STRYKER TAP 3.5
|
Facility
OP
|
$210.00
|
|
Hospital Charge Code |
40205417
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$73.50 |
Max. Negotiated Rate |
$168.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.00
|
Rate for Payer: Aetna Government |
$105.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.80
|
Rate for Payer: Group Health Inc Commercial |
$105.00
|
Rate for Payer: Group Health Inc Medicare |
$73.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
|
STRYKER T-BUTTRESS PLATE
|
Facility
OP
|
$547.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205487
|
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 T-BUTTRESS PLATE
|
Facility
IP
|
$547.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205487
|
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 TEFLON TUBE STERILE
|
Facility
OP
|
$246.00
|
|
Hospital Charge Code |
40205145
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$86.10 |
Max. Negotiated Rate |
$196.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$135.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$123.00
|
Rate for Payer: Aetna Government |
$123.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$167.28
|
Rate for Payer: Group Health Inc Commercial |
$123.00
|
Rate for Payer: Group Health Inc Medicare |
$86.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$123.00
|
|
STRYKER TIBIAL BEARING INSERT 5
|
Facility
IP
|
$6,040.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205610
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,020.00 |
Max. Negotiated Rate |
$3,020.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,020.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,020.00
|
|
STRYKER TIBIAL BEARING INSERT 5
|
Facility
OP
|
$6,040.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205610
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$6,342.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,322.00
|
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 |
$3,020.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,473.00
|
Rate for Payer: Fidelis Medicare Advantage |
$6,342.00
|
Rate for Payer: Group Health Inc Commercial |
$3,020.00
|
Rate for Payer: Group Health Inc Medicare |
$2,114.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,020.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,020.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,926.00
|
|
STRYKER TORQUE LIMITER
|
Facility
OP
|
$1,190.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205153
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,249.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$654.50
|
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 |
$595.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$684.25
|
Rate for Payer: Fidelis Medicare Advantage |
$1,249.50
|
Rate for Payer: Group Health Inc Commercial |
$595.00
|
Rate for Payer: Group Health Inc Medicare |
$416.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$595.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$595.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$773.50
|
|
STRYKER TORQUE LIMITER
|
Facility
IP
|
$1,190.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205153
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$595.00 |
Max. Negotiated Rate |
$595.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$595.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$595.00
|
|
STRYKER TOTAL K CEM STM 12MMX50MM
|
Facility
OP
|
$2,850.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206074
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,992.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,567.50
|
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 |
$1,425.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,638.75
|
Rate for Payer: Fidelis Medicare Advantage |
$2,992.50
|
Rate for Payer: Group Health Inc Commercial |
$1,425.00
|
Rate for Payer: Group Health Inc Medicare |
$997.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,425.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,425.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.50
|
|
STRYKER TOTAL K CEM STM 12MMX50MM
|
Facility
IP
|
$2,850.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206074
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,425.00 |
Max. Negotiated Rate |
$1,425.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,425.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,425.00
|
|
STRYKER TOTAL KNEE FEM COMPONENT
|
Facility
OP
|
$5,405.40
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029623
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$5,675.67 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,972.97
|
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 |
$2,702.70
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,108.10
|
Rate for Payer: Fidelis Medicare Advantage |
$5,675.67
|
Rate for Payer: Group Health Inc Commercial |
$2,702.70
|
Rate for Payer: Group Health Inc Medicare |
$1,891.89
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,702.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,702.70
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,513.51
|
|
STRYKER TOTAL KNEE FEM COMPONENT
|
Facility
IP
|
$5,405.40
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029623
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,702.70 |
Max. Negotiated Rate |
$2,702.70 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,702.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,702.70
|
|
STRYKER TOTAL KNEE KRAMTA
|
Facility
OP
|
$608.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029627
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$212.80 |
Max. Negotiated Rate |
$638.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$334.40
|
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 |
$304.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$349.60
|
Rate for Payer: Fidelis Medicare Advantage |
$638.40
|
Rate for Payer: Group Health Inc Commercial |
$304.00
|
Rate for Payer: Group Health Inc Medicare |
$212.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$304.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$304.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$395.20
|
|
STRYKER TOTAL KNEE KRAMTA
|
Facility
IP
|
$608.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029627
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$304.00 |
Max. Negotiated Rate |
$304.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$304.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$304.00
|
|
STRYKER TOTAL KNEE SYMM PATELLA
|
Facility
OP
|
$1,845.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029626
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,937.46 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,014.86
|
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 |
$922.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,060.99
|
Rate for Payer: Fidelis Medicare Advantage |
$1,937.46
|
Rate for Payer: Group Health Inc Commercial |
$922.60
|
Rate for Payer: Group Health Inc Medicare |
$645.82
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$922.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$922.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,199.38
|
|
STRYKER TOTAL KNEE SYMM PATELLA
|
Facility
IP
|
$1,845.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029626
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$922.60 |
Max. Negotiated Rate |
$922.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$922.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$922.60
|
|
STRYKER TOTAL KNEE TIBIAL BASEPLT
|
Facility
IP
|
$3,288.60
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029624
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,644.30 |
Max. Negotiated Rate |
$1,644.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,644.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,644.30
|
|
STRYKER TOTAL KNEE TIBIAL BASEPLT
|
Facility
OP
|
$3,288.60
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029624
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,453.03 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,808.73
|
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 |
$1,644.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,890.94
|
Rate for Payer: Fidelis Medicare Advantage |
$3,453.03
|
Rate for Payer: Group Health Inc Commercial |
$1,644.30
|
Rate for Payer: Group Health Inc Medicare |
$1,151.01
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,644.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,644.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,137.59
|
|
STRYKER TOTAL STABILIZER T/I #5
|
Facility
OP
|
$6,720.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205820
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$7,056.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,696.00
|
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 |
$3,360.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,864.00
|
Rate for Payer: Fidelis Medicare Advantage |
$7,056.00
|
Rate for Payer: Group Health Inc Commercial |
$3,360.00
|
Rate for Payer: Group Health Inc Medicare |
$2,352.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,360.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,360.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,368.00
|
|
STRYKER TOTAL STABILIZER T/I #5
|
Facility
IP
|
$6,720.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205820
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,360.00 |
Max. Negotiated Rate |
$3,360.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,360.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,360.00
|
|
STRYKER T-PLATE 1.7MM
|
Facility
IP
|
$408.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209607
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$204.40 |
Max. Negotiated Rate |
$204.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$204.40
|
|
STRYKER T-PLATE 1.7MM
|
Facility
OP
|
$408.80
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209607
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$429.24 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.84
|
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 |
$204.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$235.06
|
Rate for Payer: Fidelis Medicare Advantage |
$429.24
|
Rate for Payer: Group Health Inc Commercial |
$204.40
|
Rate for Payer: Group Health Inc Medicare |
$143.08
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$204.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.72
|
|
STRYKER TRANSFXNG PINS 60X250MM
|
Facility
OP
|
$231.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205558
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$80.85 |
Max. Negotiated Rate |
$242.55 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$127.05
|
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 |
$115.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.82
|
Rate for Payer: Fidelis Medicare Advantage |
$242.55
|
Rate for Payer: Group Health Inc Commercial |
$115.50
|
Rate for Payer: Group Health Inc Medicare |
$80.85
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$115.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.15
|
|
STRYKER TRANSFXNG PINS 60X250MM
|
Facility
IP
|
$231.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205558
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$115.50 |
Max. Negotiated Rate |
$115.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$115.50
|
|
STRYKER TRI #3X11MM TIB B/I PS
|
Facility
OP
|
$6,040.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205219
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$6,342.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,322.00
|
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 |
$3,020.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,473.00
|
Rate for Payer: Fidelis Medicare Advantage |
$6,342.00
|
Rate for Payer: Group Health Inc Commercial |
$3,020.00
|
Rate for Payer: Group Health Inc Medicare |
$2,114.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,020.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,020.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,926.00
|
|