|
STERILE WATER FOR INJECTION 100 ML VIAL
|
Facility
OP
|
$5.15
|
|
|
Service Code
|
HCPCS A4216
|
| Hospital Charge Code |
41642608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.50
|
| Rate for Payer: Group Health Inc Commercial |
$2.58
|
| Rate for Payer: Group Health Inc Medicare |
$1.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
|
|
STERILE WATER FOR INJECTION 20 ML
|
Facility
OP
|
$2.20
|
|
|
Service Code
|
HCPCS A4216
|
| Hospital Charge Code |
41654158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.50
|
| Rate for Payer: Group Health Inc Commercial |
$1.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
STERILE WATER FOR INJECTION 20 ML
|
Facility
OP
|
$2.20
|
|
|
Service Code
|
HCPCS A4216
|
| Hospital Charge Code |
41644158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.50
|
| Rate for Payer: Group Health Inc Commercial |
$1.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
STERILE WATER FOR INJECTION INFUSION 100
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
41642607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.62
|
| Rate for Payer: Aetna Government |
$1.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
STERILE WATER FOR INJECTION INFUSION 100
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
41652607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.62
|
| Rate for Payer: Aetna Government |
$1.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
STERILE WATER FOR IRRIGATION SOLUTION 10
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
41642509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.62
|
| Rate for Payer: Aetna Government |
$1.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
STERILE WATER FOR IRRIGATION SOLUTION 10
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
41652509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.62
|
| Rate for Payer: Aetna Government |
$1.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
STERIL WATR BLADR IRRG-3000CC
|
Facility
OP
|
$19.49
|
|
| Hospital Charge Code |
40507117
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.74
|
| Rate for Payer: Aetna Government |
$9.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.25
|
| Rate for Payer: Group Health Inc Commercial |
$9.74
|
| Rate for Payer: Group Health Inc Medicare |
$6.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.74
|
|
|
Steri Strip
|
Facility
OP
|
$1.77
|
|
| Hospital Charge Code |
40205733
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
|
|
STERITITE CONTAINER W/ LID
|
Facility
OP
|
$1,275.75
|
|
| Hospital Charge Code |
64903486
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$446.51 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$701.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.88
|
| Rate for Payer: Aetna Government |
$637.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,020.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$867.51
|
| Rate for Payer: Group Health Inc Commercial |
$637.88
|
| Rate for Payer: Group Health Inc Medicare |
$446.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$637.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.88
|
|
|
STERITITE CONTAINER WLID
|
Facility
OP
|
$1,076.25
|
|
| Hospital Charge Code |
64903478
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$376.69 |
| Max. Negotiated Rate |
$861.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$591.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$538.12
|
| Rate for Payer: Aetna Government |
$538.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$861.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$731.85
|
| Rate for Payer: Group Health Inc Commercial |
$538.12
|
| Rate for Payer: Group Health Inc Medicare |
$376.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$538.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$538.12
|
|
|
STERITITE CONT PERF BOTTLE W/LID
|
Facility
OP
|
$1,219.05
|
|
| Hospital Charge Code |
64903462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$426.67 |
| Max. Negotiated Rate |
$975.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$670.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$609.52
|
| Rate for Payer: Aetna Government |
$609.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$975.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$828.95
|
| Rate for Payer: Group Health Inc Commercial |
$609.52
|
| Rate for Payer: Group Health Inc Medicare |
$426.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$609.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$609.52
|
|
|
STERITITE UNIVER CONTA W/LID
|
Facility
OP
|
$1,429.75
|
|
| Hospital Charge Code |
64903472
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$500.41 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$786.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$714.88
|
| Rate for Payer: Aetna Government |
$714.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,143.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$972.23
|
| Rate for Payer: Group Health Inc Commercial |
$714.88
|
| Rate for Payer: Group Health Inc Medicare |
$500.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.88
|
|
|
STERNAL BIOPSY
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
40011110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.56 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
STERNAL PUNC(BONE MAROW TRAY)
|
Facility
OP
|
$65.21
|
|
| Hospital Charge Code |
40205740
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.60
|
| Rate for Payer: Aetna Government |
$32.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.34
|
| Rate for Payer: Group Health Inc Commercial |
$32.60
|
| Rate for Payer: Group Health Inc Medicare |
$22.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.60
|
|
|
STERNOTOMY
|
Facility
OP
|
$1,995.60
|
|
|
Service Code
|
HCPCS 21750
|
| Hospital Charge Code |
40024322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$698.46 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,097.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$716.83
|
| Rate for Payer: Aetna Government |
$716.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$776.87
|
| Rate for Payer: Group Health Inc Commercial |
$997.80
|
| Rate for Payer: Group Health Inc Medicare |
$698.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$997.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$997.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$863.19
|
|
|
STERNUM SAW BLADES 32MM
|
Facility
OP
|
$2.99
|
|
| Hospital Charge Code |
64905766
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.03
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
|
STERRAD TYVEK ROLL
|
Facility
OP
|
$291.90
|
|
| Hospital Charge Code |
64905295
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.16 |
| Max. Negotiated Rate |
$233.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$160.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$145.95
|
| Rate for Payer: Aetna Government |
$145.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$233.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$198.49
|
| Rate for Payer: Group Health Inc Commercial |
$145.95
|
| Rate for Payer: Group Health Inc Medicare |
$102.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.95
|
|
|
Stethoscope
|
Facility
OP
|
$25.87
|
|
| Hospital Charge Code |
40205737
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.94
|
| Rate for Payer: Aetna Government |
$12.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.59
|
| Rate for Payer: Group Health Inc Commercial |
$12.94
|
| Rate for Payer: Group Health Inc Medicare |
$9.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.94
|
|
|
STETHOSCOPE
|
Facility
OP
|
$22.32
|
|
| Hospital Charge Code |
40204849
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.16
|
| Rate for Payer: Aetna Government |
$11.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.18
|
| Rate for Payer: Group Health Inc Commercial |
$11.16
|
| Rate for Payer: Group Health Inc Medicare |
$7.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.16
|
|
|
STETHOSCOPE ESOPHAGEAL 18FR 400
|
Facility
OP
|
$5.63
|
|
| Hospital Charge Code |
64903398
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.82
|
| Rate for Payer: Aetna Government |
$2.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.83
|
| Rate for Payer: Group Health Inc Commercial |
$2.82
|
| Rate for Payer: Group Health Inc Medicare |
$1.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.82
|
|
|
STETHOSCOPE ESOPHAGEAL 9FR 400
|
Facility
OP
|
$20.00
|
|
| Hospital Charge Code |
64903400
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.00
|
| Rate for Payer: Aetna Government |
$10.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
|
|
STETHOSCOPE,SINGLE HD BLUE
|
Facility
OP
|
$3.75
|
|
| Hospital Charge Code |
64901665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.88
|
| Rate for Payer: Aetna Government |
$1.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.55
|
| Rate for Payer: Group Health Inc Commercial |
$1.88
|
| Rate for Payer: Group Health Inc Medicare |
$1.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.88
|
|
|
STILLE-LUER RONGEUR 10 (25.4)
|
Facility
OP
|
$607.18
|
|
| Hospital Charge Code |
64905653
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$212.51 |
| Max. Negotiated Rate |
$485.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$333.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$303.59
|
| Rate for Payer: Aetna Government |
$303.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$485.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$412.88
|
| Rate for Payer: Group Health Inc Commercial |
$303.59
|
| Rate for Payer: Group Health Inc Medicare |
$212.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.59
|
|
|
STIMU BIOCOMP KEEL ST5 5NL 20CC
|
Facility
OP
|
$3,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,559.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,864.50
|
| 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 |
$1,695.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,949.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,559.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,695.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,186.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,695.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,695.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,203.50
|
|
