WIRE K 1.6X200
|
Facility
OP
|
$250.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906247
|
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
|
|
WIRE K 2.0MM X 6 SMTH TROC
|
Facility
OP
|
$12.60
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40202406
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$13.23 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.93
|
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 |
$6.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.24
|
Rate for Payer: Fidelis Medicare Advantage |
$13.23
|
Rate for Payer: Group Health Inc Commercial |
$6.30
|
Rate for Payer: Group Health Inc Medicare |
$4.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.19
|
|
WIRE K 2.0MM X 6 SMTH TROC
|
Facility
IP
|
$12.60
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40202406
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$6.30 |
Max. Negotiated Rate |
$6.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.30
|
|
WIRE K 2.0MM X 6 SMTH TROC PLN
|
Facility
OP
|
$16.25
|
|
Hospital Charge Code |
64904488
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$5.69 |
Max. Negotiated Rate |
$13.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.94
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.12
|
Rate for Payer: Aetna Government |
$8.12
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.05
|
Rate for Payer: Group Health Inc Commercial |
$8.12
|
Rate for Payer: Group Health Inc Medicare |
$5.69
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$8.12
|
|
WIRE K 2.4MM X 170MM
|
Facility
IP
|
$43.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906803
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$21.50 |
Max. Negotiated Rate |
$21.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.50
|
|
WIRE K 2.4MM X 170MM
|
Facility
OP
|
$43.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906803
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$15.05 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
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 |
$21.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.72
|
Rate for Payer: Fidelis Medicare Advantage |
$45.15
|
Rate for Payer: Group Health Inc Commercial |
$21.50
|
Rate for Payer: Group Health Inc Medicare |
$15.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.95
|
|
WIRE K 3.2MMX400MM
|
Facility
IP
|
$180.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200148
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$90.00 |
Max. Negotiated Rate |
$90.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
|
WIRE K 3.2MMX400MM
|
Facility
OP
|
$180.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200148
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$63.00 |
Max. Negotiated Rate |
$189.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.00
|
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 |
$90.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.50
|
Rate for Payer: Fidelis Medicare Advantage |
$189.00
|
Rate for Payer: Group Health Inc Commercial |
$90.00
|
Rate for Payer: Group Health Inc Medicare |
$63.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.00
|
|
WIRE K 3.2X150
|
Facility
IP
|
$75.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906249
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$37.50 |
Max. Negotiated Rate |
$37.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$37.50
|
|
WIRE K 3.2X150
|
Facility
OP
|
$75.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906249
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$26.25 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.25
|
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 |
$37.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.12
|
Rate for Payer: Fidelis Medicare Advantage |
$78.75
|
Rate for Payer: Group Health Inc Commercial |
$37.50
|
Rate for Payer: Group Health Inc Medicare |
$26.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$37.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.75
|
|
WIRE K FIXATION 3X285MM WCH
|
Facility
OP
|
$522.50
|
|
Hospital Charge Code |
64906172
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$182.88 |
Max. Negotiated Rate |
$418.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$287.38
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$261.25
|
Rate for Payer: Aetna Government |
$261.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$418.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$355.30
|
Rate for Payer: Group Health Inc Commercial |
$261.25
|
Rate for Payer: Group Health Inc Medicare |
$182.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$261.25
|
|
WIRE KIRSCHNER A
|
Facility
OP
|
$232.50
|
|
Hospital Charge Code |
64904046
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$81.38 |
Max. Negotiated Rate |
$186.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$127.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$116.25
|
Rate for Payer: Aetna Government |
$116.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$186.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$158.10
|
Rate for Payer: Group Health Inc Commercial |
$116.25
|
Rate for Payer: Group Health Inc Medicare |
$81.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$116.25
|
|
WIRE KIRSCHNER B
|
Facility
OP
|
$223.75
|
|
Hospital Charge Code |
64904048
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$78.31 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.06
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.88
|
Rate for Payer: Aetna Government |
$111.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$179.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$152.15
|
Rate for Payer: Group Health Inc Commercial |
$111.88
|
Rate for Payer: Group Health Inc Medicare |
$78.31
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.88
|
|
WIRE KIRSCHNER TROCAR 150M
|
Facility
OP
|
$42.08
|
|
Hospital Charge Code |
64903012
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$14.73 |
Max. Negotiated Rate |
$33.66 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.14
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.04
|
Rate for Payer: Aetna Government |
$21.04
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.66
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.61
|
Rate for Payer: Group Health Inc Commercial |
$21.04
|
Rate for Payer: Group Health Inc Medicare |
$14.73
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.04
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.04
|
|
WIRE, K TROCAR TIP 1.2X150MM
|
Facility
OP
|
$60.09
|
|
Hospital Charge Code |
40004430
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$21.03 |
Max. Negotiated Rate |
$48.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.04
|
Rate for Payer: Aetna Government |
$30.04
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.07
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.86
|
Rate for Payer: Group Health Inc Commercial |
$30.04
|
Rate for Payer: Group Health Inc Medicare |
$21.03
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.04
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$30.04
|
|
WIRE, K TROCAR TIP 1.6X150MM
|
Facility
OP
|
$60.09
|
|
Hospital Charge Code |
40004431
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$21.03 |
Max. Negotiated Rate |
$48.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.04
|
Rate for Payer: Aetna Government |
$30.04
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.07
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.86
|
Rate for Payer: Group Health Inc Commercial |
$30.04
|
Rate for Payer: Group Health Inc Medicare |
$21.03
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.04
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$30.04
|
|
WIRE K TROC PT 2END.062X230M
|
Facility
OP
|
$26.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906681
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$9.10 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.30
|
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 |
$13.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.95
|
Rate for Payer: Fidelis Medicare Advantage |
$27.30
|
Rate for Payer: Group Health Inc Commercial |
$13.00
|
Rate for Payer: Group Health Inc Medicare |
$9.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$13.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.90
|
|
WIRE K TROC PT 2END.062X230M
|
Facility
IP
|
$26.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906681
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$13.00 |
Max. Negotiated Rate |
$13.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$13.00
|
|
WIRE K TROC PT 2 ENDS 9X.062
|
Facility
OP
|
$0.46
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200153
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.16 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
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 |
$0.23
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
Rate for Payer: Fidelis Medicare Advantage |
$0.48
|
Rate for Payer: Group Health Inc Commercial |
$0.23
|
Rate for Payer: Group Health Inc Medicare |
$0.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
WIRE K TROC PT 2 ENDS 9X.062
|
Facility
IP
|
$0.46
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200153
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.23 |
Max. Negotiated Rate |
$0.23 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
|
WIRE K W-STOPPER
|
Facility
OP
|
$250.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906246
|
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
|
|
WIRE K W-STOPPER
|
Facility
IP
|
$250.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906246
|
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
|
|
WIRE, K X2 2.0
|
Facility
OP
|
$47.48
|
|
Hospital Charge Code |
40007544
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$16.62 |
Max. Negotiated Rate |
$37.98 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.11
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.74
|
Rate for Payer: Aetna Government |
$23.74
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.98
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.29
|
Rate for Payer: Group Health Inc Commercial |
$23.74
|
Rate for Payer: Group Health Inc Medicare |
$16.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.74
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$23.74
|
|
WIRE, KX2 2.0
|
Facility
OP
|
$47.48
|
|
Hospital Charge Code |
40204625
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$16.62 |
Max. Negotiated Rate |
$37.98 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.11
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.74
|
Rate for Payer: Aetna Government |
$23.74
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.98
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.29
|
Rate for Payer: Group Health Inc Commercial |
$23.74
|
Rate for Payer: Group Health Inc Medicare |
$16.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.74
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$23.74
|
|
WIRE LIGATURE
|
Facility
IP
|
$23.85
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
64907428
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$11.92 |
Max. Negotiated Rate |
$11.92 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.92
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11.92
|
|