|
ZIM PER NAT TIBIA SZ D
|
Facility
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203384
|
|
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 PERS KNEE SYS E-ARTIC RT 11MM
|
Facility
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203379
|
|
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 PERS KNEE SYS E-ARTIC RT 11MM
|
Facility
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203379
|
|
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 PER TIBIA STEMMED RT SZ F
|
Facility
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204551
|
|
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 PER TIBIA STEMMED RT SZ F
|
Facility
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204551
|
|
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 POLY PATEL CEM 29 X 8.0 MM
|
Facility
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$880.00
|
| 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 |
$800.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$920.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,680.00
|
| Rate for Payer: Group Health Inc Commercial |
$800.00
|
| Rate for Payer: Group Health Inc Medicare |
$560.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,040.00
|
|
|
ZIM POLY PATEL CEM 29 X 8.0 MM
|
Facility
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
|
|
ZIM POROUS PLASMA CEM
|
Facility
IP
|
$10,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,062.50 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,062.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,062.50
|
|
|
ZIM POROUS PLASMA CEM
|
Facility
OP
|
$10,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$10,631.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,568.75
|
| 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 |
$5,062.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,821.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,631.25
|
| Rate for Payer: Group Health Inc Commercial |
$5,062.50
|
| Rate for Payer: Group Health Inc Medicare |
$3,543.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,062.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,062.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,581.25
|
|
|
ZIM POROUS PLASMA SM
|
Facility
IP
|
$11,955.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,977.50 |
| Max. Negotiated Rate |
$5,977.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,977.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,977.50
|
|
|
ZIM POROUS PLASMA SM
|
Facility
OP
|
$11,955.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$12,552.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,575.25
|
| 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 |
$5,977.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,874.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,552.75
|
| Rate for Payer: Group Health Inc Commercial |
$5,977.50
|
| Rate for Payer: Group Health Inc Medicare |
$4,184.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,977.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,977.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,770.75
|
|
|
ZIMR TRIBAL BEAT 20MM
|
Facility
OP
|
$3,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40008335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,465.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,815.00
|
| 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 |
$1,650.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,897.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,465.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,650.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,155.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,650.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,650.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,145.00
|
|
|
ZIMR TRIBAL BEAT 20MM
|
Facility
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40008335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,650.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,650.00
|
|
|
ZIM SEG ANCHOR PLUG
|
Facility
IP
|
$3,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$1,612.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,612.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,612.50
|
|
|
ZIM SEG ANCHOR PLUG
|
Facility
OP
|
$3,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,386.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,773.75
|
| 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 |
$1,612.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,854.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,386.25
|
| Rate for Payer: Group Health Inc Commercial |
$1,612.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,128.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,612.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,612.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,096.25
|
|
|
ZIM SHELL 56 MM OD SIZE KK
|
Facility
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,090.00
|
| 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 |
$1,900.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,185.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,990.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,900.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,900.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,900.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,470.00
|
|
|
ZIM SHELL 56 MM OD SIZE KK
|
Facility
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,900.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,900.00
|
|
|
ZIM SIZ 4 TIB COMP 12MM HGT
|
Facility
IP
|
$7,768.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009267
|
|
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 SIZ 4 TIB COMP 12MM HGT
|
Facility
OP
|
$7,768.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009267
|
|
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 STEM CEM HA 2 TAPER 12/14
|
Facility
IP
|
$7,176.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40004600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,588.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,588.00
|
|
|
ZIM STEM CEM HA 2 TAPER 12/14
|
Facility
OP
|
$7,176.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40004600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$7,534.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,946.80
|
| 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 |
$3,588.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,126.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,534.80
|
| Rate for Payer: Group Health Inc Commercial |
$3,588.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,511.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,588.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,588.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,664.40
|
|
|
ZIM STEM HA 2 TAPER 12/14
|
Facility
OP
|
$9,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40008321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$9,802.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,134.80
|
| 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 |
$4,668.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,368.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,802.80
|
| Rate for Payer: Group Health Inc Commercial |
$4,668.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,267.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,668.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,668.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,068.40
|
|
|
ZIM STEM HA 2 TAPER 12/14
|
Facility
IP
|
$9,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40008321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,668.00 |
| Max. Negotiated Rate |
$4,668.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,668.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,668.00
|
|
|
ZIM STEM S HA 5 TAPER 12/14
|
Facility
IP
|
$9,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,668.00 |
| Max. Negotiated Rate |
$4,668.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,668.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,668.00
|
|
|
ZIM STEM S HA 5 TAPER 12/14
|
Facility
OP
|
$9,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$9,802.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,134.80
|
| 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 |
$4,668.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,368.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,802.80
|
| Rate for Payer: Group Health Inc Commercial |
$4,668.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,267.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,668.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,668.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,068.40
|
|
