STRYKER BONE SCREW 3.5MMX24MM
|
Facility
OP
|
$105.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205521
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$36.75 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
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 |
$52.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.38
|
Rate for Payer: Fidelis Medicare Advantage |
$110.25
|
Rate for Payer: Group Health Inc Commercial |
$52.50
|
Rate for Payer: Group Health Inc Medicare |
$36.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.25
|
|
STRYKER BONE SCREW 3.5MMX24MM
|
Facility
IP
|
$105.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205521
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$52.50 |
Max. Negotiated Rate |
$52.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
|
STRYKER BONE SCREW 3.5MMX30MM
|
Facility
IP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205473
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$54.60 |
Max. Negotiated Rate |
$54.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$54.60
|
|
STRYKER BONE SCREW 3.5MMX30MM
|
Facility
OP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205473
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$38.22 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.06
|
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 |
$54.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.79
|
Rate for Payer: Fidelis Medicare Advantage |
$114.66
|
Rate for Payer: Group Health Inc Commercial |
$54.60
|
Rate for Payer: Group Health Inc Medicare |
$38.22
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$54.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.98
|
|
STRYKER BONE SCREW 3.5MM X 40MM
|
Facility
OP
|
$114.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205474
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.18 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.14
|
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 |
$57.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.01
|
Rate for Payer: Fidelis Medicare Advantage |
$120.54
|
Rate for Payer: Group Health Inc Commercial |
$57.40
|
Rate for Payer: Group Health Inc Medicare |
$40.18
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$57.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.62
|
|
STRYKER BONE SCREW 3.5MM X 40MM
|
Facility
IP
|
$114.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205474
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$57.40 |
Max. Negotiated Rate |
$57.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$57.40
|
|
STRYKER BONE SCREW3.5X14MM
|
Facility
IP
|
$114.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205520
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$57.40 |
Max. Negotiated Rate |
$57.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$57.40
|
|
STRYKER BONE SCREW3.5X14MM
|
Facility
OP
|
$114.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205520
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.18 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.14
|
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 |
$57.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.01
|
Rate for Payer: Fidelis Medicare Advantage |
$120.54
|
Rate for Payer: Group Health Inc Commercial |
$57.40
|
Rate for Payer: Group Health Inc Medicare |
$40.18
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$57.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.62
|
|
STRYKER BONE SCREW 3.5X20MM
|
Facility
IP
|
$200.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205333
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$100.00 |
Max. Negotiated Rate |
$100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
STRYKER BONE SCREW 3.5X20MM
|
Facility
OP
|
$200.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205333
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$70.00 |
Max. Negotiated Rate |
$210.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
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 |
$100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.00
|
Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
Rate for Payer: Group Health Inc Commercial |
$100.00
|
Rate for Payer: Group Health Inc Medicare |
$70.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
STRYKER BONE SCREW 3.5X46MM
|
Facility
IP
|
$260.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205777
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$130.20 |
Max. Negotiated Rate |
$130.20 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$130.20
|
|
STRYKER BONE SCREW 3.5X46MM
|
Facility
OP
|
$260.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205777
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$91.14 |
Max. Negotiated Rate |
$273.42 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.22
|
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 |
$130.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$149.73
|
Rate for Payer: Fidelis Medicare Advantage |
$273.42
|
Rate for Payer: Group Health Inc Commercial |
$130.20
|
Rate for Payer: Group Health Inc Medicare |
$91.14
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$130.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.26
|
|
STRYKER BONE SCREW 3.5X8
|
Facility
OP
|
$431.90
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204461
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$453.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$237.54
|
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 |
$215.95
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$248.34
|
Rate for Payer: Fidelis Medicare Advantage |
$453.50
|
Rate for Payer: Group Health Inc Commercial |
$215.95
|
Rate for Payer: Group Health Inc Medicare |
$151.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$215.95
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$215.95
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.74
|
|
STRYKER BONE SCREW 3.5X8
|
Facility
IP
|
$431.90
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204461
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$215.95 |
Max. Negotiated Rate |
$215.95 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$215.95
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$215.95
|
|
STRYKER BONE SCREW 4.0X8
|
Facility
IP
|
$474.28
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204462
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$237.14 |
Max. Negotiated Rate |
$237.14 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.14
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$237.14
|
|
STRYKER BONE SCREW 4.0X8
|
Facility
OP
|
$474.28
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204462
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$497.99 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$260.85
|
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 |
$237.14
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$272.71
|
Rate for Payer: Fidelis Medicare Advantage |
$497.99
|
Rate for Payer: Group Health Inc Commercial |
$237.14
|
Rate for Payer: Group Health Inc Medicare |
$166.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.14
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$237.14
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$308.28
|
|
STRYKER CANCELLOUS 4.0X50MM
|
Facility
OP
|
$35.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209983
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$12.25 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
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 |
$17.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.12
|
Rate for Payer: Fidelis Medicare Advantage |
$36.75
|
Rate for Payer: Group Health Inc Commercial |
$17.50
|
Rate for Payer: Group Health Inc Medicare |
$12.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.75
|
|
STRYKER CANCELLOUS 4.0X50MM
|
Facility
IP
|
$35.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209983
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.50 |
Max. Negotiated Rate |
$17.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
|
STRYKER CANN SCR 2.0X10MM
|
Facility
IP
|
$180.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40207453
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$90.00 |
Max. Negotiated Rate |
$90.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
|
STRYKER CANN SCR 2.0X10MM
|
Facility
OP
|
$180.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40207453
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$63.00 |
Max. Negotiated Rate |
$189.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.00
|
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 |
$90.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.50
|
Rate for Payer: Fidelis Medicare Advantage |
$189.00
|
Rate for Payer: Group Health Inc Commercial |
$90.00
|
Rate for Payer: Group Health Inc Medicare |
$63.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.00
|
|
STRYKER CANN.SCREW 3.0X36
|
Facility
OP
|
$366.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205584
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$128.38 |
Max. Negotiated Rate |
$385.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$201.74
|
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 |
$183.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$210.91
|
Rate for Payer: Fidelis Medicare Advantage |
$385.14
|
Rate for Payer: Group Health Inc Commercial |
$183.40
|
Rate for Payer: Group Health Inc Medicare |
$128.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.42
|
|
STRYKER CANN.SCREW 3.0X36
|
Facility
IP
|
$366.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205584
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$183.40 |
Max. Negotiated Rate |
$183.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$183.40
|
|
STRYKER CANN. SCREW 3.2
|
Facility
IP
|
$714.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205373
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$357.00 |
Max. Negotiated Rate |
$357.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$357.00
|
|
STRYKER CANN. SCREW 3.2
|
Facility
OP
|
$714.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205373
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$749.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$392.70
|
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 |
$357.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$410.55
|
Rate for Payer: Fidelis Medicare Advantage |
$749.70
|
Rate for Payer: Group Health Inc Commercial |
$357.00
|
Rate for Payer: Group Health Inc Medicare |
$249.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$357.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$464.10
|
|
STRYKER CANN SCREW 3.2X30MM
|
Facility
OP
|
$606.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205403
|
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
|
|