ZIM BIPOLA CUP LINER 28 MM I
|
Facility
OP
|
$980.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40004601
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,029.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$539.00
|
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 |
$490.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$563.50
|
Rate for Payer: Fidelis Medicare Advantage |
$1,029.00
|
Rate for Payer: Group Health Inc Commercial |
$490.00
|
Rate for Payer: Group Health Inc Medicare |
$343.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$490.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$490.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.00
|
|
ZIM BIPOLA CUP LINER 28 MM I
|
Facility
IP
|
$980.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40004601
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$490.00 |
Max. Negotiated Rate |
$490.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$490.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$490.00
|
|
ZIM BIPOLA CUP SHELL 48 MM O.D.
|
Facility
IP
|
$1,638.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40004602
|
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
|
|
ZIM BIPOLA CUP SHELL 48 MM O.D.
|
Facility
OP
|
$1,638.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40004602
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,719.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$900.90
|
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 |
$819.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$941.85
|
Rate for Payer: Fidelis Medicare Advantage |
$1,719.90
|
Rate for Payer: Group Health Inc Commercial |
$819.00
|
Rate for Payer: Group Health Inc Medicare |
$573.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$819.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$819.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,064.70
|
|
ZIM BN SCR 6.5MMX30MM
|
Facility
IP
|
$276.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003452
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$138.00 |
Max. Negotiated Rate |
$138.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.00
|
|
ZIM BN SCR 6.5MMX30MM
|
Facility
OP
|
$276.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003452
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$96.60 |
Max. Negotiated Rate |
$289.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$151.80
|
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 |
$138.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$158.70
|
Rate for Payer: Fidelis Medicare Advantage |
$289.80
|
Rate for Payer: Group Health Inc Commercial |
$138.00
|
Rate for Payer: Group Health Inc Medicare |
$96.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.40
|
|
ZIM BN SCREW 6.5MMX40MM
|
Facility
IP
|
$276.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003450
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$138.00 |
Max. Negotiated Rate |
$138.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.00
|
|
ZIM BN SCREW 6.5MMX40MM
|
Facility
OP
|
$276.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003450
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$96.60 |
Max. Negotiated Rate |
$289.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$151.80
|
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 |
$138.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$158.70
|
Rate for Payer: Fidelis Medicare Advantage |
$289.80
|
Rate for Payer: Group Health Inc Commercial |
$138.00
|
Rate for Payer: Group Health Inc Medicare |
$96.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.40
|
|
ZIM BONE SCR 6.5 DIA 35 MM LT
|
Facility
IP
|
$276.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204223
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$138.00 |
Max. Negotiated Rate |
$138.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.00
|
|
ZIM BONE SCR 6.5 DIA 35 MM LT
|
Facility
OP
|
$276.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204223
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$96.60 |
Max. Negotiated Rate |
$289.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$151.80
|
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 |
$138.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$158.70
|
Rate for Payer: Fidelis Medicare Advantage |
$289.80
|
Rate for Payer: Group Health Inc Commercial |
$138.00
|
Rate for Payer: Group Health Inc Medicare |
$96.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$138.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.40
|
|
ZIM CABLE BUTTON PLT 2.5MM
|
Facility
IP
|
$448.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008324
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$224.00 |
Max. Negotiated Rate |
$224.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$224.00
|
|
ZIM CABLE BUTTON PLT 2.5MM
|
Facility
OP
|
$448.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008324
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$470.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$246.40
|
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 |
$224.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$257.60
|
Rate for Payer: Fidelis Medicare Advantage |
$470.40
|
Rate for Payer: Group Health Inc Commercial |
$224.00
|
Rate for Payer: Group Health Inc Medicare |
$156.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$224.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.20
|
|
ZIM CABLE GRIP SYS 1.8MM 36 IN
|
Facility
IP
|
$1,152.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008298
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$576.00 |
Max. Negotiated Rate |
$576.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$576.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$576.00
|
|
ZIM CABLE GRIP SYS 1.8MM 36 IN
|
Facility
OP
|
$1,152.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008298
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,209.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$633.60
|
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 |
$576.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$662.40
|
Rate for Payer: Fidelis Medicare Advantage |
$1,209.60
|
Rate for Payer: Group Health Inc Commercial |
$576.00
|
Rate for Payer: Group Health Inc Medicare |
$403.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$576.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$576.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$748.80
|
|
ZIM CABLE GRIP SYS 1.8MM 36IN
|
Facility
IP
|
$1,152.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008300
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$576.00 |
Max. Negotiated Rate |
$576.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$576.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$576.00
|
|
ZIM CABLE GRIP SYS 1.8MM 36IN
|
Facility
OP
|
$1,152.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008300
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,209.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$633.60
|
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 |
$576.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$662.40
|
Rate for Payer: Fidelis Medicare Advantage |
$1,209.60
|
Rate for Payer: Group Health Inc Commercial |
$576.00
|
Rate for Payer: Group Health Inc Medicare |
$403.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$576.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$576.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$748.80
|
|
ZIM CENTER SLEVE 24M
|
Facility
IP
|
$1,110.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008342
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$555.00 |
Max. Negotiated Rate |
$555.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$555.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$555.00
|
|
ZIM CENTER SLEVE 24M
|
Facility
OP
|
$1,110.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008342
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$1,165.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$610.50
|
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 |
$555.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$638.25
|
Rate for Payer: Fidelis Medicare Advantage |
$1,165.50
|
Rate for Payer: Group Health Inc Commercial |
$555.00
|
Rate for Payer: Group Health Inc Medicare |
$388.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$555.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$555.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$721.50
|
|
ZIM COMPL KNEE SZ 3 FEM C-H 10MM
|
Facility
OP
|
$7,768.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40005200
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$8,156.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,272.40
|
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 |
$3,884.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,466.60
|
Rate for Payer: Fidelis Medicare Advantage |
$8,156.40
|
Rate for Payer: Group Health Inc Commercial |
$3,884.00
|
Rate for Payer: Group Health Inc Medicare |
$2,718.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,884.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,049.20
|
|
ZIM COMPL KNEE SZ 3 FEM C-H 10MM
|
Facility
IP
|
$7,768.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40005200
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,884.00 |
Max. Negotiated Rate |
$3,884.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,884.00
|
|
ZIM COMPRES DEV DIS FEMUR
|
Facility
IP
|
$22,035.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008336
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$11,017.50 |
Max. Negotiated Rate |
$11,017.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,017.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11,017.50
|
|
ZIM COMPRES DEV DIS FEMUR
|
Facility
OP
|
$22,035.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008336
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$23,136.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,119.25
|
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 |
$11,017.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,670.12
|
Rate for Payer: Fidelis Medicare Advantage |
$23,136.75
|
Rate for Payer: Group Health Inc Commercial |
$11,017.50
|
Rate for Payer: Group Health Inc Medicare |
$7,712.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,017.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11,017.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,322.75
|
|
ZIM FEMUR CEME POST STAB RT SZ 4
|
Facility
OP
|
$6,200.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204553
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$6,510.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,410.00
|
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 |
$3,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,565.00
|
Rate for Payer: Fidelis Medicare Advantage |
$6,510.00
|
Rate for Payer: Group Health Inc Commercial |
$3,100.00
|
Rate for Payer: Group Health Inc Medicare |
$2,170.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,030.00
|
|
ZIM FEMUR CEME POST STAB RT SZ 4
|
Facility
IP
|
$6,200.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204553
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,100.00 |
Max. Negotiated Rate |
$3,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,100.00
|
|
ZIM HIP FEM HEAD 12/14 3.5MMX36MM
|
Facility
OP
|
$1,908.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40003453
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,003.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,049.40
|
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 |
$954.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,097.10
|
Rate for Payer: Fidelis Medicare Advantage |
$2,003.40
|
Rate for Payer: Group Health Inc Commercial |
$954.00
|
Rate for Payer: Group Health Inc Medicare |
$667.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$954.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,240.20
|
|