STRYKER LOCKING SCREW 4.0X30-70MM
|
Facility
OP
|
$175.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206226
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$61.25 |
Max. Negotiated Rate |
$183.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
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 |
$87.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.62
|
Rate for Payer: Fidelis Medicare Advantage |
$183.75
|
Rate for Payer: Group Health Inc Commercial |
$87.50
|
Rate for Payer: Group Health Inc Medicare |
$61.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.75
|
|
STRYKER LOCKING SCREW 4.0X30-70MM
|
Facility
IP
|
$175.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206226
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$87.50 |
Max. Negotiated Rate |
$87.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$87.50
|
|
STRYKER LOCKING SCREW 4X20MM FT T
|
Facility
OP
|
$324.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205747
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$113.68 |
Max. Negotiated Rate |
$341.04 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.64
|
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 |
$162.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$186.76
|
Rate for Payer: Fidelis Medicare Advantage |
$341.04
|
Rate for Payer: Group Health Inc Commercial |
$162.40
|
Rate for Payer: Group Health Inc Medicare |
$113.68
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$162.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.12
|
|
STRYKER LOCKING SCREW 4X20MM FT T
|
Facility
IP
|
$324.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205747
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$162.40 |
Max. Negotiated Rate |
$162.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$162.40
|
|
STRYKER LOCKING SCREW 4X28MM
|
Facility
IP
|
$277.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205148
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$138.60 |
Max. Negotiated Rate |
$138.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.60
|
|
STRYKER LOCKING SCREW 4X28MM
|
Facility
OP
|
$277.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205148
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$97.02 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$152.46
|
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 |
$138.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$159.39
|
Rate for Payer: Fidelis Medicare Advantage |
$291.06
|
Rate for Payer: Group Health Inc Commercial |
$138.60
|
Rate for Payer: Group Health Inc Medicare |
$97.02
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.18
|
|
STRYKER LOCKING SCREW 4X40MM F/T
|
Facility
OP
|
$277.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205465
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$97.02 |
Max. Negotiated Rate |
$291.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$152.46
|
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 |
$138.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$159.39
|
Rate for Payer: Fidelis Medicare Advantage |
$291.06
|
Rate for Payer: Group Health Inc Commercial |
$138.60
|
Rate for Payer: Group Health Inc Medicare |
$97.02
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.18
|
|
STRYKER LOCKING SCREW 4X40MM F/T
|
Facility
IP
|
$277.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205465
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$138.60 |
Max. Negotiated Rate |
$138.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.60
|
|
STRYKER LOCKING SCREW 5.0
|
Facility
IP
|
$203.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205273
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$101.50 |
Max. Negotiated Rate |
$101.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$101.50
|
|
STRYKER LOCKING SCREW 5.0
|
Facility
OP
|
$186.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40207036
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$65.10 |
Max. Negotiated Rate |
$195.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.30
|
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 |
$93.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$106.95
|
Rate for Payer: Fidelis Medicare Advantage |
$195.30
|
Rate for Payer: Group Health Inc Commercial |
$93.00
|
Rate for Payer: Group Health Inc Medicare |
$65.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$93.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.90
|
|
STRYKER LOCKING SCREW 5.0
|
Facility
OP
|
$203.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205273
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$71.05 |
Max. Negotiated Rate |
$213.15 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$111.65
|
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 |
$101.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.72
|
Rate for Payer: Fidelis Medicare Advantage |
$213.15
|
Rate for Payer: Group Health Inc Commercial |
$101.50
|
Rate for Payer: Group Health Inc Medicare |
$71.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$101.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.95
|
|
STRYKER LOCKING SCREW 5.0
|
Facility
IP
|
$186.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40207036
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$93.00 |
Max. Negotiated Rate |
$93.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$93.00
|
|
STRYKER LOCKING SCREW 5.0 F/T
|
Facility
OP
|
$351.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206224
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$122.99 |
Max. Negotiated Rate |
$368.97 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$193.27
|
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 |
$175.70
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$202.06
|
Rate for Payer: Fidelis Medicare Advantage |
$368.97
|
Rate for Payer: Group Health Inc Commercial |
$175.70
|
Rate for Payer: Group Health Inc Medicare |
$122.99
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$175.70
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.41
|
|
STRYKER LOCKING SCREW 5.0 F/T
|
Facility
IP
|
$351.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206224
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$175.70 |
Max. Negotiated Rate |
$175.70 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$175.70
|
|
STRYKER LOCKING SCREW 50MM
|
Facility
OP
|
$429.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205442
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$450.45 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$235.95
|
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 |
$214.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$246.68
|
Rate for Payer: Fidelis Medicare Advantage |
$450.45
|
Rate for Payer: Group Health Inc Commercial |
$214.50
|
Rate for Payer: Group Health Inc Medicare |
$150.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$214.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.85
|
|
STRYKER LOCKING SCREW 50MM
|
Facility
IP
|
$429.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205442
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$214.50 |
Max. Negotiated Rate |
$214.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$214.50
|
|
STRYKER LOCKING SCRW 3.5 X
|
Facility
IP
|
$247.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208075
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$123.90 |
Max. Negotiated Rate |
$123.90 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$123.90
|
|
STRYKER LOCKING SCRW 3.5 X
|
Facility
OP
|
$247.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208075
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$86.73 |
Max. Negotiated Rate |
$260.19 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.29
|
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 |
$123.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.48
|
Rate for Payer: Fidelis Medicare Advantage |
$260.19
|
Rate for Payer: Group Health Inc Commercial |
$123.90
|
Rate for Payer: Group Health Inc Medicare |
$86.73
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$123.90
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.07
|
|
STRYKER LOCKING SCRWN FTH5X45MM
|
Facility
OP
|
$317.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206076
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$111.23 |
Max. Negotiated Rate |
$333.69 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.79
|
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 |
$158.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$182.74
|
Rate for Payer: Fidelis Medicare Advantage |
$333.69
|
Rate for Payer: Group Health Inc Commercial |
$158.90
|
Rate for Payer: Group Health Inc Medicare |
$111.23
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$158.90
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.57
|
|
STRYKER LOCKING SCRWN FTH5X45MM
|
Facility
IP
|
$317.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206076
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$158.90 |
Max. Negotiated Rate |
$158.90 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$158.90
|
|
STRYKER LOCK SCREW THREAD5X30MM
|
Facility
IP
|
$343.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005867
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$171.60 |
Max. Negotiated Rate |
$171.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$171.60
|
|
STRYKER LOCK SCREW THREAD5X30MM
|
Facility
OP
|
$343.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005867
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$120.12 |
Max. Negotiated Rate |
$360.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.76
|
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 |
$171.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$197.34
|
Rate for Payer: Fidelis Medicare Advantage |
$360.36
|
Rate for Payer: Group Health Inc Commercial |
$171.60
|
Rate for Payer: Group Health Inc Medicare |
$120.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$171.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.08
|
|
STRYKER LOCK SCREW THREAD 5X50MM
|
Facility
IP
|
$351.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005360
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$175.50 |
Max. Negotiated Rate |
$175.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$175.50
|
|
STRYKER LOCK SCREW THREAD 5X50MM
|
Facility
OP
|
$351.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005360
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$122.85 |
Max. Negotiated Rate |
$368.55 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$193.05
|
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 |
$175.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.82
|
Rate for Payer: Fidelis Medicare Advantage |
$368.55
|
Rate for Payer: Group Health Inc Commercial |
$175.50
|
Rate for Payer: Group Health Inc Medicare |
$122.85
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$175.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.15
|
|
STRYKER LONG NAIL KIT R2.0 RGHT
|
Facility
IP
|
$3,683.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205199
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,841.70 |
Max. Negotiated Rate |
$1,841.70 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,841.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,841.70
|
|