ZZ WIRE/GLIDE/.035/150CM
|
Facility
IP
|
$356.69
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569164
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$178.34 |
Max. Negotiated Rate |
$178.34 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.34
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$178.34
|
|
ZZ WIRE/GLIDE/.035/150CM
|
Facility
OP
|
$356.69
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569164
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$374.52 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.18
|
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 |
$178.34
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$205.10
|
Rate for Payer: Fidelis Medicare Advantage |
$374.52
|
Rate for Payer: Group Health Inc Commercial |
$178.34
|
Rate for Payer: Group Health Inc Medicare |
$124.84
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.34
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$178.34
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.85
|
|
ZZ WIRE/GLIDE/.038/150CM
|
Facility
OP
|
$356.69
|
|
Hospital Charge Code |
41569165
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$124.84 |
Max. Negotiated Rate |
$285.35 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.18
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$178.34
|
Rate for Payer: Aetna Government |
$178.34
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$285.35
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$242.55
|
Rate for Payer: Group Health Inc Commercial |
$178.34
|
Rate for Payer: Group Health Inc Medicare |
$124.84
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.34
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$178.34
|
|
ZZ WIRE/GLIDE SS/.035/180CM
|
Facility
IP
|
$569.31
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569159
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$284.66 |
Max. Negotiated Rate |
$284.66 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.66
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$284.66
|
|
ZZ WIRE/GLIDE SS/.035/180CM
|
Facility
OP
|
$569.31
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569159
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$597.78 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$313.12
|
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 |
$284.66
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$327.35
|
Rate for Payer: Fidelis Medicare Advantage |
$597.78
|
Rate for Payer: Group Health Inc Commercial |
$284.66
|
Rate for Payer: Group Health Inc Medicare |
$199.26
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.66
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$284.66
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.05
|
|
ZZ WIRE/GLIDE SS/.038/150CM
|
Facility
OP
|
$548.05
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569161
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$575.45 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$301.43
|
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 |
$274.02
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$315.13
|
Rate for Payer: Fidelis Medicare Advantage |
$575.45
|
Rate for Payer: Group Health Inc Commercial |
$274.02
|
Rate for Payer: Group Health Inc Medicare |
$191.82
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$274.02
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$274.02
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$356.23
|
|
ZZ WIRE/GLIDE SS/.038/150CM
|
Facility
IP
|
$548.05
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569161
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$274.02 |
Max. Negotiated Rate |
$274.02 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$274.02
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$274.02
|
|
ZZ WIRE/GLIDE SS/.038/260CM
|
Facility
OP
|
$601.21
|
|
Hospital Charge Code |
41569160
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$210.42 |
Max. Negotiated Rate |
$480.97 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.67
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.60
|
Rate for Payer: Aetna Government |
$300.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.97
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.82
|
Rate for Payer: Group Health Inc Commercial |
$300.60
|
Rate for Payer: Group Health Inc Medicare |
$210.42
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$300.60
|
|
ZZ WIRE/GOLDGLIDE/.018/180CM/45
|
Facility
OP
|
$372.10
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569166
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$390.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.66
|
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 |
$186.05
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$213.96
|
Rate for Payer: Fidelis Medicare Advantage |
$390.70
|
Rate for Payer: Group Health Inc Commercial |
$186.05
|
Rate for Payer: Group Health Inc Medicare |
$130.24
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$186.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$241.86
|
|
ZZ WIRE/GOLDGLIDE/.018/180CM/45
|
Facility
IP
|
$372.10
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569166
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$186.05 |
Max. Negotiated Rate |
$186.05 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$186.05
|
|
ZZ WIRE/GOLDGLIDE/.018/180CM/70
|
Facility
OP
|
$372.10
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569167
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$390.70 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.66
|
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 |
$186.05
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$213.96
|
Rate for Payer: Fidelis Medicare Advantage |
$390.70
|
Rate for Payer: Group Health Inc Commercial |
$186.05
|
Rate for Payer: Group Health Inc Medicare |
$130.24
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$186.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$241.86
|
|
ZZ WIRE/GOLDGLIDE/.018/180CM/70
|
Facility
IP
|
$372.10
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569167
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$186.05 |
Max. Negotiated Rate |
$186.05 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$186.05
|
|
ZZ WIRE/MEASURING/.035/145CM
|
Facility
OP
|
$10.83
|
|
Hospital Charge Code |
41569172
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$3.79 |
Max. Negotiated Rate |
$8.66 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.96
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.42
|
Rate for Payer: Aetna Government |
$5.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.66
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.36
|
Rate for Payer: Group Health Inc Commercial |
$5.42
|
Rate for Payer: Group Health Inc Medicare |
$3.79
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.42
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5.42
|
|
ZZ WIRE NEWTON LT 035-260CM
|
Facility
OP
|
$60.95
|
|
Hospital Charge Code |
41569672
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$21.33 |
Max. Negotiated Rate |
$48.76 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.52
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.48
|
Rate for Payer: Aetna Government |
$30.48
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.76
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.45
|
Rate for Payer: Group Health Inc Commercial |
$30.48
|
Rate for Payer: Group Health Inc Medicare |
$21.33
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.48
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$30.48
|
|
ZZ WIRE NITINOL 018-6CM
|
Facility
OP
|
$7.00
|
|
Hospital Charge Code |
41569673
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.45 |
Max. Negotiated Rate |
$5.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
Rate for Payer: Aetna Government |
$3.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
Rate for Payer: Group Health Inc Commercial |
$3.50
|
Rate for Payer: Group Health Inc Medicare |
$2.45
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
ZZ WIRE PLAT + 018-180
|
Facility
OP
|
$215.43
|
|
Hospital Charge Code |
41569674
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$75.40 |
Max. Negotiated Rate |
$172.34 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$118.49
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$107.72
|
Rate for Payer: Aetna Government |
$107.72
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$172.34
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.49
|
Rate for Payer: Group Health Inc Commercial |
$107.72
|
Rate for Payer: Group Health Inc Medicare |
$75.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$107.72
|
|
ZZ WIRE/PLAT+/018/260CM
|
Facility
OP
|
$222.19
|
|
Hospital Charge Code |
41569177
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$77.77 |
Max. Negotiated Rate |
$177.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.10
|
Rate for Payer: Aetna Government |
$111.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$151.09
|
Rate for Payer: Group Health Inc Commercial |
$111.10
|
Rate for Payer: Group Health Inc Medicare |
$77.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.10
|
|
ZZ WIRE PLAT+/018/80CM
|
Facility
OP
|
$183.92
|
|
Hospital Charge Code |
41569212
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$64.37 |
Max. Negotiated Rate |
$147.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.16
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.96
|
Rate for Payer: Aetna Government |
$91.96
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.14
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.07
|
Rate for Payer: Group Health Inc Commercial |
$91.96
|
Rate for Payer: Group Health Inc Medicare |
$64.37
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.96
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$91.96
|
|
ZZ WIRE/PLAT+/025/180CM
|
Facility
IP
|
$222.19
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569178
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$111.10 |
Max. Negotiated Rate |
$111.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.10
|
|
ZZ WIRE/PLAT+/025/180CM
|
Facility
OP
|
$222.19
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569178
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$233.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.20
|
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 |
$111.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.76
|
Rate for Payer: Fidelis Medicare Advantage |
$233.30
|
Rate for Payer: Group Health Inc Commercial |
$111.10
|
Rate for Payer: Group Health Inc Medicare |
$77.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$111.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.42
|
|
ZZ WIRE/ROADRUNNER/.018/180CM
|
Facility
OP
|
$201.10
|
|
Hospital Charge Code |
41569179
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$70.38 |
Max. Negotiated Rate |
$160.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.60
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.55
|
Rate for Payer: Aetna Government |
$100.55
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.75
|
Rate for Payer: Group Health Inc Commercial |
$100.55
|
Rate for Payer: Group Health Inc Medicare |
$70.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.55
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$100.55
|
|
ZZ WIRE/ROADRUNNER/.035/180CM
|
Facility
OP
|
$51.57
|
|
Hospital Charge Code |
41569181
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$18.05 |
Max. Negotiated Rate |
$41.26 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.36
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.78
|
Rate for Payer: Aetna Government |
$25.78
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.26
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.07
|
Rate for Payer: Group Health Inc Commercial |
$25.78
|
Rate for Payer: Group Health Inc Medicare |
$18.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.78
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$25.78
|
|
ZZ WIRE/ROADRUNNER LT/.035/180CM
|
Facility
OP
|
$57.75
|
|
Hospital Charge Code |
41569180
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$20.21 |
Max. Negotiated Rate |
$46.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.76
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.88
|
Rate for Payer: Aetna Government |
$28.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.27
|
Rate for Payer: Group Health Inc Commercial |
$28.88
|
Rate for Payer: Group Health Inc Medicare |
$20.21
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.88
|
|
ZZ WIRE/ROSEN/.035/180CM
|
Facility
OP
|
$27.86
|
|
Hospital Charge Code |
41569182
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$9.75 |
Max. Negotiated Rate |
$22.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.32
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.93
|
Rate for Payer: Aetna Government |
$13.93
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.29
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.94
|
Rate for Payer: Group Health Inc Commercial |
$13.93
|
Rate for Payer: Group Health Inc Medicare |
$9.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.93
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$13.93
|
|
ZZ WIRES 10/42 7F 135 160
|
Facility
OP
|
$3,896.00
|
|
Hospital Charge Code |
41567355
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,363.60 |
Max. Negotiated Rate |
$3,116.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,142.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,948.00
|
Rate for Payer: Aetna Government |
$1,948.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,116.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,649.28
|
Rate for Payer: Group Health Inc Commercial |
$1,948.00
|
Rate for Payer: Group Health Inc Medicare |
$1,363.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,948.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,948.00
|
|