SWAN GANZ BIPOLAR PACING KIT
|
Facility
OP
|
$307.95
|
|
Hospital Charge Code |
40205941
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$107.78 |
Max. Negotiated Rate |
$246.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.37
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.98
|
Rate for Payer: Aetna Government |
$153.98
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$246.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$209.41
|
Rate for Payer: Group Health Inc Commercial |
$153.98
|
Rate for Payer: Group Health Inc Medicare |
$107.78
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.98
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$153.98
|
|
SWAN GANZ SET
|
Facility
OP
|
$102.77
|
|
Hospital Charge Code |
40207592
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$35.97 |
Max. Negotiated Rate |
$82.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.52
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.38
|
Rate for Payer: Aetna Government |
$51.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.88
|
Rate for Payer: Group Health Inc Commercial |
$51.38
|
Rate for Payer: Group Health Inc Medicare |
$35.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$51.38
|
|
SWAN GANZ THERMO/CATH
|
Facility
OP
|
$307.95
|
|
Hospital Charge Code |
40205942
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$107.78 |
Max. Negotiated Rate |
$246.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.37
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.98
|
Rate for Payer: Aetna Government |
$153.98
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$246.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$209.41
|
Rate for Payer: Group Health Inc Commercial |
$153.98
|
Rate for Payer: Group Health Inc Medicare |
$107.78
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.98
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$153.98
|
|
SWARZ LAMKINS FUNAL STAIN 60ML
|
Facility
OP
|
$42.00
|
|
Hospital Charge Code |
41658013
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$14.70 |
Max. Negotiated Rate |
$33.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.00
|
Rate for Payer: Aetna Government |
$21.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
Rate for Payer: Group Health Inc Commercial |
$21.00
|
Rate for Payer: Group Health Inc Medicare |
$14.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.30
|
|
SWARZ LAMKINS FUNGAL STAIN 60ML
|
Facility
OP
|
$42.00
|
|
Hospital Charge Code |
41648013
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$14.70 |
Max. Negotiated Rate |
$33.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.00
|
Rate for Payer: Aetna Government |
$21.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
Rate for Payer: Group Health Inc Commercial |
$21.00
|
Rate for Payer: Group Health Inc Medicare |
$14.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.30
|
|
SWIVEL ARM
|
Facility
OP
|
$715.40
|
|
Hospital Charge Code |
40202153
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$250.39 |
Max. Negotiated Rate |
$572.32 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.47
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$357.70
|
Rate for Payer: Aetna Government |
$357.70
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$572.32
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$486.47
|
Rate for Payer: Group Health Inc Commercial |
$357.70
|
Rate for Payer: Group Health Inc Medicare |
$250.39
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$357.70
|
|
SYMMETRIC PATELLA 9MM S31MM
|
Facility
IP
|
$1,920.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40209847
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$960.00 |
Max. Negotiated Rate |
$960.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$960.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$960.00
|
|
SYMMETRIC PATELLA 9MM S31MM
|
Facility
OP
|
$1,920.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40209847
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,016.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,056.00
|
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 |
$960.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,104.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,016.00
|
Rate for Payer: Group Health Inc Commercial |
$960.00
|
Rate for Payer: Group Health Inc Medicare |
$672.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$960.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$960.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,248.00
|
|
SYMMETRIC PATELLA 9MM S 33MM
|
Facility
OP
|
$2,824.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40209846
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,965.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,553.20
|
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 |
$1,412.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,623.80
|
Rate for Payer: Fidelis Medicare Advantage |
$2,965.20
|
Rate for Payer: Group Health Inc Commercial |
$1,412.00
|
Rate for Payer: Group Health Inc Medicare |
$988.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,412.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,412.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,835.60
|
|
SYMMETRIC PATELLA 9MM S 33MM
|
Facility
IP
|
$2,824.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40209846
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,412.00 |
Max. Negotiated Rate |
$1,412.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,412.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,412.00
|
|
SYMMETRIC PATELLA S27 X 8MM
|
Facility
IP
|
$1,841.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40209848
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$920.50 |
Max. Negotiated Rate |
$920.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$920.50
|
|
SYMMETRIC PATELLA S27 X 8MM
|
Facility
OP
|
$1,841.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40209848
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,933.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,012.55
|
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 |
$920.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,058.58
|
Rate for Payer: Fidelis Medicare Advantage |
$1,933.05
|
Rate for Payer: Group Health Inc Commercial |
$920.50
|
Rate for Payer: Group Health Inc Medicare |
$644.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$920.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,196.65
|
|
SYMMETRIC PATELLA S29X8MM
|
Facility
IP
|
$1,841.40
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40209849
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$920.70 |
Max. Negotiated Rate |
$920.70 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$920.70
|
|
SYMMETRIC PATELLA S29X8MM
|
Facility
OP
|
$1,841.40
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40209849
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,933.47 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,012.77
|
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 |
$920.70
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,058.80
|
Rate for Payer: Fidelis Medicare Advantage |
$1,933.47
|
Rate for Payer: Group Health Inc Commercial |
$920.70
|
Rate for Payer: Group Health Inc Medicare |
$644.49
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$920.70
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,196.91
|
|
SYMPHONY BREASTMILK INIT KIT
|
Facility
OP
|
$60.79
|
|
Hospital Charge Code |
64901599
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$21.28 |
Max. Negotiated Rate |
$48.63 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.43
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.40
|
Rate for Payer: Aetna Government |
$30.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.63
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.34
|
Rate for Payer: Group Health Inc Commercial |
$30.40
|
Rate for Payer: Group Health Inc Medicare |
$21.28
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$30.40
|
|
SYMPHONY PROCESS DISPOSE
|
Facility
OP
|
$1,762.50
|
|
Hospital Charge Code |
64904217
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$616.88 |
Max. Negotiated Rate |
$1,410.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$969.38
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$881.25
|
Rate for Payer: Aetna Government |
$881.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,410.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,198.50
|
Rate for Payer: Group Health Inc Commercial |
$881.25
|
Rate for Payer: Group Health Inc Medicare |
$616.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$881.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$881.25
|
|
SYMPHONY SPRAY APPLICATOR
|
Facility
OP
|
$237.50
|
|
Hospital Charge Code |
64904219
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$83.12 |
Max. Negotiated Rate |
$190.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$118.75
|
Rate for Payer: Aetna Government |
$118.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.50
|
Rate for Payer: Group Health Inc Commercial |
$118.75
|
Rate for Payer: Group Health Inc Medicare |
$83.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$118.75
|
|
SYN 10MM TI CANN TIB 345MM S
|
Facility
IP
|
$2,815.70
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206078
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,407.85 |
Max. Negotiated Rate |
$1,407.85 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,407.85
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,407.85
|
|
SYN 10MM TI CANN TIB 345MM S
|
Facility
OP
|
$2,815.70
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206078
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,956.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,548.64
|
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 |
$1,407.85
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,619.03
|
Rate for Payer: Fidelis Medicare Advantage |
$2,956.48
|
Rate for Payer: Group Health Inc Commercial |
$1,407.85
|
Rate for Payer: Group Health Inc Medicare |
$985.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,407.85
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,407.85
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,830.20
|
|
SYN 5.0MM TI LSCRW W/T25 SDF/IM N
|
Facility
OP
|
$437.40
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206079
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$153.09 |
Max. Negotiated Rate |
$459.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$240.57
|
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 |
$218.70
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$251.50
|
Rate for Payer: Fidelis Medicare Advantage |
$459.27
|
Rate for Payer: Group Health Inc Commercial |
$218.70
|
Rate for Payer: Group Health Inc Medicare |
$153.09
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$218.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$218.70
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$284.31
|
|
SYN 5.0MM TI LSCRW W/T25 SDF/IM N
|
Facility
IP
|
$437.40
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40206079
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$218.70 |
Max. Negotiated Rate |
$218.70 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$218.70
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$218.70
|
|
SYNAPTOPHYSIN AM363-5M
|
Facility
OP
|
$663.20
|
|
Hospital Charge Code |
64902719
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$232.12 |
Max. Negotiated Rate |
$530.56 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$364.76
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$331.60
|
Rate for Payer: Aetna Government |
$331.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$530.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$450.98
|
Rate for Payer: Group Health Inc Commercial |
$331.60
|
Rate for Payer: Group Health Inc Medicare |
$232.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$331.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$331.60
|
|
SYNCHROMED II PUMP
|
Facility
OP
|
$22,400.00
|
|
Service Code
|
HCPCS C2626
|
Hospital Charge Code |
40202340
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$468.08 |
Max. Negotiated Rate |
$23,520.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,320.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$468.08
|
Rate for Payer: Aetna Government |
$468.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,200.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,880.00
|
Rate for Payer: Fidelis Medicare Advantage |
$23,520.00
|
Rate for Payer: Group Health Inc Commercial |
$11,200.00
|
Rate for Payer: Group Health Inc Medicare |
$7,840.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,200.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11,200.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,560.00
|
|
SYNCHROMED II PUMP
|
Facility
IP
|
$22,400.00
|
|
Service Code
|
HCPCS C2626
|
Hospital Charge Code |
40202340
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$11,200.00 |
Max. Negotiated Rate |
$11,200.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,200.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11,200.00
|
|
SYNCHROMED II PUMPS
|
Facility
IP
|
$11,200.00
|
|
Service Code
|
HCPCS C2626
|
Hospital Charge Code |
40206085
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$5,600.00 |
Max. Negotiated Rate |
$5,600.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,600.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5,600.00
|
|