STRYKER PIN DRIVER COMPACT
|
Facility
OP
|
$720.00
|
|
Hospital Charge Code |
40009343
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$252.00 |
Max. Negotiated Rate |
$576.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$396.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.00
|
Rate for Payer: Aetna Government |
$360.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$576.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$489.60
|
Rate for Payer: Group Health Inc Commercial |
$360.00
|
Rate for Payer: Group Health Inc Medicare |
$252.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$360.00
|
|
STRYKER PIN DRIVER COMPACT
|
Facility
IP
|
$720.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203360
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$360.00 |
Max. Negotiated Rate |
$360.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$360.00
|
|
STRYKER PIN HALF MOD 4X120MM
|
Facility
OP
|
$200.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205554
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$70.04 |
Max. Negotiated Rate |
$210.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.06
|
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 |
$100.05
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.06
|
Rate for Payer: Fidelis Medicare Advantage |
$210.10
|
Rate for Payer: Group Health Inc Commercial |
$100.05
|
Rate for Payer: Group Health Inc Medicare |
$70.04
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$100.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.06
|
|
STRYKER PIN HALF MOD 4X120MM
|
Facility
IP
|
$200.10
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205554
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$100.05 |
Max. Negotiated Rate |
$100.05 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$100.05
|
|
STRYKER PLATE 2 HOLE RIGHT
|
Facility
OP
|
$1,838.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206225
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,929.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,010.90
|
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 |
$919.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,056.85
|
Rate for Payer: Fidelis Medicare Advantage |
$1,929.90
|
Rate for Payer: Group Health Inc Commercial |
$919.00
|
Rate for Payer: Group Health Inc Medicare |
$643.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$919.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$919.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,194.70
|
|
STRYKER PLATE 2 HOLE RIGHT
|
Facility
IP
|
$1,838.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206225
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$919.00 |
Max. Negotiated Rate |
$919.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$919.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$919.00
|
|
STRYKER PLATE 5 HOLE
|
Facility
IP
|
$267.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209412
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$133.80 |
Max. Negotiated Rate |
$133.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$133.80
|
|
STRYKER PLATE 5 HOLE
|
Facility
OP
|
$267.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209412
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$93.66 |
Max. Negotiated Rate |
$280.98 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.18
|
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 |
$133.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$153.87
|
Rate for Payer: Fidelis Medicare Advantage |
$280.98
|
Rate for Payer: Group Health Inc Commercial |
$133.80
|
Rate for Payer: Group Health Inc Medicare |
$93.66
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$133.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.94
|
|
STRYKER PLATE 6 HOLE FLEX
|
Facility
IP
|
$597.80
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205374
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$298.90 |
Max. Negotiated Rate |
$298.90 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$298.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$298.90
|
|
STRYKER PLATE 6 HOLE FLEX
|
Facility
OP
|
$597.80
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205374
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$209.23 |
Max. Negotiated Rate |
$627.69 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$328.79
|
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 |
$298.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$343.74
|
Rate for Payer: Fidelis Medicare Advantage |
$627.69
|
Rate for Payer: Group Health Inc Commercial |
$298.90
|
Rate for Payer: Group Health Inc Medicare |
$209.23
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$298.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$298.90
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$388.57
|
|
STRYKER PLATE 8 HOLE
|
Facility
OP
|
$697.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205760
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$732.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$383.46
|
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 |
$348.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$400.89
|
Rate for Payer: Fidelis Medicare Advantage |
$732.06
|
Rate for Payer: Group Health Inc Commercial |
$348.60
|
Rate for Payer: Group Health Inc Medicare |
$244.02
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$348.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$453.18
|
|
STRYKER PLATE 8 HOLE
|
Facility
IP
|
$697.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205760
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$348.60 |
Max. Negotiated Rate |
$348.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$348.60
|
|
STRYKER PLATE 8 HOLE FLEX
|
Facility
IP
|
$673.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205365
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$336.70 |
Max. Negotiated Rate |
$336.70 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$336.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$336.70
|
|
STRYKER PLATE 8 HOLE FLEX
|
Facility
OP
|
$673.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205365
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$707.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$370.37
|
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 |
$336.70
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$387.20
|
Rate for Payer: Fidelis Medicare Advantage |
$707.07
|
Rate for Payer: Group Health Inc Commercial |
$336.70
|
Rate for Payer: Group Health Inc Medicare |
$235.69
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$336.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$336.70
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$437.71
|
|
STRYKER PLATE CALCANEAL
|
Facility
IP
|
$925.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209982
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$462.60 |
Max. Negotiated Rate |
$462.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$462.60
|
|
STRYKER PLATE CALCANEAL
|
Facility
OP
|
$925.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209982
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$971.46 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$508.86
|
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 |
$462.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$531.99
|
Rate for Payer: Fidelis Medicare Advantage |
$971.46
|
Rate for Payer: Group Health Inc Commercial |
$462.60
|
Rate for Payer: Group Health Inc Medicare |
$323.82
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$462.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$601.38
|
|
STRYKER PLATE COMPRESSION
|
Facility
IP
|
$274.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206838
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$137.20 |
Max. Negotiated Rate |
$137.20 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$137.20
|
|
STRYKER PLATE COMPRESSION
|
Facility
OP
|
$274.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206838
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$96.04 |
Max. Negotiated Rate |
$288.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$150.92
|
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 |
$137.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$157.78
|
Rate for Payer: Fidelis Medicare Advantage |
$288.12
|
Rate for Payer: Group Health Inc Commercial |
$137.20
|
Rate for Payer: Group Health Inc Medicare |
$96.04
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$137.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.36
|
|
STRYKER PLATE FIXATOR
|
Facility
OP
|
$1,054.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204700
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,106.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$579.70
|
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 |
$527.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$606.05
|
Rate for Payer: Fidelis Medicare Advantage |
$1,106.70
|
Rate for Payer: Group Health Inc Commercial |
$527.00
|
Rate for Payer: Group Health Inc Medicare |
$368.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$527.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$527.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$685.10
|
|
STRYKER PLATE FIXATOR
|
Facility
IP
|
$1,054.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204700
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$527.00 |
Max. Negotiated Rate |
$527.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$527.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$527.00
|
|
STRYKER PLATE OLECRANON 4H LFT
|
Facility
IP
|
$2,406.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205536
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,203.00 |
Max. Negotiated Rate |
$1,203.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,203.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,203.00
|
|
STRYKER PLATE OLECRANON 4H LFT
|
Facility
OP
|
$2,406.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205536
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,526.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,323.30
|
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 |
$1,203.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,383.45
|
Rate for Payer: Fidelis Medicare Advantage |
$2,526.30
|
Rate for Payer: Group Health Inc Commercial |
$1,203.00
|
Rate for Payer: Group Health Inc Medicare |
$842.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,203.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,203.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,563.90
|
|
STRYKER PLATE R108 6 HOLE
|
Facility
OP
|
$646.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205713
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$679.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$355.74
|
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 |
$323.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$371.91
|
Rate for Payer: Fidelis Medicare Advantage |
$679.14
|
Rate for Payer: Group Health Inc Commercial |
$323.40
|
Rate for Payer: Group Health Inc Medicare |
$226.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$323.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$420.42
|
|
STRYKER PLATE R108 6 HOLE
|
Facility
IP
|
$646.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205713
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$323.40 |
Max. Negotiated Rate |
$323.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$323.40
|
|
STRYKER PLATE RADIUS
|
Facility
IP
|
$2,758.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205564
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,379.00 |
Max. Negotiated Rate |
$1,379.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,379.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,379.00
|
|