ZIM STEM STAND 4 TAPER 12/14
|
Facility
OP
|
$9,336.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204255
|
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 STAND 4 TAPER 12/14
|
Facility
IP
|
$9,336.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204255
|
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 STAND UNCE 5 TAPER 12/14
|
Facility
IP
|
$9,336.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009279
|
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 STAND UNCE 5 TAPER 12/14
|
Facility
OP
|
$9,336.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009279
|
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 UNCEM HA 5 TAPER 12/14
|
Facility
OP
|
$9,336.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204433
|
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 UNCEM HA 5 TAPER 12/14
|
Facility
IP
|
$9,336.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204433
|
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 UNCEM HA 6 TAPER 12/14
|
Facility
IP
|
$9,336.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204432
|
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 UNCEM HA 6 TAPER 12/14
|
Facility
OP
|
$9,336.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204432
|
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 UNCEM HA 8 TAPER 12/14
|
Facility
OP
|
$9,336.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204431
|
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 UNCEM HA 8 TAPER 12/14
|
Facility
IP
|
$9,336.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40204431
|
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 SZ D 5MM AUG 2/SCREW
|
Facility
IP
|
$4,398.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40001793
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,199.00 |
Max. Negotiated Rate |
$2,199.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,199.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,199.00
|
|
ZIM SZ D 5MM AUG 2/SCREW
|
Facility
OP
|
$4,398.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40001793
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,617.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,418.90
|
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 |
$2,199.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,528.85
|
Rate for Payer: Fidelis Medicare Advantage |
$4,617.90
|
Rate for Payer: Group Health Inc Commercial |
$2,199.00
|
Rate for Payer: Group Health Inc Medicare |
$1,539.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,199.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,199.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,858.70
|
|
ZIM TIBIAL BRUSH
|
Facility
OP
|
$885.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008338
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$309.75 |
Max. Negotiated Rate |
$929.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$486.75
|
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 |
$442.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$508.88
|
Rate for Payer: Fidelis Medicare Advantage |
$929.25
|
Rate for Payer: Group Health Inc Commercial |
$442.50
|
Rate for Payer: Group Health Inc Medicare |
$309.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$442.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$442.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$575.25
|
|
ZIM TIBIAL BRUSH
|
Facility
IP
|
$885.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008338
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$442.50 |
Max. Negotiated Rate |
$442.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$442.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$442.50
|
|
ZIM TRABEC SHELL 52MM OD SZ II
|
Facility
IP
|
$3,800.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40003449
|
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 TRABEC SHELL 52MM OD SZ II
|
Facility
OP
|
$3,800.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40003449
|
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 TRABEC SHOULDER SYS GLEN 36MM
|
Facility
IP
|
$3,328.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008305
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,664.00 |
Max. Negotiated Rate |
$1,664.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,664.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,664.00
|
|
ZIM TRABEC SHOULDER SYS GLEN 36MM
|
Facility
OP
|
$3,328.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40008305
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,494.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,830.40
|
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 |
$1,664.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,913.60
|
Rate for Payer: Fidelis Medicare Advantage |
$3,494.40
|
Rate for Payer: Group Health Inc Commercial |
$1,664.00
|
Rate for Payer: Group Health Inc Medicare |
$1,164.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,664.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,664.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,163.20
|
|
ZIM TRAB METAL SHELL 58MM OD LL
|
Facility
OP
|
$3,800.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009277
|
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 TRAB METAL SHELL 58MM OD LL
|
Facility
IP
|
$3,800.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009277
|
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 TRAE METAL SHELL 54MM OD JJ
|
Facility
OP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009275
|
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 TRAE METAL SHELL 54MM OD JJ
|
Facility
IP
|
$3,400.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40009275
|
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 TRANSV PIN DEV 32MM LNG
|
Facility
OP
|
$1,215.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008331
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,275.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$668.25
|
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 |
$607.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$698.62
|
Rate for Payer: Fidelis Medicare Advantage |
$1,275.75
|
Rate for Payer: Group Health Inc Commercial |
$607.50
|
Rate for Payer: Group Health Inc Medicare |
$425.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$607.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$607.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$789.75
|
|
ZIM TRANSV PIN DEV 32MM LNG
|
Facility
IP
|
$1,215.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008331
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$607.50 |
Max. Negotiated Rate |
$607.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$607.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$607.50
|
|
ZIM TRILY ALFIT AETABLR SYS LG 36
|
Facility
IP
|
$1,700.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202637
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$850.00 |
Max. Negotiated Rate |
$850.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$850.00
|
|