STRYKER NAIL HOLDING SCREW
|
Facility
OP
|
$348.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203831
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$121.80 |
Max. Negotiated Rate |
$365.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
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 |
$174.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$200.10
|
Rate for Payer: Fidelis Medicare Advantage |
$365.40
|
Rate for Payer: Group Health Inc Commercial |
$174.00
|
Rate for Payer: Group Health Inc Medicare |
$121.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.20
|
|
STRYKER NAIL HOLDING SCREW
|
Facility
IP
|
$348.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203831
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$174.00 |
Max. Negotiated Rate |
$174.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
|
STRYKER NAIL TIB STD T2 11X37MM
|
Facility
IP
|
$2,682.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205754
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,341.20 |
Max. Negotiated Rate |
$1,341.20 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,341.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,341.20
|
|
STRYKER NAIL TIB STD T2 11X37MM
|
Facility
OP
|
$2,682.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205754
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,816.52 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,475.32
|
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 |
$1,341.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,542.38
|
Rate for Payer: Fidelis Medicare Advantage |
$2,816.52
|
Rate for Payer: Group Health Inc Commercial |
$1,341.20
|
Rate for Payer: Group Health Inc Medicare |
$938.84
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,341.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,341.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,743.56
|
|
STRYKER NEURO 1.5X 4MM SCREW
|
Facility
IP
|
$156.52
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206251
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$78.26 |
Max. Negotiated Rate |
$78.26 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.26
|
|
STRYKER NEURO 1.5X 4MM SCREW
|
Facility
OP
|
$156.52
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206251
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$54.78 |
Max. Negotiated Rate |
$164.35 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.09
|
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 |
$78.26
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.00
|
Rate for Payer: Fidelis Medicare Advantage |
$164.35
|
Rate for Payer: Group Health Inc Commercial |
$78.26
|
Rate for Payer: Group Health Inc Medicare |
$54.78
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.26
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.74
|
|
STRYKER NEURO 1.5 X 5MM SCREW
|
Facility
IP
|
$162.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206252
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$81.00 |
Max. Negotiated Rate |
$81.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$81.00
|
|
STRYKER NEURO 1.5 X 5MM SCREW
|
Facility
OP
|
$162.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206252
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$56.70 |
Max. Negotiated Rate |
$170.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.10
|
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 |
$81.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$93.15
|
Rate for Payer: Fidelis Medicare Advantage |
$170.10
|
Rate for Payer: Group Health Inc Commercial |
$81.00
|
Rate for Payer: Group Health Inc Medicare |
$56.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$81.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.30
|
|
STRYKER NEUROFLEX
|
Facility
IP
|
$3,076.44
|
|
Service Code
|
HCPCS C9355
|
Hospital Charge Code |
40004712
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1,538.22 |
Max. Negotiated Rate |
$1,538.22 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,538.22
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,538.22
|
|
STRYKER NEUROFLEX
|
Facility
OP
|
$3,076.44
|
|
Service Code
|
HCPCS C9355
|
Hospital Charge Code |
40004712
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$147.94 |
Max. Negotiated Rate |
$1,999.69 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,692.04
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.94
|
Rate for Payer: Aetna Government |
$147.94
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,538.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,768.95
|
Rate for Payer: Group Health Inc Commercial |
$1,538.22
|
Rate for Payer: Group Health Inc Medicare |
$1,076.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,538.22
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,538.22
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,999.69
|
|
STRYKER N/L SCRW 3.5
|
Facility
OP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203830
|
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 N/L SCRW 3.5
|
Facility
IP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203830
|
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 OASYS BLOCKERS
|
Facility
OP
|
$333.86
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204468
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$116.85 |
Max. Negotiated Rate |
$350.55 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$183.62
|
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 |
$166.93
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$191.97
|
Rate for Payer: Fidelis Medicare Advantage |
$350.55
|
Rate for Payer: Group Health Inc Commercial |
$166.93
|
Rate for Payer: Group Health Inc Medicare |
$116.85
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.93
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$166.93
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.01
|
|
STRYKER OASYS BLOCKERS
|
Facility
IP
|
$333.86
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204468
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$166.93 |
Max. Negotiated Rate |
$166.93 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.93
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$166.93
|
|
STRYKER OASYS PLATE MINI
|
Facility
OP
|
$10,986.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204460
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$11,535.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,042.46
|
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 |
$5,493.15
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,317.12
|
Rate for Payer: Fidelis Medicare Advantage |
$11,535.62
|
Rate for Payer: Group Health Inc Commercial |
$5,493.15
|
Rate for Payer: Group Health Inc Medicare |
$3,845.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,493.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5,493.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,141.10
|
|
STRYKER OASYS PLATE MINI
|
Facility
IP
|
$10,986.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204460
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$5,493.15 |
Max. Negotiated Rate |
$5,493.15 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,493.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5,493.15
|
|
STRYKER OLIVE K-WIRES
|
Facility
OP
|
$501.50
|
|
Hospital Charge Code |
40204475
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$175.52 |
Max. Negotiated Rate |
$401.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.82
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$250.75
|
Rate for Payer: Aetna Government |
$250.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$401.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$341.02
|
Rate for Payer: Group Health Inc Commercial |
$250.75
|
Rate for Payer: Group Health Inc Medicare |
$175.52
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.75
|
|
STRYKER OLIVE WIRE 1.5MM
|
Facility
OP
|
$312.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205937
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$109.27 |
Max. Negotiated Rate |
$327.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.71
|
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 |
$156.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$179.52
|
Rate for Payer: Fidelis Medicare Advantage |
$327.81
|
Rate for Payer: Group Health Inc Commercial |
$156.10
|
Rate for Payer: Group Health Inc Medicare |
$109.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$156.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.93
|
|
STRYKER OLIVE WIRE 1.5MM
|
Facility
IP
|
$312.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205937
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$156.10 |
Max. Negotiated Rate |
$156.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$156.10
|
|
STRYKER OMEGA COMP SCREW 32.3MM
|
Facility
IP
|
$145.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204670
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$72.80 |
Max. Negotiated Rate |
$72.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$72.80
|
|
STRYKER OMEGA COMP SCREW 32.3MM
|
Facility
OP
|
$145.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204670
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$50.96 |
Max. Negotiated Rate |
$152.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.08
|
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 |
$72.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.72
|
Rate for Payer: Fidelis Medicare Advantage |
$152.88
|
Rate for Payer: Group Health Inc Commercial |
$72.80
|
Rate for Payer: Group Health Inc Medicare |
$50.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$72.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.64
|
|
STRYKER OMEGA G/P COCR2.8X230MMTH
|
Facility
IP
|
$59.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205634
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.50 |
Max. Negotiated Rate |
$29.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.50
|
|
STRYKER OMEGA G/P COCR2.8X230MMTH
|
Facility
OP
|
$59.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205634
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.65 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.45
|
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 |
$29.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.92
|
Rate for Payer: Fidelis Medicare Advantage |
$61.95
|
Rate for Payer: Group Health Inc Commercial |
$29.50
|
Rate for Payer: Group Health Inc Medicare |
$20.65
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$29.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.35
|
|
STRYKER ORTHO PATELLA SZ 27
|
Facility
IP
|
$2,880.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205337
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,440.00 |
Max. Negotiated Rate |
$1,440.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,440.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,440.00
|
|
STRYKER ORTHO PATELLA SZ 27
|
Facility
OP
|
$2,880.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205337
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,024.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,584.00
|
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 |
$1,440.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,656.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,024.00
|
Rate for Payer: Group Health Inc Commercial |
$1,440.00
|
Rate for Payer: Group Health Inc Medicare |
$1,008.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,440.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,440.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,872.00
|
|