STRYKER 6 H PLT R POST LATERAL
|
Facility
IP
|
$2,672.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205319
|
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 6X11MM TIB BEARING INSERT
|
Facility
OP
|
$3,984.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208086
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$4,183.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,191.20
|
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 |
$1,992.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,290.80
|
Rate for Payer: Fidelis Medicare Advantage |
$4,183.20
|
Rate for Payer: Group Health Inc Commercial |
$1,992.00
|
Rate for Payer: Group Health Inc Medicare |
$1,394.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,992.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,992.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,589.60
|
|
STRYKER 6X11MM TIB BEARING INSERT
|
Facility
IP
|
$3,984.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208086
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,992.00 |
Max. Negotiated Rate |
$1,992.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,992.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,992.00
|
|
STRYKER 7 HOLE Y-PLATE
|
Facility
IP
|
$3,048.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40006560
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,524.00 |
Max. Negotiated Rate |
$1,524.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,524.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,524.00
|
|
STRYKER 7 HOLE Y-PLATE
|
Facility
OP
|
$3,048.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40006560
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,200.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,676.40
|
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 |
$1,524.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,752.60
|
Rate for Payer: Fidelis Medicare Advantage |
$3,200.40
|
Rate for Payer: Group Health Inc Commercial |
$1,524.00
|
Rate for Payer: Group Health Inc Medicare |
$1,066.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,524.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,524.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,981.20
|
|
STRYKER 7X12X14 4 AVSAS
|
Facility
IP
|
$5,842.34
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40009294
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,921.17 |
Max. Negotiated Rate |
$2,921.17 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,921.17
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,921.17
|
|
STRYKER 7X12X14 4 AVSAS
|
Facility
OP
|
$5,842.34
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40009294
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$6,134.46 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,213.29
|
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 |
$2,921.17
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,359.35
|
Rate for Payer: Fidelis Medicare Advantage |
$6,134.46
|
Rate for Payer: Group Health Inc Commercial |
$2,921.17
|
Rate for Payer: Group Health Inc Medicare |
$2,044.82
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,921.17
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,921.17
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,797.52
|
|
STRYKER 8-HL OLECRAN PLT RT
|
Facility
OP
|
$2,144.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40004617
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,251.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,179.20
|
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 |
$1,072.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,232.80
|
Rate for Payer: Fidelis Medicare Advantage |
$2,251.20
|
Rate for Payer: Group Health Inc Commercial |
$1,072.00
|
Rate for Payer: Group Health Inc Medicare |
$750.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,072.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,072.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,393.60
|
|
STRYKER 8-HL OLECRAN PLT RT
|
Facility
IP
|
$2,144.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40004617
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,072.00 |
Max. Negotiated Rate |
$1,072.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,072.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,072.00
|
|
STRYKER 8 HOLE PLATE
|
Facility
OP
|
$1,100.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205562
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,155.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$605.00
|
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 |
$550.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$632.50
|
Rate for Payer: Fidelis Medicare Advantage |
$1,155.00
|
Rate for Payer: Group Health Inc Commercial |
$550.00
|
Rate for Payer: Group Health Inc Medicare |
$385.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$550.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$715.00
|
|
STRYKER 8 HOLE PLATE
|
Facility
IP
|
$1,100.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205562
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$550.00 |
Max. Negotiated Rate |
$550.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$550.00
|
|
STRYKER 8 HOLE PLATE SHORT/NARROW
|
Facility
OP
|
$2,781.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204480
|
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
|
|
STRYKER 8 HOLE PLATE SHORT/NARROW
|
Facility
IP
|
$2,781.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204480
|
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
|
|
STRYKER 90 DEGREE POST
|
Facility
OP
|
$288.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209431
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$100.94 |
Max. Negotiated Rate |
$302.82 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$158.62
|
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 |
$144.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.83
|
Rate for Payer: Fidelis Medicare Advantage |
$302.82
|
Rate for Payer: Group Health Inc Commercial |
$144.20
|
Rate for Payer: Group Health Inc Medicare |
$100.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$144.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.46
|
|
STRYKER 90 DEGREE POST
|
Facility
OP
|
$424.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40006504
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$446.04 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.64
|
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 |
$212.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$244.26
|
Rate for Payer: Fidelis Medicare Advantage |
$446.04
|
Rate for Payer: Group Health Inc Commercial |
$212.40
|
Rate for Payer: Group Health Inc Medicare |
$148.68
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$212.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$276.12
|
|
STRYKER 90 DEGREE POST
|
Facility
IP
|
$424.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40006504
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$212.40 |
Max. Negotiated Rate |
$212.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$212.40
|
|
STRYKER 90 DEGREE POST
|
Facility
IP
|
$288.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209431
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$144.20 |
Max. Negotiated Rate |
$144.20 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$144.20
|
|
STRYKER 9X400 LFT RECON NAIL
|
Facility
OP
|
$3,504.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205723
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,679.41 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,927.31
|
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 |
$1,752.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,014.92
|
Rate for Payer: Fidelis Medicare Advantage |
$3,679.41
|
Rate for Payer: Group Health Inc Commercial |
$1,752.10
|
Rate for Payer: Group Health Inc Medicare |
$1,226.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,752.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,752.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,277.73
|
|
STRYKER 9X400 LFT RECON NAIL
|
Facility
IP
|
$3,504.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205723
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,752.10 |
Max. Negotiated Rate |
$1,752.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,752.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,752.10
|
|
STRYKER 9X420MM RECON NAIL R2 LFT
|
Facility
IP
|
$3,504.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205748
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,752.10 |
Max. Negotiated Rate |
$1,752.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,752.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,752.10
|
|
STRYKER 9X420MM RECON NAIL R2 LFT
|
Facility
OP
|
$3,504.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205748
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,679.41 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,927.31
|
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 |
$1,752.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,014.92
|
Rate for Payer: Fidelis Medicare Advantage |
$3,679.41
|
Rate for Payer: Group Health Inc Commercial |
$1,752.10
|
Rate for Payer: Group Health Inc Medicare |
$1,226.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,752.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,752.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,277.73
|
|
STRYKER ANATOMICAL LFT PLT
|
Facility
IP
|
$1,440.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205206
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$720.30 |
Max. Negotiated Rate |
$720.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$720.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$720.30
|
|
STRYKER ANATOMICAL LFT PLT
|
Facility
OP
|
$1,440.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205206
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,512.63 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$792.33
|
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 |
$720.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$828.34
|
Rate for Payer: Fidelis Medicare Advantage |
$1,512.63
|
Rate for Payer: Group Health Inc Commercial |
$720.30
|
Rate for Payer: Group Health Inc Medicare |
$504.21
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$720.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$720.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$936.39
|
|
STRYKER APEX HA COATED 180X40MM
|
Facility
OP
|
$394.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200701
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$413.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.70
|
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 |
$197.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.55
|
Rate for Payer: Fidelis Medicare Advantage |
$413.70
|
Rate for Payer: Group Health Inc Commercial |
$197.00
|
Rate for Payer: Group Health Inc Medicare |
$137.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$197.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$256.10
|
|
STRYKER APEX HA COATED 180X40MM
|
Facility
IP
|
$394.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200701
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$197.00 |
Max. Negotiated Rate |
$197.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$197.00
|
|