STRYKER TRI #3X11MM TIB B/I PS
|
Facility
IP
|
$6,040.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205219
|
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 TRIATHLON 3X13MM TIB B/I
|
Facility
IP
|
$6,040.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205288
|
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 TRIATHLON 3X13MM TIB B/I
|
Facility
OP
|
$6,040.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205288
|
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 TRIDENT CERAMIC INSRT HIP
|
Facility
IP
|
$4,614.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029617
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,307.00 |
Max. Negotiated Rate |
$2,307.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,307.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,307.00
|
|
STRYKER TRIDENT CERAMIC INSRT HIP
|
Facility
OP
|
$4,614.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029617
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$4,844.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,537.70
|
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 |
$2,307.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,653.05
|
Rate for Payer: Fidelis Medicare Advantage |
$4,844.70
|
Rate for Payer: Group Health Inc Commercial |
$2,307.00
|
Rate for Payer: Group Health Inc Medicare |
$1,614.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,307.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,307.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,999.10
|
|
STRYKER TRI P/S FEMORAL 6 LFT
|
Facility
IP
|
$8,856.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205609
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,428.00 |
Max. Negotiated Rate |
$4,428.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,428.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.00
|
|
STRYKER TRI P/S FEMORAL 6 LFT
|
Facility
OP
|
$8,856.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205609
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$9,298.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,870.80
|
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 |
$4,428.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,092.20
|
Rate for Payer: Fidelis Medicare Advantage |
$9,298.80
|
Rate for Payer: Group Health Inc Commercial |
$4,428.00
|
Rate for Payer: Group Health Inc Medicare |
$3,099.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,428.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,756.40
|
|
STRYKER TRI TOTL K TIB BAS PLTSZ7
|
Facility
OP
|
$4,662.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206073
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$4,895.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,564.10
|
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 |
$2,331.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,680.65
|
Rate for Payer: Fidelis Medicare Advantage |
$4,895.10
|
Rate for Payer: Group Health Inc Commercial |
$2,331.00
|
Rate for Payer: Group Health Inc Medicare |
$1,631.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,331.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,331.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,030.30
|
|
STRYKER TRI TOTL K TIB BAS PLTSZ7
|
Facility
IP
|
$4,662.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206073
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,331.00 |
Max. Negotiated Rate |
$2,331.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,331.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,331.00
|
|
STRYKER TROCHANT/NAIL 11X180MM
|
Facility
OP
|
$2,528.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205194
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,654.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,390.40
|
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 |
$1,264.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,453.60
|
Rate for Payer: Fidelis Medicare Advantage |
$2,654.40
|
Rate for Payer: Group Health Inc Commercial |
$1,264.00
|
Rate for Payer: Group Health Inc Medicare |
$884.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,264.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,264.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,643.20
|
|
STRYKER TROCHANT/NAIL 11X180MM
|
Facility
IP
|
$2,528.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205194
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,264.00 |
Max. Negotiated Rate |
$1,264.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,264.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,264.00
|
|
STRYKER TWIST DRILL 1.6X35MM
|
Facility
OP
|
$533.92
|
|
Hospital Charge Code |
40204686
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$186.87 |
Max. Negotiated Rate |
$427.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$293.66
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$266.96
|
Rate for Payer: Aetna Government |
$266.96
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$427.14
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$363.07
|
Rate for Payer: Group Health Inc Commercial |
$266.96
|
Rate for Payer: Group Health Inc Medicare |
$186.87
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.96
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$266.96
|
|
STRYKER UH B/P COMP 53MMX26MM
|
Facility
IP
|
$2,149.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205953
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,074.50 |
Max. Negotiated Rate |
$1,074.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,074.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,074.50
|
|
STRYKER UH B/P COMP 53MMX26MM
|
Facility
OP
|
$2,149.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205953
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,256.45 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,181.95
|
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 |
$1,074.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,235.68
|
Rate for Payer: Fidelis Medicare Advantage |
$2,256.45
|
Rate for Payer: Group Health Inc Commercial |
$1,074.50
|
Rate for Payer: Group Health Inc Medicare |
$752.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,074.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,074.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,396.85
|
|
STRYKER UHR BI/ COMP 49MMX26MM
|
Facility
IP
|
$3,010.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205784
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,505.00 |
Max. Negotiated Rate |
$1,505.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.00
|
|
STRYKER UHR BI/ COMP 49MMX26MM
|
Facility
OP
|
$3,010.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205784
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,160.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,655.50
|
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 |
$1,505.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,730.75
|
Rate for Payer: Fidelis Medicare Advantage |
$3,160.50
|
Rate for Payer: Group Health Inc Commercial |
$1,505.00
|
Rate for Payer: Group Health Inc Medicare |
$1,053.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,956.50
|
|
STRYKER UHR BI/COMP 58MMX28MM
|
Facility
IP
|
$3,010.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205913
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,505.00 |
Max. Negotiated Rate |
$1,505.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.00
|
|
STRYKER UHR BI/COMP 58MMX28MM
|
Facility
OP
|
$3,010.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205913
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,160.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,655.50
|
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 |
$1,505.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,730.75
|
Rate for Payer: Fidelis Medicare Advantage |
$3,160.50
|
Rate for Payer: Group Health Inc Commercial |
$1,505.00
|
Rate for Payer: Group Health Inc Medicare |
$1,053.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,956.50
|
|
STRYKER UHR UNIV B/P COMP 51MMX28
|
Facility
OP
|
$3,070.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205791
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,223.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,688.50
|
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 |
$1,535.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,765.25
|
Rate for Payer: Fidelis Medicare Advantage |
$3,223.50
|
Rate for Payer: Group Health Inc Commercial |
$1,535.00
|
Rate for Payer: Group Health Inc Medicare |
$1,074.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,535.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,535.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,995.50
|
|
STRYKER UHR UNIV B/P COMP 51MMX28
|
Facility
IP
|
$3,070.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205791
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,535.00 |
Max. Negotiated Rate |
$1,535.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,535.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,535.00
|
|
STRYKER UN3 COVER,10MM W/TAB
|
Facility
IP
|
$407.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203407
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$203.65 |
Max. Negotiated Rate |
$203.65 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.65
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$203.65
|
|
STRYKER UN3 COVER,10MM W/TAB
|
Facility
OP
|
$407.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203407
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$427.66 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.02
|
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 |
$203.65
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.20
|
Rate for Payer: Fidelis Medicare Advantage |
$427.66
|
Rate for Payer: Group Health Inc Commercial |
$203.65
|
Rate for Payer: Group Health Inc Medicare |
$142.56
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.65
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$203.65
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$264.74
|
|
STRYKER UN3 STRAIGHT PLATE 16HOLE
|
Facility
IP
|
$515.42
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203426
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$257.71 |
Max. Negotiated Rate |
$257.71 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.71
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$257.71
|
|
STRYKER UN3 STRAIGHT PLATE 16HOLE
|
Facility
OP
|
$515.42
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40203426
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$541.19 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$283.48
|
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 |
$257.71
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$296.37
|
Rate for Payer: Fidelis Medicare Advantage |
$541.19
|
Rate for Payer: Group Health Inc Commercial |
$257.71
|
Rate for Payer: Group Health Inc Medicare |
$180.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.71
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$257.71
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$335.02
|
|
STRYKER UNIVERSAL FEM HEAD
|
Facility
OP
|
$2,338.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40029619
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,455.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,286.01
|
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 |
$1,169.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,344.46
|
Rate for Payer: Fidelis Medicare Advantage |
$2,455.11
|
Rate for Payer: Group Health Inc Commercial |
$1,169.10
|
Rate for Payer: Group Health Inc Medicare |
$818.37
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,169.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,169.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,519.83
|
|