STRYKER PLATE RADIUS
|
Facility
OP
|
$2,758.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205564
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,895.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,516.90
|
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 |
$1,379.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,585.85
|
Rate for Payer: Fidelis Medicare Advantage |
$2,895.90
|
Rate for Payer: Group Health Inc Commercial |
$1,379.00
|
Rate for Payer: Group Health Inc Medicare |
$965.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,379.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,379.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,792.70
|
|
STRYKER PLATE TUBULAR 1/3 11HOLES
|
Facility
OP
|
$135.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209434
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$47.25 |
Max. Negotiated Rate |
$141.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.25
|
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 |
$67.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.62
|
Rate for Payer: Fidelis Medicare Advantage |
$141.75
|
Rate for Payer: Group Health Inc Commercial |
$67.50
|
Rate for Payer: Group Health Inc Medicare |
$47.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.75
|
|
STRYKER PLATE TUBULAR 1/3 11HOLES
|
Facility
IP
|
$135.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209434
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$67.50 |
Max. Negotiated Rate |
$67.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
|
STRYKER PLATE TUBULAR 1/3 3 H
|
Facility
IP
|
$81.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205719
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.60 |
Max. Negotiated Rate |
$40.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.60
|
|
STRYKER PLATE TUBULAR 1/3 3 H
|
Facility
OP
|
$81.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205719
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.42 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.66
|
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 |
$40.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.69
|
Rate for Payer: Fidelis Medicare Advantage |
$85.26
|
Rate for Payer: Group Health Inc Commercial |
$40.60
|
Rate for Payer: Group Health Inc Medicare |
$28.42
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.78
|
|
STRYKER PLATE TUBULAR 1/3 8HOLES
|
Facility
IP
|
$121.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209443
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$60.75 |
Max. Negotiated Rate |
$60.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$60.75
|
|
STRYKER PLATE TUBULAR 1/3 8HOLES
|
Facility
OP
|
$121.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209443
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$42.52 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.82
|
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 |
$60.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.86
|
Rate for Payer: Fidelis Medicare Advantage |
$127.58
|
Rate for Payer: Group Health Inc Commercial |
$60.75
|
Rate for Payer: Group Health Inc Medicare |
$42.52
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$60.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.98
|
|
STRYKER PLATE TUBULAR 1/3 9HOLES
|
Facility
IP
|
$121.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209444
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$60.75 |
Max. Negotiated Rate |
$60.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$60.75
|
|
STRYKER PLATE TUBULAR 1/3 9HOLES
|
Facility
OP
|
$121.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209444
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$42.52 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.82
|
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 |
$60.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.86
|
Rate for Payer: Fidelis Medicare Advantage |
$127.58
|
Rate for Payer: Group Health Inc Commercial |
$60.75
|
Rate for Payer: Group Health Inc Medicare |
$42.52
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$60.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.98
|
|
STRYKER POINT REDUCTION
|
Facility
OP
|
$677.00
|
|
Hospital Charge Code |
40205491
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$236.95 |
Max. Negotiated Rate |
$541.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$372.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$338.50
|
Rate for Payer: Aetna Government |
$338.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$541.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$460.36
|
Rate for Payer: Group Health Inc Commercial |
$338.50
|
Rate for Payer: Group Health Inc Medicare |
$236.95
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$338.50
|
|
STRYKER POSTERIORLY STAB/FEMORAL
|
Facility
IP
|
$6,324.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40207045
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,162.00 |
Max. Negotiated Rate |
$3,162.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,162.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,162.00
|
|
STRYKER POSTERIORLY STAB/FEMORAL
|
Facility
OP
|
$6,324.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40207045
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$6,640.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,478.20
|
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 |
$3,162.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,636.30
|
Rate for Payer: Fidelis Medicare Advantage |
$6,640.20
|
Rate for Payer: Group Health Inc Commercial |
$3,162.00
|
Rate for Payer: Group Health Inc Medicare |
$2,213.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,162.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,162.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,110.60
|
|
STRYKER PROX HUMERAL NAIL 8X280MM
|
Facility
IP
|
$3,162.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205143
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,581.00 |
Max. Negotiated Rate |
$1,581.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,581.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,581.00
|
|
STRYKER PROX HUMERAL NAIL 8X280MM
|
Facility
OP
|
$3,162.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205143
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,320.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,739.10
|
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 |
$1,581.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,818.15
|
Rate for Payer: Fidelis Medicare Advantage |
$3,320.10
|
Rate for Payer: Group Health Inc Commercial |
$1,581.00
|
Rate for Payer: Group Health Inc Medicare |
$1,106.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,581.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,581.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,055.30
|
|
STRYKER PS FEM COMP #2 R CEMENTED
|
Facility
OP
|
$5,352.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205218
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$5,619.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,943.60
|
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 |
$2,676.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,077.40
|
Rate for Payer: Fidelis Medicare Advantage |
$5,619.60
|
Rate for Payer: Group Health Inc Commercial |
$2,676.00
|
Rate for Payer: Group Health Inc Medicare |
$1,873.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,676.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,676.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,478.80
|
|
STRYKER PS FEM COMP #2 R CEMENTED
|
Facility
IP
|
$5,352.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205218
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,676.00 |
Max. Negotiated Rate |
$2,676.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,676.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,676.00
|
|
STRYKER PS TIBIAL B/I SIZE 4
|
Facility
OP
|
$5,808.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205205
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$6,098.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,194.40
|
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 |
$2,904.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,339.60
|
Rate for Payer: Fidelis Medicare Advantage |
$6,098.40
|
Rate for Payer: Group Health Inc Commercial |
$2,904.00
|
Rate for Payer: Group Health Inc Medicare |
$2,032.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,904.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,904.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,775.20
|
|
STRYKER PS TIBIAL B/I SIZE 4
|
Facility
IP
|
$5,808.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205205
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,904.00 |
Max. Negotiated Rate |
$2,904.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,904.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,904.00
|
|
STRYKER PT CANCELLOUS SCREW 6.5MM
|
Facility
OP
|
$53.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205275
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$18.62 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.26
|
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 |
$26.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.59
|
Rate for Payer: Fidelis Medicare Advantage |
$55.86
|
Rate for Payer: Group Health Inc Commercial |
$26.60
|
Rate for Payer: Group Health Inc Medicare |
$18.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.58
|
|
STRYKER PT CANCELLOUS SCREW 6.5MM
|
Facility
IP
|
$53.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205275
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$26.60 |
Max. Negotiated Rate |
$26.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.60
|
|
STRYKER PT CNCLL SCRW 6.5X60MM
|
Facility
OP
|
$66.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205274
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$23.10 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.30
|
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 |
$33.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.95
|
Rate for Payer: Fidelis Medicare Advantage |
$69.30
|
Rate for Payer: Group Health Inc Commercial |
$33.00
|
Rate for Payer: Group Health Inc Medicare |
$23.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$33.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.90
|
|
STRYKER PT CNCLL SCRW 6.5X60MM
|
Facility
IP
|
$66.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205274
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$33.00 |
Max. Negotiated Rate |
$33.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$33.00
|
|
STRYKER R88 4HOLE MPS CURVED PLT
|
Facility
OP
|
$547.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205682
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$574.77 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$301.07
|
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 |
$273.70
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$314.76
|
Rate for Payer: Fidelis Medicare Advantage |
$574.77
|
Rate for Payer: Group Health Inc Commercial |
$273.70
|
Rate for Payer: Group Health Inc Medicare |
$191.59
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$273.70
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$355.81
|
|
STRYKER R88 4HOLE MPS CURVED PLT
|
Facility
IP
|
$547.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205682
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$273.70 |
Max. Negotiated Rate |
$273.70 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$273.70
|
|
STRYKER R88 5H MPS CURVED PLATE
|
Facility
IP
|
$597.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205683
|
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
|
|