated Rate |
$226.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$118.58
|
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 |
$107.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$123.97
|
Rate for Payer: Fidelis Medicare Advantage |
$226.38
|
Rate for Payer: Group Health Inc Commercial |
$107.80
|
Rate for Payer: Group Health Inc Medicare |
$75.46
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$107.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.14
|
|
STRYKER 4X90X20MM S/D T
|
Facility
IP
|
$154.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205758
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$77.00 |
Max. Negotiated Rate |
$77.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
|
STRYKER 4X90X20MM S/D T
|
Facility
OP
|
$154.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205758
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$53.90 |
Max. Negotiated Rate |
$161.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.70
|
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 |
$77.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.55
|
Rate for Payer: Fidelis Medicare Advantage |
$161.70
|
Rate for Payer: Group Health Inc Commercial |
$77.00
|
Rate for Payer: Group Health Inc Medicare |
$53.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.10
|
|
STRYKER 4X LOCKING SCREW
|
Facility
OP
|
$266.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205746
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$93.10 |
Max. Negotiated Rate |
$279.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$146.30
|
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 |
$133.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$152.95
|
Rate for Payer: Fidelis Medicare Advantage |
$279.30
|
Rate for Payer: Group Health Inc Commercial |
$133.00
|
Rate for Payer: Group Health Inc Medicare |
$93.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$133.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.90
|
|
STRYKER 4X LOCKING SCREW
|
Facility
IP
|
$266.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205746
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$133.00 |
Max. Negotiated Rate |
$133.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$133.00
|
|
STRYKER 52MM CUP HEM HIP
|
Facility
OP
|
$4,438.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029622
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$4,659.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,440.90
|
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 |
$2,219.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,551.85
|
Rate for Payer: Fidelis Medicare Advantage |
$4,659.90
|
Rate for Payer: Group Health Inc Commercial |
$2,219.00
|
Rate for Payer: Group Health Inc Medicare |
$1,553.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,219.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,219.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,884.70
|
|
STRYKER 52MM CUP HEM HIP
|
Facility
IP
|
$4,438.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029622
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,219.00 |
Max. Negotiated Rate |
$2,219.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,219.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,219.00
|
|
STRYKER 5 HOLE COMPRESSION PLATE
|
Facility
IP
|
$470.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204883
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$235.20 |
Max. Negotiated Rate |
$235.20 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$235.20
|
|
STRYKER 5 HOLE COMPRESSION PLATE
|
Facility
OP
|
$470.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204883
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$493.92 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.72
|
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 |
$235.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.48
|
Rate for Payer: Fidelis Medicare Advantage |
$493.92
|
Rate for Payer: Group Health Inc Commercial |
$235.20
|
Rate for Payer: Group Health Inc Medicare |
$164.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$235.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.76
|
|
STRYKER 5 HOLE PIN CLAMP
|
Facility
OP
|
$1,660.90
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40006502
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,743.94 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$913.50
|
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 |
$830.45
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$955.02
|
Rate for Payer: Fidelis Medicare Advantage |
$1,743.94
|
Rate for Payer: Group Health Inc Commercial |
$830.45
|
Rate for Payer: Group Health Inc Medicare |
$581.32
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$830.45
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$830.45
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,079.58
|
|
STRYKER 5 HOLE PIN CLAMP
|
Facility
IP
|
$1,660.90
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40006502
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$830.45 |
Max. Negotiated Rate |
$830.45 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$830.45
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$830.45
|
|
STRYKER 5 HOLE WAISTED COMP/PLATE
|
Facility
IP
|
$221.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205672
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$110.60 |
Max. Negotiated Rate |
$110.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$110.60
|
|
STRYKER 5 HOLE WAISTED COMP/PLATE
|
Facility
OP
|
$221.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205672
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$77.42 |
Max. Negotiated Rate |
$232.26 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.66
|
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 |
$110.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.19
|
Rate for Payer: Fidelis Medicare Advantage |
$232.26
|
Rate for Payer: Group Health Inc Commercial |
$110.60
|
Rate for Payer: Group Health Inc Medicare |
$77.42
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$110.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.78
|
|
STRYKER 6.0X600 VITALIUM ROD
|
Facility
IP
|
$2,092.76
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205239
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,046.38 |
Max. Negotiated Rate |
$1,046.38 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,046.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,046.38
|
|
STRYKER 6.0X600 VITALIUM ROD
|
Facility
OP
|
$2,092.76
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205239
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,197.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,151.02
|
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 |
$1,046.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,203.34
|
Rate for Payer: Fidelis Medicare Advantage |
$2,197.40
|
Rate for Payer: Group Health Inc Commercial |
$1,046.38
|
Rate for Payer: Group Health Inc Medicare |
$732.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,046.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,046.38
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,360.29
|
|
STRYKER 6H DISTAL FEMUR LOC/PLT
|
Facility
IP
|
$2,726.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209923
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,363.00 |
Max. Negotiated Rate |
$1,363.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,363.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,363.00
|
|
STRYKER 6H DISTAL FEMUR LOC/PLT
|
Facility
OP
|
$2,726.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209923
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,862.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,499.30
|
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 |
$1,363.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,567.45
|
Rate for Payer: Fidelis Medicare Advantage |
$2,862.30
|
Rate for Payer: Group Health Inc Commercial |
$1,363.00
|
Rate for Payer: Group Health Inc Medicare |
$954.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,363.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,363.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,771.90
|
|
STRYKER 6 HOLE OLECRANON PLATE RT
|
Facility
IP
|
$2,666.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204884
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,333.00 |
Max. Negotiated Rate |
$1,333.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,333.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,333.00
|
|
STRYKER 6 HOLE OLECRANON PLATE RT
|
Facility
OP
|
$2,666.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204884
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,799.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,466.30
|
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 |
$1,333.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,532.95
|
Rate for Payer: Fidelis Medicare Advantage |
$2,799.30
|
Rate for Payer: Group Health Inc Commercial |
$1,333.00
|
Rate for Payer: Group Health Inc Medicare |
$933.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,333.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,333.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,732.90
|
|
STRYKER 6 HOLE W/BAR
|
Facility
OP
|
$448.46
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008266
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$470.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$246.65
|
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 |
$224.23
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$257.86
|
Rate for Payer: Fidelis Medicare Advantage |
$470.88
|
Rate for Payer: Group Health Inc Commercial |
$224.23
|
Rate for Payer: Group Health Inc Medicare |
$156.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.23
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$224.23
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.50
|
|
STRYKER 6 HOLE W/BAR
|
Facility
IP
|
$448.46
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008266
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$224.23 |
Max. Negotiated Rate |
$224.23 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.23
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$224.23
|
|
STRYKER 6 H PLT R EXT MED
|
Facility
OP
|
$2,672.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205318
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,805.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,469.60
|
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 |
$1,336.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,536.40
|
Rate for Payer: Fidelis Medicare Advantage |
$2,805.60
|
Rate for Payer: Group Health Inc Commercial |
$1,336.00
|
Rate for Payer: Group Health Inc Medicare |
$935.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,336.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,336.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,736.80
|
|
STRYKER 6 H PLT R EXT MED
|
Facility
IP
|
$2,672.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205318
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,336.00 |
Max. Negotiated Rate |
$1,336.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,336.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,336.00
|
|
STRYKER 6 H PLT R POST LATERAL
|
Facility
OP
|
$2,672.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205319
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,805.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,469.60
|
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 |
$1,336.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,536.40
|
Rate for Payer: Fidelis Medicare Advantage |
$2,805.60
|
Rate for Payer: Group Health Inc Commercial |
$1,336.00
|
Rate for Payer: Group Health Inc Medicare |
$935.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,336.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,336.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,736.80
|
|