|
ZIMM NEXGEN BLETE KNEE
|
Facility
OP
|
$1,920.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009745
|
|
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
|
|
|
ZIMM PERSONA BL SYSTEM F TRABE
|
Facility
IP
|
$8,200.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009735
|
|
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
|
|
|
ZIMM PERSONA BL SYSTEM F TRABE
|
Facility
OP
|
$8,200.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009735
|
|
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
|
|
|
ZIMM ROTAT BLGE KNEE A E23MM
|
Facility
IP
|
$5,408.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,704.00 |
| Max. Negotiated Rate |
$2,704.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,704.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,704.00
|
|
|
ZIMM ROTAT BLGE KNEE A E23MM
|
Facility
OP
|
$5,408.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,678.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,974.40
|
| 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 |
$2,704.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,109.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,678.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,704.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,892.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,704.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,704.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,515.20
|
|
|
ZIMM ROTAT BLGE KNEE F COM E
|
Facility
OP
|
$24,624.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$25,855.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,543.20
|
| 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 |
$12,312.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,158.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,855.20
|
| Rate for Payer: Group Health Inc Commercial |
$12,312.00
|
| Rate for Payer: Group Health Inc Medicare |
$8,618.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,312.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,312.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,005.60
|
|
|
ZIMM ROTAT BLGE KNEE F COM E
|
Facility
IP
|
$24,624.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,312.00 |
| Max. Negotiated Rate |
$12,312.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,312.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,312.00
|
|
|
ZIMM ROTAT BLGE KNEE T COMP 4
|
Facility
OP
|
$12,208.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$12,818.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,714.40
|
| 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 |
$6,104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,019.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,818.40
|
| Rate for Payer: Group Health Inc Commercial |
$6,104.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,272.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,104.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,935.20
|
|
|
ZIMM ROTAT BLGE KNEE T COMP 4
|
Facility
IP
|
$12,208.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,104.00 |
| Max. Negotiated Rate |
$6,104.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,104.00
|
|
|
ZIMM SCREW 5.0 34MM
|
Facility
IP
|
$348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
|
|
ZIMM SCREW 5.0 34MM
|
Facility
OP
|
$348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| 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 |
$174.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$200.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.40
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.20
|
|
|
ZIMM SCREW 5.0 36MM
|
Facility
IP
|
$348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
|
|
ZIMM SCREW 5.0 36MM
|
Facility
OP
|
$348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| 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 |
$174.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$200.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.40
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.20
|
|
|
ZIMM SCREW 5.0 40MM
|
Facility
OP
|
$348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| 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 |
$174.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$200.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.40
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.20
|
|
|
ZIMM SCREW 5.0 40MM
|
Facility
IP
|
$348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
|
|
ZIMM SCREW 5.0 46MM
|
Facility
OP
|
$348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| 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 |
$174.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$200.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.40
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.20
|
|
|
ZIMM SCREW 5.0 46MM
|
Facility
IP
|
$348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
|
|
ZIMM SCREW 5.0 48MM
|
Facility
IP
|
$348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
|
|
ZIMM SCREW 5.0 48MM
|
Facility
OP
|
$348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| 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 |
$174.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$200.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.40
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.20
|
|
|
ZIMM STEM BLON STRAIG X
|
Facility
OP
|
$2,425.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,546.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,334.05
|
| 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 |
$1,212.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,394.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,546.82
|
| Rate for Payer: Group Health Inc Commercial |
$1,212.77
|
| Rate for Payer: Group Health Inc Medicare |
$848.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,212.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,212.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,576.60
|
|
|
ZIMM STEM BLON STRAIG X
|
Facility
IP
|
$2,425.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.77 |
| Max. Negotiated Rate |
$1,212.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,212.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,212.77
|
|
|
ZIMM TIBIAL BLRIGHT LAR X 34
|
Facility
IP
|
$9,366.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,683.26 |
| Max. Negotiated Rate |
$4,683.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,683.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,683.26
|
|
|
ZIMM TIBIAL BLRIGHT LAR X 34
|
Facility
OP
|
$9,366.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$9,834.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,151.59
|
| 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 |
$4,683.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,385.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,834.85
|
| Rate for Payer: Group Health Inc Commercial |
$4,683.26
|
| Rate for Payer: Group Health Inc Medicare |
$3,278.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,683.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,683.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,088.24
|
|
|
ZIMM TRABECULAR BLETAL REVE TA
|
Facility
OP
|
$5,328.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40009732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$5,594.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,930.40
|
| 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 |
$2,664.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,063.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,594.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,664.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,864.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,664.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,664.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,463.20
|
|
|
ZIMM TRABECULAR BLETAL REVE TA
|
Facility
IP
|
$5,328.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40009732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.00 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,664.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,664.00
|
|
