|
STRYKER CANN SCREW 3.2X30MM
|
Facility
IP
|
$606.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205403
|
|
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 CANN SCREW 3.2X34MM
|
Facility
OP
|
$606.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205404
|
|
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 CANN SCREW 3.2X34MM
|
Facility
IP
|
$606.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205404
|
|
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 CANN SCREW 4.0MM
|
Facility
OP
|
$397.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$417.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$218.62
|
| 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 |
$198.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$228.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$417.38
|
| Rate for Payer: Group Health Inc Commercial |
$198.75
|
| Rate for Payer: Group Health Inc Medicare |
$139.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$258.38
|
|
|
STRYKER CANN SCREW 4.0MM
|
Facility
IP
|
$397.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.75 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.75
|
|
|
STRYKER CANN ST SS 7.3X100MM
|
Facility
IP
|
$406.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.00
|
|
|
STRYKER CANN ST SS 7.3X100MM
|
Facility
OP
|
$406.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$426.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$223.30
|
| 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 |
$203.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$426.30
|
| Rate for Payer: Group Health Inc Commercial |
$203.00
|
| Rate for Payer: Group Health Inc Medicare |
$142.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$263.90
|
|
|
STRYKER CANNULATED SCREW 18X2.3MM
|
Facility
OP
|
$143.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$150.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$78.65
|
| 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 |
$71.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.15
|
| Rate for Payer: Group Health Inc Commercial |
$71.50
|
| Rate for Payer: Group Health Inc Medicare |
$50.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.95
|
|
|
STRYKER CANNULATED SCREW 18X2.3MM
|
Facility
IP
|
$143.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$71.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.50
|
|
|
STRYKER CANNULATED SCRW 3.2X20MM
|
Facility
IP
|
$571.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.60
|
|
|
STRYKER CANNULATED SCRW 3.2X20MM
|
Facility
OP
|
$571.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$599.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$314.16
|
| 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 |
$285.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$328.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$599.76
|
| Rate for Payer: Group Health Inc Commercial |
$285.60
|
| Rate for Payer: Group Health Inc Medicare |
$199.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.28
|
|
|
STRYKER CARBON ROD 8X150MM
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
STRYKER CARBON ROD 8X150MM
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| 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 |
$125.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$262.50
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.50
|
|
|
STRYKER CARBON ROD 8X250MM
|
Facility
OP
|
$298.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$313.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$164.01
|
| 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 |
$149.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$171.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$313.11
|
| Rate for Payer: Group Health Inc Commercial |
$149.10
|
| Rate for Payer: Group Health Inc Medicare |
$104.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.83
|
|
|
STRYKER CARBON ROD 8X250MM
|
Facility
IP
|
$298.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$149.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.10
|
|
|
STRYKER CARBON ROD 8X300MM
|
Facility
OP
|
$229.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$241.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.28
|
| 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 |
$114.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$241.08
|
| Rate for Payer: Group Health Inc Commercial |
$114.80
|
| Rate for Payer: Group Health Inc Medicare |
$80.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.24
|
|
|
STRYKER CARBON ROD 8X300MM
|
Facility
IP
|
$229.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$114.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.80
|
|
|
STRYKER CARBON ROD 8X350MM
|
Facility
IP
|
$298.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$149.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.10
|
|
|
STRYKER CARBON ROD 8X350MM
|
Facility
OP
|
$298.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$313.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$164.01
|
| 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 |
$149.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$171.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$313.11
|
| Rate for Payer: Group Health Inc Commercial |
$149.10
|
| Rate for Payer: Group Health Inc Medicare |
$104.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.83
|
|
|
STRYKER CLAMP
|
Facility
OP
|
$600.00
|
|
| Hospital Charge Code |
40009341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.00
|
| Rate for Payer: Aetna Government |
$300.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
|
|
STRYKER CLAMP
|
Facility
OP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| 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 |
$300.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$345.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
|
|
STRYKER CLAMP
|
Facility
IP
|
$600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
|
|
STRYKER CLAMP 10 HOLE
|
Facility
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$797.50
|
| 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 |
$725.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$833.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,522.50
|
| Rate for Payer: Group Health Inc Commercial |
$725.00
|
| Rate for Payer: Group Health Inc Medicare |
$507.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$725.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$942.50
|
|
|
STRYKER CLAMP 10 HOLE
|
Facility
OP
|
$1,450.00
|
|
| Hospital Charge Code |
40009322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.50 |
| Max. Negotiated Rate |
$1,160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$797.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$725.00
|
| Rate for Payer: Aetna Government |
$725.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$986.00
|
| Rate for Payer: Group Health Inc Commercial |
$725.00
|
| Rate for Payer: Group Health Inc Medicare |
$507.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$725.00
|
|
|
STRYKER CLAMP 10 HOLE
|
Facility
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$725.00 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$725.00
|
|
