SHEATH INTRODUCER 5FR 2.5/10CM
|
Facility
OP
|
$190.00
|
|
Hospital Charge Code |
64906775
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$66.50 |
Max. Negotiated Rate |
$152.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.00
|
Rate for Payer: Aetna Government |
$95.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
Rate for Payer: Group Health Inc Commercial |
$95.00
|
Rate for Payer: Group Health Inc Medicare |
$66.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
|
SHEATH INTRODUCER PERIPH 16FR
|
Facility
OP
|
$297.58
|
|
Hospital Charge Code |
64904715
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$104.15 |
Max. Negotiated Rate |
$238.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.67
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$148.79
|
Rate for Payer: Aetna Government |
$148.79
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$238.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$202.35
|
Rate for Payer: Group Health Inc Commercial |
$148.79
|
Rate for Payer: Group Health Inc Medicare |
$104.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.79
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$148.79
|
|
SHEATH INTRODUCER TEAR AWAY
|
Facility
OP
|
$150.00
|
|
Hospital Charge Code |
40200973
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$52.50 |
Max. Negotiated Rate |
$120.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.00
|
Rate for Payer: Aetna Government |
$75.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.00
|
Rate for Payer: Group Health Inc Commercial |
$75.00
|
Rate for Payer: Group Health Inc Medicare |
$52.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
|
SHEATH INTRODUCER TEAR AWAY 7FR
|
Facility
OP
|
$146.72
|
|
Hospital Charge Code |
64904531
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$51.35 |
Max. Negotiated Rate |
$117.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.36
|
Rate for Payer: Aetna Government |
$73.36
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$117.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$99.77
|
Rate for Payer: Group Health Inc Commercial |
$73.36
|
Rate for Payer: Group Health Inc Medicare |
$51.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.36
|
|
SHEATH INTRODUCER TEARAWAY SET9FR
|
Facility
OP
|
$510.00
|
|
Hospital Charge Code |
40200975
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$178.50 |
Max. Negotiated Rate |
$408.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$280.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$255.00
|
Rate for Payer: Aetna Government |
$255.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$408.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$346.80
|
Rate for Payer: Group Health Inc Commercial |
$255.00
|
Rate for Payer: Group Health Inc Medicare |
$178.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$255.00
|
|
SHEATH ROOBEE
|
Facility
OP
|
$143.50
|
|
Hospital Charge Code |
64905926
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$50.22 |
Max. Negotiated Rate |
$114.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$78.92
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$71.75
|
Rate for Payer: Aetna Government |
$71.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$114.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$97.58
|
Rate for Payer: Group Health Inc Commercial |
$71.75
|
Rate for Payer: Group Health Inc Medicare |
$50.22
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$71.75
|
|
SHEATH SAFE 7F TEARAWY VALVE W/PT
|
Facility
OP
|
$187.50
|
|
Hospital Charge Code |
64902621
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$65.62 |
Max. Negotiated Rate |
$150.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.12
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.75
|
Rate for Payer: Aetna Government |
$93.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.50
|
Rate for Payer: Group Health Inc Commercial |
$93.75
|
Rate for Payer: Group Health Inc Medicare |
$65.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
|
SHEATH SLIDE-ON FOR PENTAX
|
Facility
OP
|
$42.50
|
|
Hospital Charge Code |
64902711
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$14.88 |
Max. Negotiated Rate |
$34.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.38
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.25
|
Rate for Payer: Aetna Government |
$21.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.90
|
Rate for Payer: Group Health Inc Commercial |
$21.25
|
Rate for Payer: Group Health Inc Medicare |
$14.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.25
|
|
SHEATH TEAR AWAY INTRADYN 13FR
|
Facility
OP
|
$189.39
|
|
Hospital Charge Code |
64902880
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$66.29 |
Max. Negotiated Rate |
$151.51 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.16
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.70
|
Rate for Payer: Aetna Government |
$94.70
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$151.51
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$128.79
|
Rate for Payer: Group Health Inc Commercial |
$94.70
|
Rate for Payer: Group Health Inc Medicare |
$66.29
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$94.70
|
|
SHEATH TEAR AWAY INTRADYN 13FR
|
Facility
OP
|
$514.00
|
|
Hospital Charge Code |
40200976
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$179.90 |
Max. Negotiated Rate |
$411.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$282.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.00
|
Rate for Payer: Aetna Government |
$257.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$411.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$349.52
|
Rate for Payer: Group Health Inc Commercial |
$257.00
|
Rate for Payer: Group Health Inc Medicare |
$179.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$257.00
|
|
SHEATH TUNNELER ORG SCANLAN
|
Facility
OP
|
$75.60
|
|
Hospital Charge Code |
40206013
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$26.46 |
Max. Negotiated Rate |
$60.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.58
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.80
|
Rate for Payer: Aetna Government |
$37.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$60.48
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.41
|
Rate for Payer: Group Health Inc Commercial |
$37.80
|
Rate for Payer: Group Health Inc Medicare |
$26.46
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$37.80
|
|
SHEATH URET ACCESS 13/15FR 28CM
|
Facility
OP
|
$1,365.90
|
|
Hospital Charge Code |
64904869
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$478.06 |
Max. Negotiated Rate |
$1,092.72 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$751.24
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$682.95
|
Rate for Payer: Aetna Government |
$682.95
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,092.72
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$928.81
|
Rate for Payer: Group Health Inc Commercial |
$682.95
|
Rate for Payer: Group Health Inc Medicare |
$478.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$682.95
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$682.95
|
|
SHEATH URO
|
Facility
IP
|
$343.75
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
64907159
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$171.88 |
Max. Negotiated Rate |
$171.88 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$171.88
|
|
SHEATH URO
|
Facility
OP
|
$343.75
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
64907159
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.82 |
Max. Negotiated Rate |
$360.94 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$189.06
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
Rate for Payer: Aetna Government |
$0.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$171.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$197.66
|
Rate for Payer: Fidelis Medicare Advantage |
$360.94
|
Rate for Payer: Group Health Inc Commercial |
$171.88
|
Rate for Payer: Group Health Inc Medicare |
$120.31
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$171.88
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.44
|
|
SHEATH URTHL NAV11/13FR46CM
|
Facility
OP
|
$138.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
64906244
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.82 |
Max. Negotiated Rate |
$144.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$75.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
Rate for Payer: Aetna Government |
$0.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$69.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$79.35
|
Rate for Payer: Fidelis Medicare Advantage |
$144.90
|
Rate for Payer: Group Health Inc Commercial |
$69.00
|
Rate for Payer: Group Health Inc Medicare |
$48.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$69.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.70
|
|
SHEATH URTHL NAV11/13FR46CM
|
Facility
IP
|
$138.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
64906244
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$69.00 |
Max. Negotiated Rate |
$69.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$69.00
|
|
SHEATH URTH NAV 12/15F 43CM
|
Facility
IP
|
$344.87
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
64906746
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$172.44 |
Max. Negotiated Rate |
$172.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$172.44
|
|
SHEATH URTH NAV 12/15F 43CM
|
Facility
OP
|
$344.87
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
64906746
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.82 |
Max. Negotiated Rate |
$362.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$189.68
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
Rate for Payer: Aetna Government |
$0.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$172.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$198.30
|
Rate for Payer: Fidelis Medicare Advantage |
$362.11
|
Rate for Payer: Group Health Inc Commercial |
$172.44
|
Rate for Payer: Group Health Inc Medicare |
$120.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$172.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.17
|
|
SHEATH WELCH ALLYN EXAM LIGHT
|
Facility
OP
|
$165.63
|
|
Hospital Charge Code |
64902819
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$57.97 |
Max. Negotiated Rate |
$132.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$82.82
|
Rate for Payer: Aetna Government |
$82.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.63
|
Rate for Payer: Group Health Inc Commercial |
$82.82
|
Rate for Payer: Group Health Inc Medicare |
$57.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.82
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$82.82
|
|
SHEEPSKIN
|
Facility
OP
|
$42.88
|
|
Hospital Charge Code |
40207608
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$15.01 |
Max. Negotiated Rate |
$34.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.58
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.44
|
Rate for Payer: Aetna Government |
$21.44
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.16
|
Rate for Payer: Group Health Inc Commercial |
$21.44
|
Rate for Payer: Group Health Inc Medicare |
$15.01
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.44
|
|
SHEEPSKIN DECUBICARE 30 X 24
|
Facility
OP
|
$12.92
|
|
Hospital Charge Code |
64901072
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.52 |
Max. Negotiated Rate |
$10.34 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.11
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.46
|
Rate for Payer: Aetna Government |
$6.46
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.34
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.79
|
Rate for Payer: Group Health Inc Commercial |
$6.46
|
Rate for Payer: Group Health Inc Medicare |
$4.52
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.46
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.46
|
|
SHEET ARTHRO W/FLUID CTRL POUCH
|
Facility
OP
|
$35.01
|
|
Hospital Charge Code |
64902316
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$12.25 |
Max. Negotiated Rate |
$28.01 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.26
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.50
|
Rate for Payer: Aetna Government |
$17.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.01
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.81
|
Rate for Payer: Group Health Inc Commercial |
$17.50
|
Rate for Payer: Group Health Inc Medicare |
$12.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
|
SHEET ORBITL MICROTHIN 30X50X.4MM
|
Facility
IP
|
$1,232.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902573
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$616.25 |
Max. Negotiated Rate |
$616.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$616.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$616.25
|
|
SHEET ORBITL MICROTHIN 30X50X.4MM
|
Facility
OP
|
$1,232.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64902573
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,294.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$677.88
|
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 |
$616.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$708.69
|
Rate for Payer: Fidelis Medicare Advantage |
$1,294.12
|
Rate for Payer: Group Health Inc Commercial |
$616.25
|
Rate for Payer: Group Health Inc Medicare |
$431.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$616.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$616.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$801.12
|
|
SHELL 52MM BIPOLAR
|
Facility
IP
|
$1,638.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
64906920
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$819.00 |
Max. Negotiated Rate |
$819.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$819.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$819.00
|
|