STRYKER SCREW CANN LP 6.5MM
|
Facility
IP
|
$1,228.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205792
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$614.25 |
Max. Negotiated Rate |
$614.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$614.25
|
|
STRYKER SCREW CANN LP 6.5MM
|
Facility
OP
|
$1,228.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205792
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,289.92 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$675.68
|
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 |
$614.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$706.39
|
Rate for Payer: Fidelis Medicare Advantage |
$1,289.92
|
Rate for Payer: Group Health Inc Commercial |
$614.25
|
Rate for Payer: Group Health Inc Medicare |
$429.98
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$614.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$798.52
|
|
STRYKER SCREW CANN SS FT 4.0
|
Facility
IP
|
$40.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205551
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$20.19 |
Max. Negotiated Rate |
$20.19 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.19
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$20.19
|
|
STRYKER SCREW CANN SS FT 4.0
|
Facility
OP
|
$40.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205551
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$14.13 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.21
|
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 |
$20.19
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.22
|
Rate for Payer: Fidelis Medicare Advantage |
$42.40
|
Rate for Payer: Group Health Inc Commercial |
$20.19
|
Rate for Payer: Group Health Inc Medicare |
$14.13
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.19
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$20.19
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.25
|
|
STRYKER SCREW CANNULATED 4.0X50MM
|
Facility
OP
|
$390.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205591
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$409.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
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 |
$195.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
Rate for Payer: Group Health Inc Commercial |
$195.00
|
Rate for Payer: Group Health Inc Medicare |
$136.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
STRYKER SCREW CANNULATED 4.0X50MM
|
Facility
IP
|
$390.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205591
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$195.00 |
Max. Negotiated Rate |
$195.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
STRYKER SCREW CORTEX 4.5X 40MM
|
Facility
OP
|
$28.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203832
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$9.80 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
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 |
$14.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.10
|
Rate for Payer: Fidelis Medicare Advantage |
$29.40
|
Rate for Payer: Group Health Inc Commercial |
$14.00
|
Rate for Payer: Group Health Inc Medicare |
$9.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.20
|
|
STRYKER SCREW CORTEX 4.5X 40MM
|
Facility
IP
|
$28.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203832
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$14.00 |
Max. Negotiated Rate |
$14.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
|
STRYKER SCREW CORTEX 4.5X42 HEX
|
Facility
OP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203833
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$19.91 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.28
|
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 |
$28.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.71
|
Rate for Payer: Fidelis Medicare Advantage |
$59.72
|
Rate for Payer: Group Health Inc Commercial |
$28.44
|
Rate for Payer: Group Health Inc Medicare |
$19.91
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.97
|
|
STRYKER SCREW CORTEX 4.5X42 HEX
|
Facility
IP
|
$56.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203833
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.44 |
Max. Negotiated Rate |
$28.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.44
|
|
STRYKER SCREW CORTEX 4.5X48
|
Facility
OP
|
$116.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203834
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.91 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.28
|
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 |
$58.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.21
|
Rate for Payer: Fidelis Medicare Advantage |
$122.72
|
Rate for Payer: Group Health Inc Commercial |
$58.44
|
Rate for Payer: Group Health Inc Medicare |
$40.91
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$58.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.97
|
|
STRYKER SCREW CORTEX 4.5X48
|
Facility
IP
|
$116.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203834
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$58.44 |
Max. Negotiated Rate |
$58.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$58.44
|
|
STRYKER SCREW CORTEX ST 3.5MM X
|
Facility
OP
|
$60.15
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205369
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$21.05 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.08
|
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 |
$30.08
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.59
|
Rate for Payer: Fidelis Medicare Advantage |
$63.16
|
Rate for Payer: Group Health Inc Commercial |
$30.08
|
Rate for Payer: Group Health Inc Medicare |
$21.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$30.08
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.10
|
|
STRYKER SCREW CORTEX ST 3.5MM X
|
Facility
IP
|
$60.15
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205369
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$30.08 |
Max. Negotiated Rate |
$30.08 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$30.08
|
|
STRYKER SCREW CORTX ST 3.5MMX16MM
|
Facility
OP
|
$35.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205172
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$12.25 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
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 |
$17.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.12
|
Rate for Payer: Fidelis Medicare Advantage |
$36.75
|
Rate for Payer: Group Health Inc Commercial |
$17.50
|
Rate for Payer: Group Health Inc Medicare |
$12.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.75
|
|
STRYKER SCREW CORTX ST 3.5MMX16MM
|
Facility
IP
|
$35.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205172
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.50 |
Max. Negotiated Rate |
$17.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
|
STRYKER SCREW LAG 10.5 X 100MM
|
Facility
OP
|
$963.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208098
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$337.12 |
Max. Negotiated Rate |
$1,011.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$529.76
|
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 |
$481.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$553.84
|
Rate for Payer: Fidelis Medicare Advantage |
$1,011.36
|
Rate for Payer: Group Health Inc Commercial |
$481.60
|
Rate for Payer: Group Health Inc Medicare |
$337.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$481.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$626.08
|
|
STRYKER SCREW LAG 10.5 X 100MM
|
Facility
IP
|
$963.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208098
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$481.60 |
Max. Negotiated Rate |
$481.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$481.60
|
|
STRYKER SCREW LAG 10.5X110MM
|
Facility
IP
|
$963.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206055
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$481.60 |
Max. Negotiated Rate |
$481.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$481.60
|
|
STRYKER SCREW LAG 10.5X110MM
|
Facility
OP
|
$963.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206055
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$337.12 |
Max. Negotiated Rate |
$1,011.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$529.76
|
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 |
$481.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$553.84
|
Rate for Payer: Fidelis Medicare Advantage |
$1,011.36
|
Rate for Payer: Group Health Inc Commercial |
$481.60
|
Rate for Payer: Group Health Inc Medicare |
$337.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$481.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$626.08
|
|
STRYKER SCREW LAG 6.5 X 70MM
|
Facility
OP
|
$444.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204664
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$466.83 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$244.53
|
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 |
$222.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.64
|
Rate for Payer: Fidelis Medicare Advantage |
$466.83
|
Rate for Payer: Group Health Inc Commercial |
$222.30
|
Rate for Payer: Group Health Inc Medicare |
$155.61
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$222.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.99
|
|
STRYKER SCREW LAG 6.5 X 70MM
|
Facility
IP
|
$444.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204664
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$222.30 |
Max. Negotiated Rate |
$222.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$222.30
|
|
STRYKER SCREW LAG 6.5X80MM T2 REC
|
Facility
OP
|
$443.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204665
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$465.99 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$244.09
|
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 |
$221.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.18
|
Rate for Payer: Fidelis Medicare Advantage |
$465.99
|
Rate for Payer: Group Health Inc Commercial |
$221.90
|
Rate for Payer: Group Health Inc Medicare |
$155.33
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$221.90
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.47
|
|
STRYKER SCREW LAG 6.5X80MM T2 REC
|
Facility
IP
|
$443.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204665
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$221.90 |
Max. Negotiated Rate |
$221.90 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$221.90
|
|
STRYKER SCREW LAG 6.5 X 85MM
|
Facility
IP
|
$402.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204666
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$201.30 |
Max. Negotiated Rate |
$201.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$201.30
|
|