STRYKER SCFREW 1.7X6MM
|
Facility
IP
|
$183.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204488
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$91.65 |
Max. Negotiated Rate |
$91.65 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.65
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$91.65
|
|
STRYKER SCFREW 1.7X6MM
|
Facility
OP
|
$183.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204488
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$64.16 |
Max. Negotiated Rate |
$192.46 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.82
|
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 |
$91.65
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
Rate for Payer: Fidelis Medicare Advantage |
$192.46
|
Rate for Payer: Group Health Inc Commercial |
$91.65
|
Rate for Payer: Group Health Inc Medicare |
$64.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.65
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$91.65
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.14
|
|
STRYKER SCFREW LOCKING 1.7MMX5
|
Facility
OP
|
$183.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204487
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$64.16 |
Max. Negotiated Rate |
$192.46 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.82
|
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 |
$91.65
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.40
|
Rate for Payer: Fidelis Medicare Advantage |
$192.46
|
Rate for Payer: Group Health Inc Commercial |
$91.65
|
Rate for Payer: Group Health Inc Medicare |
$64.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.65
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$91.65
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.14
|
|
STRYKER SCFREW LOCKING 1.7MMX5
|
Facility
IP
|
$183.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204487
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$91.65 |
Max. Negotiated Rate |
$91.65 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.65
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$91.65
|
|
STRYKER SCREW 2.4X10
|
Facility
IP
|
$119.89
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202654
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$59.94 |
Max. Negotiated Rate |
$59.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$59.94
|
|
STRYKER SCREW 2.4X10
|
Facility
OP
|
$119.89
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202654
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$41.96 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.94
|
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 |
$59.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.94
|
Rate for Payer: Fidelis Medicare Advantage |
$125.88
|
Rate for Payer: Group Health Inc Commercial |
$59.94
|
Rate for Payer: Group Health Inc Medicare |
$41.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$59.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.93
|
|
STRYKER SCREW 2.4X12
|
Facility
IP
|
$119.89
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202655
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$59.94 |
Max. Negotiated Rate |
$59.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$59.94
|
|
STRYKER SCREW 2.4X12
|
Facility
OP
|
$119.89
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202655
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$41.96 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.94
|
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 |
$59.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.94
|
Rate for Payer: Fidelis Medicare Advantage |
$125.88
|
Rate for Payer: Group Health Inc Commercial |
$59.94
|
Rate for Payer: Group Health Inc Medicare |
$41.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$59.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.93
|
|
STRYKER SCREW 35MM (1896-5035S)
|
Facility
OP
|
$280.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40029611
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$98.00 |
Max. Negotiated Rate |
$294.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.00
|
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 |
$140.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.00
|
Rate for Payer: Fidelis Medicare Advantage |
$294.00
|
Rate for Payer: Group Health Inc Commercial |
$140.00
|
Rate for Payer: Group Health Inc Medicare |
$98.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$140.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.00
|
|
STRYKER SCREW 35MM (1896-5035S)
|
Facility
IP
|
$280.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40029611
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$140.00 |
Max. Negotiated Rate |
$140.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$140.00
|
|
STRYKER SCREW 40 MM (1896-5040S)
|
Facility
IP
|
$280.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40029610
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$140.00 |
Max. Negotiated Rate |
$140.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$140.00
|
|
STRYKER SCREW 40 MM (1896-5040S)
|
Facility
OP
|
$280.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40029610
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$98.00 |
Max. Negotiated Rate |
$294.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.00
|
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 |
$140.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.00
|
Rate for Payer: Fidelis Medicare Advantage |
$294.00
|
Rate for Payer: Group Health Inc Commercial |
$140.00
|
Rate for Payer: Group Health Inc Medicare |
$98.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$140.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.00
|
|
STRYKER SCREW 45MM (1896-5045S)
|
Facility
IP
|
$280.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40029609
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$140.00 |
Max. Negotiated Rate |
$140.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$140.00
|
|
STRYKER SCREW 45MM (1896-5045S)
|
Facility
OP
|
$280.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40029609
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$98.00 |
Max. Negotiated Rate |
$294.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.00
|
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 |
$140.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.00
|
Rate for Payer: Fidelis Medicare Advantage |
$294.00
|
Rate for Payer: Group Health Inc Commercial |
$140.00
|
Rate for Payer: Group Health Inc Medicare |
$98.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$140.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.00
|
|
STRYKER SCREW 5MM T2 NAILING SYS
|
Facility
OP
|
$266.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205181
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$93.10 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$146.30
|
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 |
$133.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$152.95
|
Rate for Payer: Fidelis Medicare Advantage |
$279.30
|
Rate for Payer: Group Health Inc Commercial |
$133.00
|
Rate for Payer: Group Health Inc Medicare |
$93.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$133.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.90
|
|
STRYKER SCREW 5MM T2 NAILING SYS
|
Facility
IP
|
$266.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205181
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$133.00 |
Max. Negotiated Rate |
$133.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$133.00
|
|
STRYKER SCREW 5X
|
Facility
OP
|
$334.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206100
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$117.11 |
Max. Negotiated Rate |
$351.33 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$184.03
|
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 |
$167.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$192.40
|
Rate for Payer: Fidelis Medicare Advantage |
$351.33
|
Rate for Payer: Group Health Inc Commercial |
$167.30
|
Rate for Payer: Group Health Inc Medicare |
$117.11
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$167.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.49
|
|
STRYKER SCREW 5X
|
Facility
IP
|
$334.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206100
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$167.30 |
Max. Negotiated Rate |
$167.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$167.30
|
|
STRYKER SCREW 8MM T2 END CAP ST
|
Facility
OP
|
$337.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205415
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$118.09 |
Max. Negotiated Rate |
$354.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$185.57
|
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 |
$168.70
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$194.00
|
Rate for Payer: Fidelis Medicare Advantage |
$354.27
|
Rate for Payer: Group Health Inc Commercial |
$168.70
|
Rate for Payer: Group Health Inc Medicare |
$118.09
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$168.70
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$219.31
|
|
STRYKER SCREW 8MM T2 END CAP ST
|
Facility
IP
|
$337.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205415
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$168.70 |
Max. Negotiated Rate |
$168.70 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$168.70
|
|
STRYKER SCREW BONE 2.3X18MM
|
Facility
IP
|
$119.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205246
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$59.50 |
Max. Negotiated Rate |
$59.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$59.50
|
|
STRYKER SCREW BONE 2.3X18MM
|
Facility
OP
|
$119.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205246
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$41.65 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.45
|
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 |
$59.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.42
|
Rate for Payer: Fidelis Medicare Advantage |
$124.95
|
Rate for Payer: Group Health Inc Commercial |
$59.50
|
Rate for Payer: Group Health Inc Medicare |
$41.65
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$59.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.35
|
|
STRYKER SCREW BONE 3.5
|
Facility
IP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205418
|
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 SCREW BONE 3.5
|
Facility
OP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205418
|
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 SCREW BONE 3.5MM
|
Facility
IP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205497
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$73.94 |
Max. Negotiated Rate |
$73.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
|