STRYKER SCREW BONE 3.5MM
|
Facility
OP
|
$147.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205497
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.76 |
Max. Negotiated Rate |
$155.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.33
|
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 |
$73.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.03
|
Rate for Payer: Fidelis Medicare Advantage |
$155.27
|
Rate for Payer: Group Health Inc Commercial |
$73.94
|
Rate for Payer: Group Health Inc Medicare |
$51.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.12
|
|
STRYKER SCREW BONE 3.5X10MM
|
Facility
OP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205499
|
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 3.5X10MM
|
Facility
IP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205499
|
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 3.5X18MM
|
Facility
OP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205495
|
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 3.5X18MM
|
Facility
IP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205495
|
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 3.5X26MM
|
Facility
IP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205530
|
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 3.5X26MM
|
Facility
OP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205530
|
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 3.5X42MM
|
Facility
IP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205503
|
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 3.5X42MM
|
Facility
OP
|
$109.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205503
|
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 3.5X60MM
|
Facility
IP
|
$114.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205504
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$57.40 |
Max. Negotiated Rate |
$57.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$57.40
|
|
STRYKER SCREW BONE 3.5X60MM
|
Facility
OP
|
$114.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205504
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.18 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.14
|
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 |
$57.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.01
|
Rate for Payer: Fidelis Medicare Advantage |
$120.54
|
Rate for Payer: Group Health Inc Commercial |
$57.40
|
Rate for Payer: Group Health Inc Medicare |
$40.18
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$57.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.62
|
|
STRYKER SCREW BONE TIT 2.3X16MM
|
Facility
OP
|
$78.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205247
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$27.30 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.90
|
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 |
$39.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.85
|
Rate for Payer: Fidelis Medicare Advantage |
$81.90
|
Rate for Payer: Group Health Inc Commercial |
$39.00
|
Rate for Payer: Group Health Inc Medicare |
$27.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$39.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.70
|
|
STRYKER SCREW BONE TIT 2.3X16MM
|
Facility
IP
|
$78.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205247
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$39.00 |
Max. Negotiated Rate |
$39.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$39.00
|
|
STRYKER SCREW CANC 4.0X18MM HEX F
|
Facility
IP
|
$32.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205550
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$16.10 |
Max. Negotiated Rate |
$16.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$16.10
|
|
STRYKER SCREW CANC 4.0X18MM HEX F
|
Facility
OP
|
$32.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205550
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$11.27 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
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 |
$16.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
Rate for Payer: Fidelis Medicare Advantage |
$33.81
|
Rate for Payer: Group Health Inc Commercial |
$16.10
|
Rate for Payer: Group Health Inc Medicare |
$11.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$16.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.93
|
|
STRYKER SCREW CANN 4.0X60MM PT
|
Facility
OP
|
$336.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205498
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$117.60 |
Max. Negotiated Rate |
$352.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$184.80
|
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 |
$168.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$193.20
|
Rate for Payer: Fidelis Medicare Advantage |
$352.80
|
Rate for Payer: Group Health Inc Commercial |
$168.00
|
Rate for Payer: Group Health Inc Medicare |
$117.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$168.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.40
|
|
STRYKER SCREW CANN 4.0X60MM PT
|
Facility
IP
|
$336.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205498
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$168.00 |
Max. Negotiated Rate |
$168.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$168.00
|
|
STRYKER SCREW CANN 4.0X65 PT
|
Facility
IP
|
$448.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205522
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$224.00 |
Max. Negotiated Rate |
$224.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$224.00
|
|
STRYKER SCREW CANN 4.0X65 PT
|
Facility
OP
|
$448.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205522
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$470.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$246.40
|
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 |
$224.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$257.60
|
Rate for Payer: Fidelis Medicare Advantage |
$470.40
|
Rate for Payer: Group Health Inc Commercial |
$224.00
|
Rate for Payer: Group Health Inc Medicare |
$156.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$224.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.20
|
|
STRYKER SCREW CANN 6.5
|
Facility
IP
|
$594.95
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205947
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$297.48 |
Max. Negotiated Rate |
$297.48 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.48
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$297.48
|
|
STRYKER SCREW CANN 6.5
|
Facility
OP
|
$594.95
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205947
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$624.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$327.22
|
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 |
$297.48
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$342.10
|
Rate for Payer: Fidelis Medicare Advantage |
$624.70
|
Rate for Payer: Group Health Inc Commercial |
$297.48
|
Rate for Payer: Group Health Inc Medicare |
$208.23
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.48
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$297.48
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$386.72
|
|
STRYKER SCREW CANN 6.5 X 95 MM
|
Facility
OP
|
$205.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201569
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$71.75 |
Max. Negotiated Rate |
$215.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$112.75
|
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 |
$102.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$117.88
|
Rate for Payer: Fidelis Medicare Advantage |
$215.25
|
Rate for Payer: Group Health Inc Commercial |
$102.50
|
Rate for Payer: Group Health Inc Medicare |
$71.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$102.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.25
|
|
STRYKER SCREW CANN 6.5 X 95 MM
|
Facility
IP
|
$205.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201569
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$102.50 |
Max. Negotiated Rate |
$102.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$102.50
|
|
STRYKER SCREW CANN ASNIS III
|
Facility
IP
|
$612.95
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206254
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$306.48 |
Max. Negotiated Rate |
$306.48 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$306.48
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$306.48
|
|
STRYKER SCREW CANN ASNIS III
|
Facility
OP
|
$612.95
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40206254
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$643.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.12
|
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 |
$306.48
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$352.45
|
Rate for Payer: Fidelis Medicare Advantage |
$643.60
|
Rate for Payer: Group Health Inc Commercial |
$306.48
|
Rate for Payer: Group Health Inc Medicare |
$214.53
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$306.48
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$306.48
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$398.42
|
|