WASHER 4MM
|
Facility
IP
|
$137.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903235
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$68.75 |
Max. Negotiated Rate |
$68.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$68.75
|
|
WASHER 7MM
|
Facility
IP
|
$137.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903237
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$68.75 |
Max. Negotiated Rate |
$68.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$68.75
|
|
WASHER 7MM
|
Facility
OP
|
$137.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903237
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$48.12 |
Max. Negotiated Rate |
$144.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$75.62
|
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 |
$68.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$79.06
|
Rate for Payer: Fidelis Medicare Advantage |
$144.38
|
Rate for Payer: Group Health Inc Commercial |
$68.75
|
Rate for Payer: Group Health Inc Medicare |
$48.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$68.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.38
|
|
WASHER 9MM
|
Facility
OP
|
$165.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901959
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$58.01 |
Max. Negotiated Rate |
$174.04 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.16
|
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 |
$82.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.31
|
Rate for Payer: Fidelis Medicare Advantage |
$174.04
|
Rate for Payer: Group Health Inc Commercial |
$82.88
|
Rate for Payer: Group Health Inc Medicare |
$58.01
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$82.88
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.74
|
|
WASHER 9MM
|
Facility
IP
|
$165.75
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901959
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$82.88 |
Max. Negotiated Rate |
$82.88 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$82.88
|
|
WASHER ASNIS 35.OMM SS
|
Facility
IP
|
$50.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205077
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$25.20 |
Max. Negotiated Rate |
$25.20 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$25.20
|
|
WASHER ASNIS 35.OMM SS
|
Facility
OP
|
$50.40
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205077
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.64 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.72
|
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 |
$25.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.98
|
Rate for Payer: Fidelis Medicare Advantage |
$52.92
|
Rate for Payer: Group Health Inc Commercial |
$25.20
|
Rate for Payer: Group Health Inc Medicare |
$17.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$25.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.76
|
|
WASHER BONE 4.0MM ROUND
|
Facility
IP
|
$60.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901686
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$30.06 |
Max. Negotiated Rate |
$30.06 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$30.06
|
|
WASHER BONE 4.0MM ROUND
|
Facility
OP
|
$60.13
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901686
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$21.05 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.07
|
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 |
$30.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.57
|
Rate for Payer: Fidelis Medicare Advantage |
$63.14
|
Rate for Payer: Group Health Inc Commercial |
$30.06
|
Rate for Payer: Group Health Inc Medicare |
$21.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$30.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.08
|
|
WASHER CANNULATED SCREW SS
|
Facility
OP
|
$78.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902481
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$27.30 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.90
|
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 |
$39.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.85
|
Rate for Payer: Fidelis Medicare Advantage |
$81.90
|
Rate for Payer: Group Health Inc Commercial |
$39.00
|
Rate for Payer: Group Health Inc Medicare |
$27.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$39.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.70
|
|
WASHER CANNULATED SCREW SS
|
Facility
IP
|
$78.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902481
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$39.00 |
Max. Negotiated Rate |
$39.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$39.00
|
|
WASHER FIXATION BOLT 4.0MM S&N
|
Facility
OP
|
$66.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901286
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$23.27 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.56
|
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 |
$33.24
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.23
|
Rate for Payer: Fidelis Medicare Advantage |
$69.80
|
Rate for Payer: Group Health Inc Commercial |
$33.24
|
Rate for Payer: Group Health Inc Medicare |
$23.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$33.24
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.21
|
|
WASHER FIXATION BOLT 4.0MM S&N
|
Facility
IP
|
$66.48
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901286
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$33.24 |
Max. Negotiated Rate |
$33.24 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$33.24
|
|
WASHER FOR 4MM SCREW IN STEEL
|
Facility
IP
|
$55.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200146
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$27.50 |
Max. Negotiated Rate |
$27.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$27.50
|
|
WASHER FOR 4MM SCREW IN STEEL
|
Facility
OP
|
$55.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200146
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$19.25 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.25
|
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 |
$27.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.62
|
Rate for Payer: Fidelis Medicare Advantage |
$57.75
|
Rate for Payer: Group Health Inc Commercial |
$27.50
|
Rate for Payer: Group Health Inc Medicare |
$19.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$27.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.75
|
|
WASHER SCR 3.75 TITAN
|
Facility
OP
|
$143.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40004885
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$50.05 |
Max. Negotiated Rate |
$150.15 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$78.65
|
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 |
$71.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.22
|
Rate for Payer: Fidelis Medicare Advantage |
$150.15
|
Rate for Payer: Group Health Inc Commercial |
$71.50
|
Rate for Payer: Group Health Inc Medicare |
$50.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$71.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.95
|
|
WASHER SCR 3.75 TITAN
|
Facility
IP
|
$143.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40004885
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$71.50 |
Max. Negotiated Rate |
$71.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$71.50
|
|
WASHER SUTURE TITANIUM
|
Facility
OP
|
$250.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906862
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$87.50 |
Max. Negotiated Rate |
$262.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
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 |
$125.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.75
|
Rate for Payer: Fidelis Medicare Advantage |
$262.50
|
Rate for Payer: Group Health Inc Commercial |
$125.00
|
Rate for Payer: Group Health Inc Medicare |
$87.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.50
|
|
WASHER SUTURE TITANIUM
|
Facility
IP
|
$250.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906862
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$125.00 |
Max. Negotiated Rate |
$125.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
WASTE OMALIZUMA 150MG ML
|
Facility
OP
|
$29.46
|
|
Service Code
|
HCPCS J2357 JW
|
Hospital Charge Code |
41649980
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.31 |
Max. Negotiated Rate |
$19.15 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.73
|
Rate for Payer: Aetna Government |
$14.73
|
Rate for Payer: Cash Price |
$39.46
|
Rate for Payer: Cash Price |
$39.46
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.73
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.94
|
Rate for Payer: Group Health Inc Commercial |
$14.73
|
Rate for Payer: Group Health Inc Medicare |
$10.31
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.73
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14.73
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.15
|
|
WASTE OMALIZUMA 150MG ML
|
Facility
IP
|
$29.46
|
|
Service Code
|
HCPCS J2357 JW
|
Hospital Charge Code |
41649980
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.73 |
Max. Negotiated Rate |
$14.73 |
Rate for Payer: Cash Price |
$39.46
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.73
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14.73
|
|
WATER BED
|
Facility
OP
|
$70.17
|
|
Hospital Charge Code |
40200860
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$24.56 |
Max. Negotiated Rate |
$56.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.59
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.08
|
Rate for Payer: Aetna Government |
$35.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.14
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.72
|
Rate for Payer: Group Health Inc Commercial |
$35.08
|
Rate for Payer: Group Health Inc Medicare |
$24.56
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$35.08
|
|
WATER FOR INJECTION 10 ML
|
Facility
OP
|
$1.47
|
|
Service Code
|
HCPCS A4216
|
Hospital Charge Code |
41654208
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$0.25 |
Max. Negotiated Rate |
$1.18 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.81
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
Rate for Payer: Aetna Government |
$0.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.18
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.00
|
Rate for Payer: Group Health Inc Commercial |
$0.74
|
Rate for Payer: Group Health Inc Medicare |
$0.51
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.74
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.74
|
|
WATER FOR INJECTION 10 ML
|
Facility
OP
|
$1.47
|
|
Service Code
|
HCPCS A4216
|
Hospital Charge Code |
41644208
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$0.25 |
Max. Negotiated Rate |
$1.18 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.81
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
Rate for Payer: Aetna Government |
$0.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.18
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.00
|
Rate for Payer: Group Health Inc Commercial |
$0.74
|
Rate for Payer: Group Health Inc Medicare |
$0.51
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.74
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.74
|
|
WATER FOR INJECTION 50 ML
|
Facility
OP
|
$0.66
|
|
Service Code
|
HCPCS A4216
|
Hospital Charge Code |
41654209
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$0.23 |
Max. Negotiated Rate |
$0.53 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
Rate for Payer: Aetna Government |
$0.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.53
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.45
|
Rate for Payer: Group Health Inc Commercial |
$0.33
|
Rate for Payer: Group Health Inc Medicare |
$0.23
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
|