STRY VITOSS BIM 10CC
|
Facility
IP
|
$7,472.66
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003444
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,736.33 |
Max. Negotiated Rate |
$3,736.33 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,736.33
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,736.33
|
|
STRY VITOSS BIMODAL 2.5CC
|
Facility
OP
|
$4,009.72
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204252
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,210.21 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,205.35
|
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 |
$2,004.86
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,305.59
|
Rate for Payer: Fidelis Medicare Advantage |
$4,210.21
|
Rate for Payer: Group Health Inc Commercial |
$2,004.86
|
Rate for Payer: Group Health Inc Medicare |
$1,403.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,004.86
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,004.86
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,606.32
|
|
STRY VITOSS BIMODAL 2.5CC
|
Facility
IP
|
$4,009.72
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204252
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,004.86 |
Max. Negotiated Rate |
$2,004.86 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,004.86
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,004.86
|
|
STRY XIA3 PA SCR 6.0X35MM
|
Facility
IP
|
$4,057.02
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003440
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,028.51 |
Max. Negotiated Rate |
$2,028.51 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,028.51
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,028.51
|
|
STRY XIA3 PA SCR 6.0X35MM
|
Facility
OP
|
$4,057.02
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003440
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,259.87 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,231.36
|
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 |
$2,028.51
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,332.79
|
Rate for Payer: Fidelis Medicare Advantage |
$4,259.87
|
Rate for Payer: Group Health Inc Commercial |
$2,028.51
|
Rate for Payer: Group Health Inc Medicare |
$1,419.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,028.51
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,028.51
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,637.06
|
|
STRY XIA ROD 480X6MM
|
Facility
OP
|
$1,508.72
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008318
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,584.16 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$829.80
|
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 |
$754.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$867.51
|
Rate for Payer: Fidelis Medicare Advantage |
$1,584.16
|
Rate for Payer: Group Health Inc Commercial |
$754.36
|
Rate for Payer: Group Health Inc Medicare |
$528.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$754.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$754.36
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$980.67
|
|
STRY XIA ROD 480X6MM
|
Facility
IP
|
$1,508.72
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008318
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$754.36 |
Max. Negotiated Rate |
$754.36 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$754.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$754.36
|
|
STUDIES W/&W/O BRONCHDIALTOR
|
Facility
OP
|
$766.58
|
|
Service Code
|
HCPCS 94060 TC
|
Hospital Charge Code |
40401500
|
Hospital Revenue Code
|
460
|
Min. Negotiated Rate |
$31.75 |
Max. Negotiated Rate |
$613.26 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.29
|
Rate for Payer: Aetna Government |
$383.29
|
Rate for Payer: Cash Price |
$362.98
|
Rate for Payer: Cash Price |
$362.98
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.75
|
Rate for Payer: Group Health Inc Commercial |
$383.29
|
Rate for Payer: Group Health Inc Medicare |
$268.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.28
|
|
STUDY-HALOPERIDL/METOCLPRM INJ
|
Facility
OP
|
$0.01
|
|
Service Code
|
HCPCS J3490 Q0
|
Hospital Charge Code |
41650239
|
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
|
|
STUDY-HALOPERIDL/METOCLPRM INJ
|
Facility
IP
|
$0.01
|
|
Service Code
|
HCPCS J3490 Q0
|
Hospital Charge Code |
41640239
|
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
|
|
STUDY-HALOPERIDL/METOCLPRM INJ
|
Facility
IP
|
$0.01
|
|
Service Code
|
HCPCS J3490 Q0
|
Hospital Charge Code |
41650239
|
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
|
|
STUDY-HALOPERIDL/METOCLPRM INJ
|
Facility
OP
|
$0.01
|
|
Service Code
|
HCPCS J3490 Q0
|
Hospital Charge Code |
41640239
|
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
|
|
STYKER LOCKING 2.7MMX12MM 656312
|
Facility
OP
|
$562.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005354
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$590.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$309.10
|
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 |
$281.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$323.15
|
Rate for Payer: Fidelis Medicare Advantage |
$590.10
|
Rate for Payer: Group Health Inc Commercial |
$281.00
|
Rate for Payer: Group Health Inc Medicare |
$196.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.30
|
|
STYKER LOCKING 2.7MMX12MM 656312
|
Facility
IP
|
$562.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005354
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$281.00 |
Max. Negotiated Rate |
$281.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.00
|
|
STYKER LOCKING 2.7MMX14MM 656314
|
Facility
IP
|
$562.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005352
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$281.00 |
Max. Negotiated Rate |
$281.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.00
|
|
STYKER LOCKING 2.7MMX14MM 656314
|
Facility
OP
|
$562.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40005352
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$590.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$309.10
|
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 |
$281.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$323.15
|
Rate for Payer: Fidelis Medicare Advantage |
$590.10
|
Rate for Payer: Group Health Inc Commercial |
$281.00
|
Rate for Payer: Group Health Inc Medicare |
$196.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$281.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.30
|
|
STYKER SCREW 3.5 X 14 MM
|
Facility
IP
|
$2,160.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205006
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,080.00 |
Max. Negotiated Rate |
$1,080.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,080.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,080.00
|
|
STYKER SCREW 3.5 X 14 MM
|
Facility
OP
|
$2,160.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205006
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,268.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,188.00
|
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 |
$1,080.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,242.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,268.00
|
Rate for Payer: Group Health Inc Commercial |
$1,080.00
|
Rate for Payer: Group Health Inc Medicare |
$756.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,080.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,080.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,404.00
|
|
STYKER SCREW LAG 6.5X90MM
|
Facility
OP
|
$343.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205083
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$120.05 |
Max. Negotiated Rate |
$360.15 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.65
|
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 |
$171.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$197.22
|
Rate for Payer: Fidelis Medicare Advantage |
$360.15
|
Rate for Payer: Group Health Inc Commercial |
$171.50
|
Rate for Payer: Group Health Inc Medicare |
$120.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$171.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$222.95
|
|
STYKER SCREW LAG 6.5X90MM
|
Facility
IP
|
$343.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205083
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$171.50 |
Max. Negotiated Rate |
$171.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$171.50
|
|
STYKER SCREW LOCKING 2.7
|
Facility
IP
|
$243.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205547
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$121.80 |
Max. Negotiated Rate |
$121.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$121.80
|
|
STYKER SCREW LOCKING 2.7
|
Facility
OP
|
$243.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205547
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$85.26 |
Max. Negotiated Rate |
$255.78 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.98
|
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 |
$121.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.07
|
Rate for Payer: Fidelis Medicare Advantage |
$255.78
|
Rate for Payer: Group Health Inc Commercial |
$121.80
|
Rate for Payer: Group Health Inc Medicare |
$85.26
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$121.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.34
|
|
STYLET, 59CM TAPERED SOFT
|
Facility
OP
|
$125.00
|
|
Hospital Charge Code |
64902644
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$43.75 |
Max. Negotiated Rate |
$100.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$68.75
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.50
|
Rate for Payer: Aetna Government |
$62.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.00
|
Rate for Payer: Group Health Inc Commercial |
$62.50
|
Rate for Payer: Group Health Inc Medicare |
$43.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$62.50
|
|
STYLET ENDOTRACH NEONAT SLICK 6FR
|
Facility
OP
|
$6.75
|
|
Hospital Charge Code |
64902431
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.36 |
Max. Negotiated Rate |
$5.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.71
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.38
|
Rate for Payer: Aetna Government |
$3.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.59
|
Rate for Payer: Group Health Inc Commercial |
$3.38
|
Rate for Payer: Group Health Inc Medicare |
$2.36
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.38
|
|
STYLET FLEXI-SLIP 14FR
|
Facility
OP
|
$4.60
|
|
Hospital Charge Code |
64904081
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1.61 |
Max. Negotiated Rate |
$3.68 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.53
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.30
|
Rate for Payer: Aetna Government |
$2.30
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.13
|
Rate for Payer: Group Health Inc Commercial |
$2.30
|
Rate for Payer: Group Health Inc Medicare |
$1.61
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2.30
|
|