STRYKER DRIVE TARGATING (HOWMEDIC
|
Facility
OP
|
$390.00
|
|
Hospital Charge Code |
40029613
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$136.50 |
Max. Negotiated Rate |
$312.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$195.00
|
Rate for Payer: Aetna Government |
$195.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$312.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$265.20
|
Rate for Payer: Group Health Inc Commercial |
$195.00
|
Rate for Payer: Group Health Inc Medicare |
$136.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
STRYKER EASY CLIP 8MM
|
Facility
OP
|
$2,250.00
|
|
Hospital Charge Code |
40206249
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$787.50 |
Max. Negotiated Rate |
$1,800.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,237.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,125.00
|
Rate for Payer: Aetna Government |
$1,125.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,800.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,530.00
|
Rate for Payer: Group Health Inc Commercial |
$1,125.00
|
Rate for Payer: Group Health Inc Medicare |
$787.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,125.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,125.00
|
|
STRYKER END TAP 3.5MM
|
Facility
OP
|
$229.00
|
|
Hospital Charge Code |
40205482
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$80.15 |
Max. Negotiated Rate |
$183.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.95
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.50
|
Rate for Payer: Aetna Government |
$114.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.72
|
Rate for Payer: Group Health Inc Commercial |
$114.50
|
Rate for Payer: Group Health Inc Medicare |
$80.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$114.50
|
|
STRYKER FEMORAL HEAD #5 RGHT
|
Facility
OP
|
$8,856.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205670
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$9,298.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,870.80
|
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 |
$4,428.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,092.20
|
Rate for Payer: Fidelis Medicare Advantage |
$9,298.80
|
Rate for Payer: Group Health Inc Commercial |
$4,428.00
|
Rate for Payer: Group Health Inc Medicare |
$3,099.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,428.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,756.40
|
|
STRYKER FEMORAL HEAD #5 RGHT
|
Facility
IP
|
$8,856.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205670
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,428.00 |
Max. Negotiated Rate |
$4,428.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,428.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.00
|
|
STRYKER FEMORAL NAIL
|
Facility
OP
|
$24.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40029599
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8.61 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.53
|
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 |
$12.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.14
|
Rate for Payer: Fidelis Medicare Advantage |
$25.83
|
Rate for Payer: Group Health Inc Commercial |
$12.30
|
Rate for Payer: Group Health Inc Medicare |
$8.61
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$12.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.99
|
|
STRYKER FEMORAL NAIL
|
Facility
IP
|
$24.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40029599
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$12.30 |
Max. Negotiated Rate |
$12.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$12.30
|
|
STRYKER FEMORAL NAIL 9X340MM
|
Facility
OP
|
$3,115.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205567
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,270.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,713.25
|
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 |
$1,557.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,791.12
|
Rate for Payer: Fidelis Medicare Advantage |
$3,270.75
|
Rate for Payer: Group Health Inc Commercial |
$1,557.50
|
Rate for Payer: Group Health Inc Medicare |
$1,090.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,557.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,557.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,024.75
|
|
STRYKER FEMORAL NAIL 9X340MM
|
Facility
IP
|
$3,115.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205567
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,557.50 |
Max. Negotiated Rate |
$1,557.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,557.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,557.50
|
|
STRYKER FEMORAL NAIL AR T2 12X340
|
Facility
IP
|
$2,648.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205948
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,324.00 |
Max. Negotiated Rate |
$1,324.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,324.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,324.00
|
|
STRYKER FEMORAL NAIL AR T2 12X340
|
Facility
OP
|
$2,648.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205948
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,780.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,456.40
|
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 |
$1,324.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,522.60
|
Rate for Payer: Fidelis Medicare Advantage |
$2,780.40
|
Rate for Payer: Group Health Inc Commercial |
$1,324.00
|
Rate for Payer: Group Health Inc Medicare |
$926.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,324.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,324.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,721.20
|
|
STRYKER FEMORAL NAIL T2 10X400MM
|
Facility
IP
|
$3,115.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205648
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,557.50 |
Max. Negotiated Rate |
$1,557.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,557.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,557.50
|
|
STRYKER FEMORAL NAIL T2 10X400MM
|
Facility
OP
|
$3,115.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205648
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,270.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,713.25
|
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 |
$1,557.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,791.12
|
Rate for Payer: Fidelis Medicare Advantage |
$3,270.75
|
Rate for Payer: Group Health Inc Commercial |
$1,557.50
|
Rate for Payer: Group Health Inc Medicare |
$1,090.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,557.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,557.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,024.75
|
|
STRYKER FEMORAL N AR T2 12X380MM
|
Facility
IP
|
$2,966.60
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208119
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,483.30 |
Max. Negotiated Rate |
$1,483.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,483.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,483.30
|
|
STRYKER FEMORAL N AR T2 12X380MM
|
Facility
OP
|
$2,966.60
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208119
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,114.93 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,631.63
|
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 |
$1,483.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,705.80
|
Rate for Payer: Fidelis Medicare Advantage |
$3,114.93
|
Rate for Payer: Group Health Inc Commercial |
$1,483.30
|
Rate for Payer: Group Health Inc Medicare |
$1,038.31
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,483.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,483.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,928.29
|
|
STRYKER FRACTURE PLT, 4 HOLES
|
Facility
OP
|
$570.22
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203428
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$598.73 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$313.62
|
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 |
$285.11
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$327.88
|
Rate for Payer: Fidelis Medicare Advantage |
$598.73
|
Rate for Payer: Group Health Inc Commercial |
$285.11
|
Rate for Payer: Group Health Inc Medicare |
$199.58
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.11
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$285.11
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.64
|
|
STRYKER FRACTURE PLT, 4 HOLES
|
Facility
IP
|
$570.22
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203428
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$285.11 |
Max. Negotiated Rate |
$285.11 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.11
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$285.11
|
|
STRYKER GAMMA3 10X320MM 125D LFT
|
Facility
IP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205425
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,116.10 |
Max. Negotiated Rate |
$2,116.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
|
STRYKER GAMMA3 10X320MM 125D LFT
|
Facility
OP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205425
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,443.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,327.71
|
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 |
$2,116.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,433.52
|
Rate for Payer: Fidelis Medicare Advantage |
$4,443.81
|
Rate for Payer: Group Health Inc Commercial |
$2,116.10
|
Rate for Payer: Group Health Inc Medicare |
$1,481.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,750.93
|
|
STRYKER GAMMA 3, 3.5MM HEX SCREW
|
Facility
IP
|
$1,456.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206232
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$728.00 |
Max. Negotiated Rate |
$728.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$728.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$728.00
|
|
STRYKER GAMMA 3, 3.5MM HEX SCREW
|
Facility
OP
|
$1,456.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206232
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,528.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$800.80
|
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 |
$728.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$837.20
|
Rate for Payer: Fidelis Medicare Advantage |
$1,528.80
|
Rate for Payer: Group Health Inc Commercial |
$728.00
|
Rate for Payer: Group Health Inc Medicare |
$509.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$728.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$728.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$946.40
|
|
STRYKER GAMMA3 LFT 11X340X125D
|
Facility
IP
|
$3,245.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208157
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,622.60 |
Max. Negotiated Rate |
$1,622.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,622.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,622.60
|
|
STRYKER GAMMA3 LFT 11X340X125D
|
Facility
OP
|
$3,245.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208157
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,407.46 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,784.86
|
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 |
$1,622.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,865.99
|
Rate for Payer: Fidelis Medicare Advantage |
$3,407.46
|
Rate for Payer: Group Health Inc Commercial |
$1,622.60
|
Rate for Payer: Group Health Inc Medicare |
$1,135.82
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,622.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,622.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,109.38
|
|
STRYKER GAMMA NAIL 11X320MM
|
Facility
OP
|
$3,441.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205586
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,613.26 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,892.66
|
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 |
$1,720.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,978.69
|
Rate for Payer: Fidelis Medicare Advantage |
$3,613.26
|
Rate for Payer: Group Health Inc Commercial |
$1,720.60
|
Rate for Payer: Group Health Inc Medicare |
$1,204.42
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,720.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,720.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,236.78
|
|
STRYKER GAMMA NAIL 11X320MM
|
Facility
IP
|
$3,441.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205586
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,720.60 |
Max. Negotiated Rate |
$1,720.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,720.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,720.60
|
|