ANCHOR
|
Facility
OP
|
$550.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40209639
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$577.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
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 |
$275.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$316.25
|
Rate for Payer: Fidelis Medicare Advantage |
$577.50
|
Rate for Payer: Group Health Inc Commercial |
$275.00
|
Rate for Payer: Group Health Inc Medicare |
$192.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$275.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$357.50
|
|
ANCHOR 5.5MM REELX STT
|
Facility
OP
|
$1,118.53
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902736
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,174.46 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$615.19
|
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 |
$559.26
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$643.15
|
Rate for Payer: Fidelis Medicare Advantage |
$1,174.46
|
Rate for Payer: Group Health Inc Commercial |
$559.26
|
Rate for Payer: Group Health Inc Medicare |
$391.49
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$559.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$559.26
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$727.04
|
|
ANCHOR 5.5MM REELX STT
|
Facility
IP
|
$1,118.53
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902736
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$559.26 |
Max. Negotiated Rate |
$559.26 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$559.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$559.26
|
|
ANCHORAGE UTIL PLATE STR 4 HOLE
|
Facility
IP
|
$3,572.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005918
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,786.00 |
Max. Negotiated Rate |
$1,786.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,786.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,786.00
|
|
ANCHORAGE UTIL PLATE STR 4 HOLE
|
Facility
OP
|
$3,572.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005918
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,750.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,964.60
|
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 |
$1,786.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,053.90
|
Rate for Payer: Fidelis Medicare Advantage |
$3,750.60
|
Rate for Payer: Group Health Inc Commercial |
$1,786.00
|
Rate for Payer: Group Health Inc Medicare |
$1,250.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,786.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,786.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,321.80
|
|
ANCHOR C 7 X 12 X 14 -48321074
|
Facility
OP
|
$9,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64906588
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$7,200.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,950.00
|
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 |
$7,200.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,120.00
|
Rate for Payer: Group Health Inc Commercial |
$4,500.00
|
Rate for Payer: Group Health Inc Medicare |
$3,150.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,500.00
|
|
ANCHORLOCK LEADING EDGE SOFT
|
Facility
IP
|
$790.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200247
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$395.00 |
Max. Negotiated Rate |
$395.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$395.00
|
|
ANCHORLOCK LEADING EDGE SOFT
|
Facility
OP
|
$790.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200247
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$829.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$434.50
|
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 |
$395.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$454.25
|
Rate for Payer: Fidelis Medicare Advantage |
$829.50
|
Rate for Payer: Group Health Inc Commercial |
$395.00
|
Rate for Payer: Group Health Inc Medicare |
$276.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$395.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$513.50
|
|
ANCHOR LUNBAR SA 10X22X30MMX12
|
Facility
IP
|
$23,220.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905080
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$11,610.00 |
Max. Negotiated Rate |
$11,610.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,610.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11,610.00
|
|
ANCHOR LUNBAR SA 10X22X30MMX12
|
Facility
OP
|
$23,220.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905080
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$24,381.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,771.00
|
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 |
$11,610.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,351.50
|
Rate for Payer: Fidelis Medicare Advantage |
$24,381.00
|
Rate for Payer: Group Health Inc Commercial |
$11,610.00
|
Rate for Payer: Group Health Inc Medicare |
$8,127.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,610.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11,610.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,093.00
|
|
ANCHOR MENISCAL REPAIR 0-DEG
|
Facility
IP
|
$910.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902440
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$455.00 |
Max. Negotiated Rate |
$455.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$455.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$455.00
|
|
ANCHOR MENISCAL REPAIR 0-DEG
|
Facility
OP
|
$910.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902440
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$955.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$500.50
|
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 |
$455.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$523.25
|
Rate for Payer: Fidelis Medicare Advantage |
$955.50
|
Rate for Payer: Group Health Inc Commercial |
$455.00
|
Rate for Payer: Group Health Inc Medicare |
$318.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$455.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$455.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$591.50
|
|
ANCHOR MENISCAL REPAIR 12-DEG
|
Facility
IP
|
$910.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902436
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$455.00 |
Max. Negotiated Rate |
$455.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$455.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$455.00
|
|
ANCHOR MENISCAL REPAIR 12-DEG
|
Facility
OP
|
$910.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902436
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$955.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$500.50
|
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 |
$455.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$523.25
|
Rate for Payer: Fidelis Medicare Advantage |
$955.50
|
Rate for Payer: Group Health Inc Commercial |
$455.00
|
Rate for Payer: Group Health Inc Medicare |
$318.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$455.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$455.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$591.50
|
|
ANCHOR MENISCAL REPAIR 27-DEG
|
Facility
OP
|
$875.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902438
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$918.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$481.25
|
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 |
$437.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$503.12
|
Rate for Payer: Fidelis Medicare Advantage |
$918.75
|
Rate for Payer: Group Health Inc Commercial |
$437.50
|
Rate for Payer: Group Health Inc Medicare |
$306.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$437.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$437.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$568.75
|
|
ANCHOR MENISCAL REPAIR 27-DEG
|
Facility
IP
|
$875.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902438
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$437.50 |
Max. Negotiated Rate |
$437.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$437.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$437.50
|
|
ANCHOR MINI QUICK PLUS W/2/0 CORD
|
Facility
IP
|
$1,210.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902319
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$605.00 |
Max. Negotiated Rate |
$605.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$605.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$605.00
|
|
ANCHOR MINI QUICK PLUS W/2/0 CORD
|
Facility
OP
|
$1,210.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902319
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,270.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$665.50
|
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 |
$605.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$695.75
|
Rate for Payer: Fidelis Medicare Advantage |
$1,270.50
|
Rate for Payer: Group Health Inc Commercial |
$605.00
|
Rate for Payer: Group Health Inc Medicare |
$423.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$605.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$605.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$786.50
|
|
ANCHOR, Q11 QA PLUS, O/C
|
Facility
IP
|
$1,212.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905609
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$606.25 |
Max. Negotiated Rate |
$606.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$606.25
|
|
ANCHOR, Q11 QA PLUS, O/C
|
Facility
OP
|
$1,212.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905609
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,273.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$666.88
|
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 |
$606.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$697.19
|
Rate for Payer: Fidelis Medicare Advantage |
$1,273.12
|
Rate for Payer: Group Health Inc Commercial |
$606.25
|
Rate for Payer: Group Health Inc Medicare |
$424.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$606.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$788.12
|
|
ANCHOR QUICK GII W/2 ETHIBOND
|
Facility
OP
|
$1,212.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901606
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,273.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$666.88
|
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 |
$606.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$697.19
|
Rate for Payer: Fidelis Medicare Advantage |
$1,273.12
|
Rate for Payer: Group Health Inc Commercial |
$606.25
|
Rate for Payer: Group Health Inc Medicare |
$424.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$606.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$788.12
|
|
ANCHOR QUICK GII W/2 ETHIBOND
|
Facility
IP
|
$1,212.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64901606
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$606.25 |
Max. Negotiated Rate |
$606.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$606.25
|
|
ANCHOR, SUPER QA PLUS, DS O/C
|
Facility
OP
|
$1,212.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905608
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,273.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$666.88
|
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 |
$606.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$697.19
|
Rate for Payer: Fidelis Medicare Advantage |
$1,273.12
|
Rate for Payer: Group Health Inc Commercial |
$606.25
|
Rate for Payer: Group Health Inc Medicare |
$424.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$606.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$788.12
|
|
ANCHOR, SUPER QA PLUS, DS O/C
|
Facility
IP
|
$1,212.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905608
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$606.25 |
Max. Negotiated Rate |
$606.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$606.25
|
|
Anderson Tube
|
Facility
OP
|
$90.02
|
|
Hospital Charge Code |
40200338
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$31.51 |
Max. Negotiated Rate |
$72.02 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.51
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.01
|
Rate for Payer: Aetna Government |
$45.01
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.02
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.21
|
Rate for Payer: Group Health Inc Commercial |
$45.01
|
Rate for Payer: Group Health Inc Medicare |
$31.51
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.01
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$45.01
|
|