STRYKER GAMNMA 3 SYSTEM 10X420MM
|
Facility
IP
|
$4,529.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206231
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,264.50 |
Max. Negotiated Rate |
$2,264.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,264.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,264.50
|
|
STRYKER GAMNMA 3 SYSTEM 10X420MM
|
Facility
OP
|
$4,529.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206231
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,755.45 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,490.95
|
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 |
$2,264.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,604.18
|
Rate for Payer: Fidelis Medicare Advantage |
$4,755.45
|
Rate for Payer: Group Health Inc Commercial |
$2,264.50
|
Rate for Payer: Group Health Inc Medicare |
$1,585.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,264.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,264.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,943.85
|
|
STRYKER GMRS D FEM COMP STD R65MM
|
Facility
OP
|
$386.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205317
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$135.10 |
Max. Negotiated Rate |
$405.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$212.30
|
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 |
$193.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$221.95
|
Rate for Payer: Fidelis Medicare Advantage |
$405.30
|
Rate for Payer: Group Health Inc Commercial |
$193.00
|
Rate for Payer: Group Health Inc Medicare |
$135.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.90
|
|
STRYKER GMRS D FEM COMP STD R65MM
|
Facility
IP
|
$386.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205317
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$193.00 |
Max. Negotiated Rate |
$193.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$193.00
|
|
STRYKER GMRS EXTENSION PIECE 50MM
|
Facility
IP
|
$7,880.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205324
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,940.00 |
Max. Negotiated Rate |
$3,940.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,940.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,940.00
|
|
STRYKER GMRS EXTENSION PIECE 50MM
|
Facility
OP
|
$7,880.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205324
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$8,274.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,334.00
|
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 |
$3,940.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,531.00
|
Rate for Payer: Fidelis Medicare Advantage |
$8,274.00
|
Rate for Payer: Group Health Inc Commercial |
$3,940.00
|
Rate for Payer: Group Health Inc Medicare |
$2,758.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,940.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,940.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,122.00
|
|
STRYKER GMRS PROX F/C STD RT 65MM
|
Facility
OP
|
$13,244.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205914
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$13,906.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,284.20
|
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 |
$6,622.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,615.30
|
Rate for Payer: Fidelis Medicare Advantage |
$13,906.20
|
Rate for Payer: Group Health Inc Commercial |
$6,622.00
|
Rate for Payer: Group Health Inc Medicare |
$4,635.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,622.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6,622.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,608.60
|
|
STRYKER GMRS PROX F/C STD RT 65MM
|
Facility
IP
|
$13,244.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205914
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$6,622.00 |
Max. Negotiated Rate |
$6,622.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,622.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6,622.00
|
|
STRYKER GUIDEWIRE BALL-TIP 3X1000
|
Facility
OP
|
$299.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40005361
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$239.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$164.45
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$239.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$203.32
|
Rate for Payer: Group Health Inc Commercial |
$149.50
|
Rate for Payer: Group Health Inc Medicare |
$104.65
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$149.50
|
|
STRYKER HOLDERS PIN SKINMAN BOHLR
|
Facility
OP
|
$806.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40029606
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$846.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$443.30
|
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 |
$403.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$463.45
|
Rate for Payer: Fidelis Medicare Advantage |
$846.30
|
Rate for Payer: Group Health Inc Commercial |
$403.00
|
Rate for Payer: Group Health Inc Medicare |
$282.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$403.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$403.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$523.90
|
|
STRYKER HOLDERS PIN SKINMAN BOHLR
|
Facility
IP
|
$806.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40029606
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$403.00 |
Max. Negotiated Rate |
$403.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$403.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$403.00
|
|
STRYKER INS, MIX EVAC 3
|
Facility
OP
|
$2,053.60
|
|
Hospital Charge Code |
40205336
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$718.76 |
Max. Negotiated Rate |
$1,642.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,129.48
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,026.80
|
Rate for Payer: Aetna Government |
$1,026.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,642.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,396.45
|
Rate for Payer: Group Health Inc Commercial |
$1,026.80
|
Rate for Payer: Group Health Inc Medicare |
$718.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,026.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,026.80
|
|
STRYKER INTERMED SHORT PLATE RT
|
Facility
OP
|
$2,888.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204496
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,032.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,588.40
|
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 |
$1,444.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,660.60
|
Rate for Payer: Fidelis Medicare Advantage |
$3,032.40
|
Rate for Payer: Group Health Inc Commercial |
$1,444.00
|
Rate for Payer: Group Health Inc Medicare |
$1,010.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,444.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,877.20
|
|
STRYKER INTERMED SHORT PLATE RT
|
Facility
IP
|
$2,888.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204496
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,444.00 |
Max. Negotiated Rate |
$1,444.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,444.00
|
|
STRYKER INTER SHORT PLT RT
|
Facility
IP
|
$2,888.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204719
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,444.00 |
Max. Negotiated Rate |
$1,444.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,444.00
|
|
STRYKER INTER SHORT PLT RT
|
Facility
OP
|
$2,888.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204719
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,032.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,588.40
|
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 |
$1,444.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,660.60
|
Rate for Payer: Fidelis Medicare Advantage |
$3,032.40
|
Rate for Payer: Group Health Inc Commercial |
$1,444.00
|
Rate for Payer: Group Health Inc Medicare |
$1,010.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,444.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,877.20
|
|
STRYKER INTER STAND PLATE LT
|
Facility
IP
|
$2,888.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203392
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,444.00 |
Max. Negotiated Rate |
$1,444.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,444.00
|
|
STRYKER INTER STAND PLATE LT
|
Facility
OP
|
$2,888.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203392
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,032.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,588.40
|
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 |
$1,444.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,660.60
|
Rate for Payer: Fidelis Medicare Advantage |
$3,032.40
|
Rate for Payer: Group Health Inc Commercial |
$1,444.00
|
Rate for Payer: Group Health Inc Medicare |
$1,010.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,444.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,877.20
|
|
STRYKER K-WIRE 1.0MM
|
Facility
OP
|
$5.60
|
|
Hospital Charge Code |
40205402
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1.96 |
Max. Negotiated Rate |
$4.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.08
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.80
|
Rate for Payer: Aetna Government |
$2.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.48
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.81
|
Rate for Payer: Group Health Inc Commercial |
$2.80
|
Rate for Payer: Group Health Inc Medicare |
$1.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2.80
|
|
STRYKER K-WIRE 1.14 X 160MM
|
Facility
OP
|
$120.00
|
|
Hospital Charge Code |
40029592
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$42.00 |
Max. Negotiated Rate |
$96.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$60.00
|
Rate for Payer: Aetna Government |
$60.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.60
|
Rate for Payer: Group Health Inc Commercial |
$60.00
|
Rate for Payer: Group Health Inc Medicare |
$42.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
|
STRYKER K WIRE 1.2
|
Facility
OP
|
$57.40
|
|
Hospital Charge Code |
40205582
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$20.09 |
Max. Negotiated Rate |
$45.92 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.57
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.70
|
Rate for Payer: Aetna Government |
$28.70
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.92
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.03
|
Rate for Payer: Group Health Inc Commercial |
$28.70
|
Rate for Payer: Group Health Inc Medicare |
$20.09
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.70
|
|
STRYKER K WIRE 1.6 X200
|
Facility
OP
|
$78.40
|
|
Hospital Charge Code |
40205590
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$27.44 |
Max. Negotiated Rate |
$62.72 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.12
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.20
|
Rate for Payer: Aetna Government |
$39.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.72
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.31
|
Rate for Payer: Group Health Inc Commercial |
$39.20
|
Rate for Payer: Group Health Inc Medicare |
$27.44
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$39.20
|
|
STRYKER K-WIRE 3.2X450MM
|
Facility
IP
|
$161.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40202400
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$80.50 |
Max. Negotiated Rate |
$80.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$80.50
|
|
STRYKER K-WIRE 3.2X450MM
|
Facility
OP
|
$161.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40202400
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$169.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$92.58
|
Rate for Payer: Fidelis Medicare Advantage |
$169.05
|
Rate for Payer: Group Health Inc Commercial |
$80.50
|
Rate for Payer: Group Health Inc Medicare |
$56.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$80.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.65
|
|
STRYKER K-WIRES 2.0X150MM
|
Facility
OP
|
$14.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40205277
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$14.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.05
|
Rate for Payer: Fidelis Medicare Advantage |
$14.70
|
Rate for Payer: Group Health Inc Commercial |
$7.00
|
Rate for Payer: Group Health Inc Medicare |
$4.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|