ZIM HIP FEM HEAD 12/14 3.5MMX36MM
|
Facility
IP
|
$1,908.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40003453
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$954.00 |
Max. Negotiated Rate |
$954.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$954.00
|
|
ZIM HIP FEM HEAD 12/14-40MM DI
|
Facility
OP
|
$1,908.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008299
|
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
|
|
ZIM HIP FEM HEAD 12/14-40MM DI
|
Facility
IP
|
$1,908.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008299
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$954.00 |
Max. Negotiated Rate |
$954.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$954.00
|
|
ZIM HIP SYS FM HD 12/14-10.5X36NK
|
Facility
OP
|
$2,544.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204222
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,671.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,399.20
|
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 |
$1,272.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,462.80
|
Rate for Payer: Fidelis Medicare Advantage |
$2,671.20
|
Rate for Payer: Group Health Inc Commercial |
$1,272.00
|
Rate for Payer: Group Health Inc Medicare |
$890.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,272.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,272.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,653.60
|
|
ZIM HIP SYS FM HD 12/14-10.5X36NK
|
Facility
IP
|
$2,544.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204222
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,272.00 |
Max. Negotiated Rate |
$1,272.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,272.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,272.00
|
|
ZIM KNEE-12MM EF/PS FEMUR 69
|
Facility
IP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008297
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,700.00 |
Max. Negotiated Rate |
$1,700.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|
ZIM KNEE-12MM EF/PS FEMUR 69
|
Facility
OP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008297
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,570.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
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 |
$1,700.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,955.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,570.00
|
Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,210.00
|
|
ZIM KNEE ART SUR LT 14MM HT
|
Facility
IP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009283
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,700.00 |
Max. Negotiated Rate |
$1,700.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|
ZIM KNEE ART SUR LT 14MM HT
|
Facility
OP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009283
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,570.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
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 |
$1,700.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,955.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,570.00
|
Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,210.00
|
|
ZIM KNEE FEM TRAB POST LT SZ 6
|
Facility
IP
|
$8,200.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009282
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,100.00 |
Max. Negotiated Rate |
$4,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,100.00
|
|
ZIM KNEE FEM TRAB POST LT SZ 6
|
Facility
OP
|
$8,200.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009282
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$8,610.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,510.00
|
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 |
$4,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,715.00
|
Rate for Payer: Fidelis Medicare Advantage |
$8,610.00
|
Rate for Payer: Group Health Inc Commercial |
$4,100.00
|
Rate for Payer: Group Health Inc Medicare |
$2,870.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,330.00
|
|
ZIM KNEE FEMUR TRAB LT SZ 3
|
Facility
OP
|
$8,200.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40001784
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$8,610.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,510.00
|
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 |
$4,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,715.00
|
Rate for Payer: Fidelis Medicare Advantage |
$8,610.00
|
Rate for Payer: Group Health Inc Commercial |
$4,100.00
|
Rate for Payer: Group Health Inc Medicare |
$2,870.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,330.00
|
|
ZIM KNEE FEMUR TRAB LT SZ 3
|
Facility
IP
|
$8,200.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40001784
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,100.00 |
Max. Negotiated Rate |
$4,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4,100.00
|
|
ZIM KNEE SYS FEMUR CEM LT SZ 6
|
Facility
OP
|
$6,200.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204552
|
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 KNEE SYS FEMUR CEM LT SZ 6
|
Facility
IP
|
$6,200.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204552
|
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 KNEE SYS STEM RT SZ E
|
Facility
IP
|
$4,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40203381
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,000.00 |
Max. Negotiated Rate |
$2,000.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,000.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,000.00
|
|
ZIM KNEE SYS STEM RT SZ E
|
Facility
OP
|
$4,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40203381
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$4,200.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,200.00
|
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 |
$2,000.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,300.00
|
Rate for Payer: Fidelis Medicare Advantage |
$4,200.00
|
Rate for Payer: Group Health Inc Commercial |
$2,000.00
|
Rate for Payer: Group Health Inc Medicare |
$1,400.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,000.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,000.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,600.00
|
|
ZIM KNEE TIBIA CEM 5 STEM LT SZ C
|
Facility
OP
|
$4,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40001783
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$4,200.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,200.00
|
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 |
$2,000.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,300.00
|
Rate for Payer: Fidelis Medicare Advantage |
$4,200.00
|
Rate for Payer: Group Health Inc Commercial |
$2,000.00
|
Rate for Payer: Group Health Inc Medicare |
$1,400.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,000.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,000.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,600.00
|
|
ZIM KNEE TIBIA CEM 5 STEM LT SZ C
|
Facility
IP
|
$4,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40001783
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,000.00 |
Max. Negotiated Rate |
$2,000.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,000.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,000.00
|
|
ZIM KNEE TRO PIN 3.2X75MM
|
Facility
IP
|
$678.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008341
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.00 |
Max. Negotiated Rate |
$339.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$339.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$339.00
|
|
ZIM KNEE TRO PIN 3.2X75MM
|
Facility
OP
|
$678.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008341
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$711.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$372.90
|
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 |
$339.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$389.85
|
Rate for Payer: Fidelis Medicare Advantage |
$711.90
|
Rate for Payer: Group Health Inc Commercial |
$339.00
|
Rate for Payer: Group Health Inc Medicare |
$237.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$339.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$339.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$440.70
|
|
ZIM KNEE VIVACIT-E ART FX BEAR 11
|
Facility
IP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009281
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,700.00 |
Max. Negotiated Rate |
$1,700.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|
ZIM KNEE VIVACIT-E ART FX BEAR 11
|
Facility
OP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009281
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,570.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
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 |
$1,700.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,955.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,570.00
|
Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,210.00
|
|
ZIM KNEE VIVACIT-E ARTIC FX 12M
|
Facility
OP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40001794
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,570.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
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 |
$1,700.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,955.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,570.00
|
Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,210.00
|
|
ZIM KNEE VIVACIT-E ARTIC FX 12M
|
Facility
IP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40001794
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,700.00 |
Max. Negotiated Rate |
$1,700.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|