BEARING PSN KNEE LFT 20MM
|
Facility
OP
|
$1,700.00
|
|
Hospital Charge Code |
64906271
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$595.00 |
Max. Negotiated Rate |
$1,360.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$935.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$850.00
|
Rate for Payer: Aetna Government |
$850.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,360.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,156.00
|
Rate for Payer: Group Health Inc Commercial |
$850.00
|
Rate for Payer: Group Health Inc Medicare |
$595.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$850.00
|
|
BEARING PSN L TB E-F FM 6-9
|
Facility
OP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906657
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,570.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
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 |
$1,700.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,955.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,570.00
|
Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,210.00
|
|
BEARING PSN L TB E-F FM 6-9
|
Facility
IP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906657
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,700.00 |
Max. Negotiated Rate |
$1,700.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|
BEARING PSN RGT 11MM C-D 00511
|
Facility
OP
|
$3,400.00
|
|
Hospital Charge Code |
64906734
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$1,190.00 |
Max. Negotiated Rate |
$2,720.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,700.00
|
Rate for Payer: Aetna Government |
$1,700.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,720.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,312.00
|
Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|
BEARING PSN RGT SZ 12MM C-D
|
Facility
OP
|
$3,400.00
|
|
Hospital Charge Code |
64906713
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$1,190.00 |
Max. Negotiated Rate |
$2,720.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,700.00
|
Rate for Payer: Aetna Government |
$1,700.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,720.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,312.00
|
Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|
BEARING PSN R TB C-D FM 6-9
|
Facility
IP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906659
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,700.00 |
Max. Negotiated Rate |
$1,700.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|
BEARING PSN R TB C-D FM 6-9
|
Facility
OP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906659
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,570.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
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 |
$1,700.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,955.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,570.00
|
Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,210.00
|
|
BEARING SHOULDER VIV-E 36MM
|
Facility
IP
|
$4,620.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906971
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,310.00 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,310.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,310.00
|
|
BEARING SHOULDER VIV-E 36MM
|
Facility
OP
|
$4,620.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906971
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$4,851.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,541.00
|
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 |
$2,310.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,656.50
|
Rate for Payer: Fidelis Medicare Advantage |
$4,851.00
|
Rate for Payer: Group Health Inc Commercial |
$2,310.00
|
Rate for Payer: Group Health Inc Medicare |
$1,617.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,310.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,310.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,003.00
|
|
BEARING TIB
|
Facility
OP
|
$10,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64907256
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$10,500.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,500.00
|
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 |
$5,000.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,750.00
|
Rate for Payer: Fidelis Medicare Advantage |
$10,500.00
|
Rate for Payer: Group Health Inc Commercial |
$5,000.00
|
Rate for Payer: Group Health Inc Medicare |
$3,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,000.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5,000.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,500.00
|
|
BEARING TIB
|
Facility
IP
|
$10,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64907256
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$5,000.00 |
Max. Negotiated Rate |
$5,000.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,000.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5,000.00
|
|
BEARING VIVACIT E 3MM REV
|
Facility
OP
|
$4,620.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64907003
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$4,851.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,541.00
|
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 |
$2,310.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,656.50
|
Rate for Payer: Fidelis Medicare Advantage |
$4,851.00
|
Rate for Payer: Group Health Inc Commercial |
$2,310.00
|
Rate for Payer: Group Health Inc Medicare |
$1,617.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,310.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,310.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,003.00
|
|
BEARING VIVACIT E 3MM REV
|
Facility
IP
|
$4,620.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64907003
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,310.00 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,310.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,310.00
|
|
BEBTELOVIMAB (COVID-19 MAB) INJ
|
Facility
OP
|
$0.01
|
|
Service Code
|
HCPCS J3490
|
Hospital Charge Code |
41640333
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
Rate for Payer: Aetna Government |
$0.01
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
Rate for Payer: Group Health Inc Commercial |
$0.01
|
Rate for Payer: Group Health Inc Medicare |
$0.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
BEBTELOVIMAB (COVID-19 MAB) INJ
|
Facility
OP
|
$0.01
|
|
Service Code
|
HCPCS J3490
|
Hospital Charge Code |
41650333
|
Hospital Revenue Code
|
636
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
Rate for Payer: Aetna Government |
$0.01
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
Rate for Payer: Group Health Inc Commercial |
$0.01
|
Rate for Payer: Group Health Inc Medicare |
$0.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
BEBTELOVIMAB (COVID-19 MAB) INJ
|
Facility
IP
|
$0.01
|
|
Service Code
|
HCPCS J3490
|
Hospital Charge Code |
41640333
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
BEBTELOVIMAB (COVID-19 MAB) INJ
|
Facility
IP
|
$0.01
|
|
Service Code
|
HCPCS J3490
|
Hospital Charge Code |
41650333
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
BECLOMETHASONE INHALER 40 MCG/INHALATION
|
Facility
OP
|
$193.00
|
|
Hospital Charge Code |
41644328
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$67.55 |
Max. Negotiated Rate |
$154.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$106.15
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.50
|
Rate for Payer: Aetna Government |
$96.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$154.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$131.24
|
Rate for Payer: Group Health Inc Commercial |
$96.50
|
Rate for Payer: Group Health Inc Medicare |
$67.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$96.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.45
|
|
BECLOMETHASONE INHALER 40 MCG/INHALATION
|
Facility
OP
|
$193.00
|
|
Hospital Charge Code |
41654328
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$67.55 |
Max. Negotiated Rate |
$154.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$106.15
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.50
|
Rate for Payer: Aetna Government |
$96.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$154.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$131.24
|
Rate for Payer: Group Health Inc Commercial |
$96.50
|
Rate for Payer: Group Health Inc Medicare |
$67.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$96.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.45
|
|
BED EFICA
|
Facility
OP
|
$349.85
|
|
Hospital Charge Code |
64902954
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$122.45 |
Max. Negotiated Rate |
$279.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.42
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$174.92
|
Rate for Payer: Aetna Government |
$174.92
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$279.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$237.90
|
Rate for Payer: Group Health Inc Commercial |
$174.92
|
Rate for Payer: Group Health Inc Medicare |
$122.45
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.92
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$174.92
|
|
BED ELEXIS
|
Facility
OP
|
$345.00
|
|
Hospital Charge Code |
64902966
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$120.75 |
Max. Negotiated Rate |
$276.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$189.75
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$172.50
|
Rate for Payer: Aetna Government |
$172.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$276.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.60
|
Rate for Payer: Group Health Inc Commercial |
$172.50
|
Rate for Payer: Group Health Inc Medicare |
$120.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$172.50
|
|
BED FLEXICAIR W/SCALE
|
Facility
OP
|
$186.20
|
|
Hospital Charge Code |
64902952
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$65.17 |
Max. Negotiated Rate |
$148.96 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.41
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.10
|
Rate for Payer: Aetna Government |
$93.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$148.96
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.62
|
Rate for Payer: Group Health Inc Commercial |
$93.10
|
Rate for Payer: Group Health Inc Medicare |
$65.17
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$93.10
|
|
BEDPAN 2QT STACKABLE TEAL H113-13
|
Facility
OP
|
$1.49
|
|
Hospital Charge Code |
40209461
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$0.52 |
Max. Negotiated Rate |
$1.19 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.82
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
Rate for Payer: Aetna Government |
$0.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.19
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.01
|
Rate for Payer: Group Health Inc Commercial |
$0.75
|
Rate for Payer: Group Health Inc Medicare |
$0.52
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.75
|
|
BEDPAN FRACTURE GOLD
|
Facility
OP
|
$1.70
|
|
Hospital Charge Code |
64901856
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$0.60 |
Max. Negotiated Rate |
$1.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.94
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.85
|
Rate for Payer: Aetna Government |
$0.85
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.16
|
Rate for Payer: Group Health Inc Commercial |
$0.85
|
Rate for Payer: Group Health Inc Medicare |
$0.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.85
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.85
|
|
BED PULMONEX
|
Facility
OP
|
$162.50
|
|
Hospital Charge Code |
64902956
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$56.88 |
Max. Negotiated Rate |
$130.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.38
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.25
|
Rate for Payer: Aetna Government |
$81.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.50
|
Rate for Payer: Group Health Inc Commercial |
$81.25
|
Rate for Payer: Group Health Inc Medicare |
$56.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$81.25
|
|