STRYKER VLIFT CAGE 18X20MM
|
Facility
IP
|
$14,350.04
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205237
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$7,175.02 |
Max. Negotiated Rate |
$7,175.02 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,175.02
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7,175.02
|
|
STRYKER VLIFT CAGE 18X20MM
|
Facility
OP
|
$14,350.04
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205237
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$15,067.54 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,892.52
|
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 |
$7,175.02
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,251.27
|
Rate for Payer: Fidelis Medicare Advantage |
$15,067.54
|
Rate for Payer: Group Health Inc Commercial |
$7,175.02
|
Rate for Payer: Group Health Inc Medicare |
$5,022.51
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,175.02
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7,175.02
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,327.53
|
|
STRYKER VOLAR DR PLATE LONG
|
Facility
IP
|
$1,309.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205951
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$654.50 |
Max. Negotiated Rate |
$654.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$654.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$654.50
|
|
STRYKER VOLAR DR PLATE LONG
|
Facility
OP
|
$1,309.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205951
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,374.45 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$719.95
|
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 |
$654.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$752.68
|
Rate for Payer: Fidelis Medicare Advantage |
$1,374.45
|
Rate for Payer: Group Health Inc Commercial |
$654.50
|
Rate for Payer: Group Health Inc Medicare |
$458.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$654.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$654.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$850.85
|
|
STRYKER VOLAR DR PLATE RIGHT LONG
|
Facility
IP
|
$1,587.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205751
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$793.80 |
Max. Negotiated Rate |
$793.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$793.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$793.80
|
|
STRYKER VOLAR DR PLATE RIGHT LONG
|
Facility
OP
|
$1,587.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205751
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,666.98 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$873.18
|
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 |
$793.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$912.87
|
Rate for Payer: Fidelis Medicare Advantage |
$1,666.98
|
Rate for Payer: Group Health Inc Commercial |
$793.80
|
Rate for Payer: Group Health Inc Medicare |
$555.66
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$793.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$793.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,031.94
|
|
STRYKER VOLAR DR PLATE SHORT
|
Facility
IP
|
$1,039.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205950
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$519.50 |
Max. Negotiated Rate |
$519.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$519.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$519.50
|
|
STRYKER VOLAR DR PLATE SHORT
|
Facility
OP
|
$1,039.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205950
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,090.95 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$571.45
|
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 |
$519.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$597.42
|
Rate for Payer: Fidelis Medicare Advantage |
$1,090.95
|
Rate for Payer: Group Health Inc Commercial |
$519.50
|
Rate for Payer: Group Health Inc Medicare |
$363.65
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$519.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$519.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$675.35
|
|
STRYKER VOLAR NARROW LEFT
|
Facility
OP
|
$1,512.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205506
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,587.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$831.60
|
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 |
$756.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$869.40
|
Rate for Payer: Fidelis Medicare Advantage |
$1,587.60
|
Rate for Payer: Group Health Inc Commercial |
$756.00
|
Rate for Payer: Group Health Inc Medicare |
$529.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$756.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$756.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$982.80
|
|
STRYKER VOLAR NARROW LEFT
|
Facility
IP
|
$1,512.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205506
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$756.00 |
Max. Negotiated Rate |
$756.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$756.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$756.00
|
|
STRYKER VOLAR PLATE
|
Facility
IP
|
$1,184.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209970
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$592.20 |
Max. Negotiated Rate |
$592.20 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$592.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$592.20
|
|
STRYKER VOLAR PLATE
|
Facility
OP
|
$1,184.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209970
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,243.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$651.42
|
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 |
$592.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$681.03
|
Rate for Payer: Fidelis Medicare Advantage |
$1,243.62
|
Rate for Payer: Group Health Inc Commercial |
$592.20
|
Rate for Payer: Group Health Inc Medicare |
$414.54
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$592.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$592.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$769.86
|
|
STRYKER WASHER
|
Facility
IP
|
$300.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008254
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$150.00 |
Max. Negotiated Rate |
$150.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
|
STRYKER WASHER
|
Facility
OP
|
$300.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008254
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$105.00 |
Max. Negotiated Rate |
$315.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
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 |
$150.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$172.50
|
Rate for Payer: Fidelis Medicare Advantage |
$315.00
|
Rate for Payer: Group Health Inc Commercial |
$150.00
|
Rate for Payer: Group Health Inc Medicare |
$105.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.00
|
|
STRYKER WASHER 2.0-9.0MM
|
Facility
OP
|
$148.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208171
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.97 |
Max. Negotiated Rate |
$155.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.66
|
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 |
$74.24
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.38
|
Rate for Payer: Fidelis Medicare Advantage |
$155.90
|
Rate for Payer: Group Health Inc Commercial |
$74.24
|
Rate for Payer: Group Health Inc Medicare |
$51.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$74.24
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.51
|
|
STRYKER WASHER 2.0-9.0MM
|
Facility
IP
|
$148.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208171
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$74.24 |
Max. Negotiated Rate |
$74.24 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$74.24
|
|
STRYKER WASHER FOR 8MM SCRW STEEL
|
Facility
IP
|
$64.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208174
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$32.20 |
Max. Negotiated Rate |
$32.20 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$32.20
|
|
STRYKER WASHER FOR 8MM SCRW STEEL
|
Facility
OP
|
$64.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40208174
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$22.54 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.42
|
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 |
$32.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.03
|
Rate for Payer: Fidelis Medicare Advantage |
$67.62
|
Rate for Payer: Group Health Inc Commercial |
$32.20
|
Rate for Payer: Group Health Inc Medicare |
$22.54
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$32.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.86
|
|
STRYKER WIRE GUIDE 100MM (1806-00
|
Facility
OP
|
$310.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40029614
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$248.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$170.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$248.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$210.80
|
Rate for Payer: Group Health Inc Commercial |
$155.00
|
Rate for Payer: Group Health Inc Medicare |
$108.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$155.00
|
|
STRYKER WIRE KIRSCHNER (1806-0050
|
Facility
OP
|
$190.00
|
|
Hospital Charge Code |
40029615
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$66.50 |
Max. Negotiated Rate |
$152.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.00
|
Rate for Payer: Aetna Government |
$95.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
Rate for Payer: Group Health Inc Commercial |
$95.00
|
Rate for Payer: Group Health Inc Medicare |
$66.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
|
STRYKER WIRE TROC PT 2 E 9X.035
|
Facility
IP
|
$43.40
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40205161
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$21.70 |
Max. Negotiated Rate |
$21.70 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.70
|
|
STRYKER WIRE TROC PT 2 E 9X.035
|
Facility
OP
|
$43.40
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40205161
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$45.57 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.87
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.70
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.96
|
Rate for Payer: Fidelis Medicare Advantage |
$45.57
|
Rate for Payer: Group Health Inc Commercial |
$21.70
|
Rate for Payer: Group Health Inc Medicare |
$15.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.70
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.21
|
|
STRYKER XIA3 PA SCREW 5.5X45MM
|
Facility
IP
|
$3,379.94
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205235
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,689.97 |
Max. Negotiated Rate |
$1,689.97 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,689.97
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,689.97
|
|
STRYKER XIA3 PA SCREW 5.5X45MM
|
Facility
OP
|
$3,379.94
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205235
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,548.94 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,858.97
|
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 |
$1,689.97
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,943.47
|
Rate for Payer: Fidelis Medicare Advantage |
$3,548.94
|
Rate for Payer: Group Health Inc Commercial |
$1,689.97
|
Rate for Payer: Group Health Inc Medicare |
$1,182.98
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,689.97
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,689.97
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,196.96
|
|
STRYKER XIA3PA SCRW 5.5X40MM
|
Facility
IP
|
$3,307.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208156
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,653.75 |
Max. Negotiated Rate |
$1,653.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,653.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,653.75
|
|