|
STRYKER SCREW LAG 6.5 X 85MM
|
Facility
OP
|
$402.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$422.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$221.43
|
| 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 |
$201.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$231.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.73
|
| Rate for Payer: Group Health Inc Commercial |
$201.30
|
| Rate for Payer: Group Health Inc Medicare |
$140.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$261.69
|
|
|
STRYKER SCREW LOCKING 1.7MMX8
|
Facility
OP
|
$183.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204489
|
|
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 SCREW LOCKING 1.7MMX8
|
Facility
IP
|
$183.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204489
|
|
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 LOCKING 1.9MMX5
|
Facility
OP
|
$157.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.06 |
| Max. Negotiated Rate |
$165.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.52
|
| 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 |
$78.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.16
|
| Rate for Payer: Group Health Inc Commercial |
$78.65
|
| Rate for Payer: Group Health Inc Medicare |
$55.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.24
|
|
|
STRYKER SCREW LOCKING 1.9MMX5
|
Facility
IP
|
$157.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.65
|
|
|
STRYKER SCREW LOCKING 2.3X
|
Facility
IP
|
$230.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.35 |
| Max. Negotiated Rate |
$115.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.35
|
|
|
STRYKER SCREW LOCKING 2.3X
|
Facility
OP
|
$230.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.74 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.88
|
| 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 |
$115.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.24
|
| Rate for Payer: Group Health Inc Commercial |
$115.35
|
| Rate for Payer: Group Health Inc Medicare |
$80.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.96
|
|
|
STRYKER SCREW LOCKING 3.5
|
Facility
OP
|
$247.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$260.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.29
|
| 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 |
$123.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$260.19
|
| Rate for Payer: Group Health Inc Commercial |
$123.90
|
| Rate for Payer: Group Health Inc Medicare |
$86.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.07
|
|
|
STRYKER SCREW LOCKING 3.5
|
Facility
IP
|
$247.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$123.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.90
|
|
|
STRYKER SCREW LOCKING 3.5MM
|
Facility
IP
|
$247.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$123.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.90
|
|
|
STRYKER SCREW LOCKING 3.5MM
|
Facility
OP
|
$247.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$260.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.29
|
| 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 |
$123.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$260.19
|
| Rate for Payer: Group Health Inc Commercial |
$123.90
|
| Rate for Payer: Group Health Inc Medicare |
$86.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.07
|
|
|
STRYKER SCREW NON-LK 3.5X14MM
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
|
|
STRYKER SCREW NON-LK 3.5X14MM
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$323.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.40
|
| 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 |
$154.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$177.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.40
|
| Rate for Payer: Group Health Inc Commercial |
$154.00
|
| Rate for Payer: Group Health Inc Medicare |
$107.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.20
|
|
|
STRYKER SCREW NON-LK 3.5X18MM
|
Facility
OP
|
$320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.00
|
| 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 |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.00
|
| Rate for Payer: Group Health Inc Commercial |
$160.00
|
| Rate for Payer: Group Health Inc Medicare |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.00
|
|
|
STRYKER SCREW NON-LK 3.5X18MM
|
Facility
IP
|
$320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
|
|
STRYKER SCREW NON-LK 3.5X20 MM
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
|
|
STRYKER SCREW NON-LK 3.5X20 MM
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$323.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.40
|
| 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 |
$154.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$177.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.40
|
| Rate for Payer: Group Health Inc Commercial |
$154.00
|
| Rate for Payer: Group Health Inc Medicare |
$107.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.20
|
|
|
STRYKER SCREW NON-LK 3.5X20MM
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$323.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.40
|
| 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 |
$154.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$177.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.40
|
| Rate for Payer: Group Health Inc Commercial |
$154.00
|
| Rate for Payer: Group Health Inc Medicare |
$107.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.20
|
|
|
STRYKER SCREW NON-LK 3.5X20MM
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
|
|
STRYKER SCREW NON-LK 3.5X22MM
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
|
|
STRYKER SCREW NON-LK 3.5X22MM
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$323.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.40
|
| 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 |
$154.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$177.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.40
|
| Rate for Payer: Group Health Inc Commercial |
$154.00
|
| Rate for Payer: Group Health Inc Medicare |
$107.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.20
|
|
|
STRYKER SCREW NON-LK 3.5X26MM
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$323.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.40
|
| 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 |
$154.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$177.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.40
|
| Rate for Payer: Group Health Inc Commercial |
$154.00
|
| Rate for Payer: Group Health Inc Medicare |
$107.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.20
|
|
|
STRYKER SCREW NON-LK 3.5X26MM
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
|
|
STRYKER SCREW NON-LK 3.5X28MM
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$323.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.40
|
| 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 |
$154.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$177.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.40
|
| Rate for Payer: Group Health Inc Commercial |
$154.00
|
| Rate for Payer: Group Health Inc Medicare |
$107.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.20
|
|
|
STRYKER SCREW NON-LK 3.5X28MM
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40004624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.00
|
|
