TROCAR 10/11MM 100MM LENGTH
|
Facility
OP
|
$891.95
|
|
Hospital Charge Code |
64902723
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$312.18 |
Max. Negotiated Rate |
$713.56 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$490.57
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$445.98
|
Rate for Payer: Aetna Government |
$445.98
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$713.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$606.53
|
Rate for Payer: Group Health Inc Commercial |
$445.98
|
Rate for Payer: Group Health Inc Medicare |
$312.18
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$445.98
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$445.98
|
|
TROCAR ASSEMBLY 4MM LONG
|
Facility
OP
|
$226.80
|
|
Hospital Charge Code |
40200151
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$79.38 |
Max. Negotiated Rate |
$181.44 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.40
|
Rate for Payer: Aetna Government |
$113.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$181.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$154.22
|
Rate for Payer: Group Health Inc Commercial |
$113.40
|
Rate for Payer: Group Health Inc Medicare |
$79.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$113.40
|
|
TROCAR ASSEMBLY 4MM SHRT
|
Facility
OP
|
$606.00
|
|
Hospital Charge Code |
40200188
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$212.10 |
Max. Negotiated Rate |
$484.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$333.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$303.00
|
Rate for Payer: Aetna Government |
$303.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$484.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$412.08
|
Rate for Payer: Group Health Inc Commercial |
$303.00
|
Rate for Payer: Group Health Inc Medicare |
$212.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$303.00
|
|
TROCAR ASSEMBLY 5MM EXTRA SHORT
|
Facility
OP
|
$605.38
|
|
Hospital Charge Code |
40200325
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$211.88 |
Max. Negotiated Rate |
$484.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$332.96
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$302.69
|
Rate for Payer: Aetna Government |
$302.69
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$484.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$411.66
|
Rate for Payer: Group Health Inc Commercial |
$302.69
|
Rate for Payer: Group Health Inc Medicare |
$211.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$302.69
|
|
TROCAR ASSEMBLY 5MM SHORT
|
Facility
OP
|
$605.38
|
|
Hospital Charge Code |
40200326
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$211.88 |
Max. Negotiated Rate |
$484.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$332.96
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$302.69
|
Rate for Payer: Aetna Government |
$302.69
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$484.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$411.66
|
Rate for Payer: Group Health Inc Commercial |
$302.69
|
Rate for Payer: Group Health Inc Medicare |
$211.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$302.69
|
|
TROCAR ASSEMBLY 6MM LONG
|
Facility
OP
|
$605.38
|
|
Hospital Charge Code |
40200328
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$211.88 |
Max. Negotiated Rate |
$484.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$332.96
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$302.69
|
Rate for Payer: Aetna Government |
$302.69
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$484.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$411.66
|
Rate for Payer: Group Health Inc Commercial |
$302.69
|
Rate for Payer: Group Health Inc Medicare |
$211.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$302.69
|
|
TROCAR ASSEMBLY 6MM SHORT
|
Facility
OP
|
$605.38
|
|
Hospital Charge Code |
40200327
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$211.88 |
Max. Negotiated Rate |
$484.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$332.96
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$302.69
|
Rate for Payer: Aetna Government |
$302.69
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$484.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$411.66
|
Rate for Payer: Group Health Inc Commercial |
$302.69
|
Rate for Payer: Group Health Inc Medicare |
$211.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$302.69
|
|
TROCAR BALLOON&INFLATION BULB
|
Facility
IP
|
$531.08
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
40207000
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.54 |
Max. Negotiated Rate |
$265.54 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$265.54
|
|
TROCAR BALLOON&INFLATION BULB
|
Facility
OP
|
$531.08
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
40207000
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$557.63 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$292.09
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
Rate for Payer: Aetna Government |
$44.85
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$265.54
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$305.37
|
Rate for Payer: Fidelis Medicare Advantage |
$557.63
|
Rate for Payer: Group Health Inc Commercial |
$265.54
|
Rate for Payer: Group Health Inc Medicare |
$185.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$265.54
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$345.20
|
|
TROCAR BLADELESS 5MM W
|
Facility
OP
|
$40.70
|
|
Hospital Charge Code |
64907081
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$14.24 |
Max. Negotiated Rate |
$32.56 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.38
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.35
|
Rate for Payer: Aetna Government |
$20.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.68
|
Rate for Payer: Group Health Inc Commercial |
$20.35
|
Rate for Payer: Group Health Inc Medicare |
$14.24
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$20.35
|
|
TROCAR,BLADELESS,OB,OPT,12/100MM
|
Facility
OP
|
$114.20
|
|
Hospital Charge Code |
64904369
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$39.97 |
Max. Negotiated Rate |
$91.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.81
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.10
|
Rate for Payer: Aetna Government |
$57.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$91.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.66
|
Rate for Payer: Group Health Inc Commercial |
$57.10
|
Rate for Payer: Group Health Inc Medicare |
$39.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$57.10
|
|
TROCAR BLADELESS W/OPT 5X100MM
|
Facility
OP
|
$57.63
|
|
Hospital Charge Code |
64906043
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$20.17 |
Max. Negotiated Rate |
$46.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.82
|
Rate for Payer: Aetna Government |
$28.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.19
|
Rate for Payer: Group Health Inc Commercial |
$28.82
|
Rate for Payer: Group Health Inc Medicare |
$20.17
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.82
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.82
|
|
TROCAR BLADELESS W/OPT 5X75MM
|
Facility
OP
|
$375.00
|
|
Hospital Charge Code |
64906044
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$131.25 |
Max. Negotiated Rate |
$300.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$187.50
|
Rate for Payer: Aetna Government |
$187.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$300.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.00
|
Rate for Payer: Group Health Inc Commercial |
$187.50
|
Rate for Payer: Group Health Inc Medicare |
$131.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$187.50
|
|
TROCAR BLADELESS W/ST 12X100MM
|
Facility
OP
|
$83.60
|
|
Hospital Charge Code |
64906046
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$29.26 |
Max. Negotiated Rate |
$66.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.98
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.80
|
Rate for Payer: Aetna Government |
$41.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.85
|
Rate for Payer: Group Health Inc Commercial |
$41.80
|
Rate for Payer: Group Health Inc Medicare |
$29.26
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$41.80
|
|
TROCAR BLADELESS W/STAB-REPROCES
|
Facility
OP
|
$426.90
|
|
Hospital Charge Code |
64905430
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$149.42 |
Max. Negotiated Rate |
$341.52 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$234.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$213.45
|
Rate for Payer: Aetna Government |
$213.45
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$341.52
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$290.29
|
Rate for Payer: Group Health Inc Commercial |
$213.45
|
Rate for Payer: Group Health Inc Medicare |
$149.42
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.45
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$213.45
|
|
TROCAR BLADELESS XCEL W/STABILITY
|
Facility
OP
|
$12.48
|
|
Hospital Charge Code |
64905811
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.37 |
Max. Negotiated Rate |
$9.98 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.86
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.24
|
Rate for Payer: Aetna Government |
$6.24
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.98
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.49
|
Rate for Payer: Group Health Inc Commercial |
$6.24
|
Rate for Payer: Group Health Inc Medicare |
$4.37
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.24
|
|
TROCAR BLPRT PLS 5-12MM W/FMGRP
|
Facility
OP
|
$124.00
|
|
Hospital Charge Code |
40206037
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$43.40 |
Max. Negotiated Rate |
$99.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$68.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.00
|
Rate for Payer: Aetna Government |
$62.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$99.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$84.32
|
Rate for Payer: Group Health Inc Commercial |
$62.00
|
Rate for Payer: Group Health Inc Medicare |
$43.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$62.00
|
|
TROCAR BLUNT TIP SYRINGE
|
Facility
OP
|
$180.00
|
|
Hospital Charge Code |
64904167
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$63.00 |
Max. Negotiated Rate |
$144.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$90.00
|
Rate for Payer: Aetna Government |
$90.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.40
|
Rate for Payer: Group Health Inc Commercial |
$90.00
|
Rate for Payer: Group Health Inc Medicare |
$63.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
|
TROCAR BLUNT TP XCEL 12X100 REPR
|
Facility
OP
|
$83.60
|
|
Hospital Charge Code |
64905433
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$29.26 |
Max. Negotiated Rate |
$66.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.98
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.80
|
Rate for Payer: Aetna Government |
$41.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.85
|
Rate for Payer: Group Health Inc Commercial |
$41.80
|
Rate for Payer: Group Health Inc Medicare |
$29.26
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$41.80
|
|
TROCAR DRILL PIN 3.2 75MM
|
Facility
OP
|
$847.50
|
|
Hospital Charge Code |
64906072
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$296.62 |
Max. Negotiated Rate |
$678.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$466.12
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$423.75
|
Rate for Payer: Aetna Government |
$423.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$678.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$576.30
|
Rate for Payer: Group Health Inc Commercial |
$423.75
|
Rate for Payer: Group Health Inc Medicare |
$296.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$423.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$423.75
|
|
TROCAR ENDOPATH XCEL 12MM BLDLS
|
Facility
OP
|
$132.45
|
|
Hospital Charge Code |
64904627
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$46.36 |
Max. Negotiated Rate |
$105.96 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.85
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.22
|
Rate for Payer: Aetna Government |
$66.22
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.96
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.07
|
Rate for Payer: Group Health Inc Commercial |
$66.22
|
Rate for Payer: Group Health Inc Medicare |
$46.36
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.22
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$66.22
|
|
TROCAR ENDOPATH XCEL 5M BLDLS
|
Facility
OP
|
$304.22
|
|
Hospital Charge Code |
40206056
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$106.48 |
Max. Negotiated Rate |
$243.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$167.32
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$152.11
|
Rate for Payer: Aetna Government |
$152.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$243.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$206.87
|
Rate for Payer: Group Health Inc Commercial |
$152.11
|
Rate for Payer: Group Health Inc Medicare |
$106.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.11
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$152.11
|
|
TROCAR,ENDO XCEL,BLDLS,11MM,STRL
|
Facility
OP
|
$110.81
|
|
Hospital Charge Code |
64904365
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$38.78 |
Max. Negotiated Rate |
$88.65 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.95
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.40
|
Rate for Payer: Aetna Government |
$55.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.65
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.35
|
Rate for Payer: Group Health Inc Commercial |
$55.40
|
Rate for Payer: Group Health Inc Medicare |
$38.78
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$55.40
|
|
TROCAR TIP DILA BLADS
|
Facility
OP
|
$300.00
|
|
Hospital Charge Code |
40206049
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$105.00 |
Max. Negotiated Rate |
$240.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.00
|
Rate for Payer: Aetna Government |
$150.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
Rate for Payer: Group Health Inc Commercial |
$150.00
|
Rate for Payer: Group Health Inc Medicare |
$105.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
|
TROCAR VERSA1 BLNT
|
Facility
OP
|
$35.60
|
|
Hospital Charge Code |
64907102
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$12.46 |
Max. Negotiated Rate |
$28.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.58
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.80
|
Rate for Payer: Aetna Government |
$17.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.48
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.21
|
Rate for Payer: Group Health Inc Commercial |
$17.80
|
Rate for Payer: Group Health Inc Medicare |
$12.46
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.80
|
|