ZZ 4FT PRESSURE MONITORING LINE
|
Facility
OP
|
$5.95
|
|
Hospital Charge Code |
41569016
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.08 |
Max. Negotiated Rate |
$4.76 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.27
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.98
|
Rate for Payer: Aetna Government |
$2.98
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.76
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.05
|
Rate for Payer: Group Health Inc Commercial |
$2.98
|
Rate for Payer: Group Health Inc Medicare |
$2.08
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
|
ZZ ABBOTT CLINCHER
|
Facility
OP
|
$56.70
|
|
Hospital Charge Code |
41569533
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$19.84 |
Max. Negotiated Rate |
$45.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.18
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.35
|
Rate for Payer: Aetna Government |
$28.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.56
|
Rate for Payer: Group Health Inc Commercial |
$28.35
|
Rate for Payer: Group Health Inc Medicare |
$19.84
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.35
|
|
ZZ ABBOTT FC PTA CATH 7.0MM/40MM
|
Facility
OP
|
$790.00
|
|
Hospital Charge Code |
41561896
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$276.50 |
Max. Negotiated Rate |
$632.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$434.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$395.00
|
Rate for Payer: Aetna Government |
$395.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$632.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$537.20
|
Rate for Payer: Group Health Inc Commercial |
$395.00
|
Rate for Payer: Group Health Inc Medicare |
$276.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$395.00
|
|
ZZ ABBOTT PERCLOSE
|
Facility
OP
|
$637.88
|
|
Hospital Charge Code |
41569532
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$223.26 |
Max. Negotiated Rate |
$510.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$350.83
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$318.94
|
Rate for Payer: Aetna Government |
$318.94
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$510.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$433.76
|
Rate for Payer: Group Health Inc Commercial |
$318.94
|
Rate for Payer: Group Health Inc Medicare |
$223.26
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$318.94
|
|
ZZ ABBOTT PERCLOSE SNARED
|
Facility
OP
|
$56.70
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569534
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$19.84 |
Max. Negotiated Rate |
$59.54 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.18
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
Rate for Payer: Aetna Government |
$44.85
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.35
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.60
|
Rate for Payer: Fidelis Medicare Advantage |
$59.54
|
Rate for Payer: Group Health Inc Commercial |
$28.35
|
Rate for Payer: Group Health Inc Medicare |
$19.84
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.35
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.86
|
|
ZZ ABBOTT PERCLOSE SNARED
|
Facility
IP
|
$56.70
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569534
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.35 |
Max. Negotiated Rate |
$28.35 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.35
|
|
ZZ ACCESS BEREN 5/.035140
|
Facility
IP
|
$53.87
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567245
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$26.94 |
Max. Negotiated Rate |
$26.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.94
|
|
ZZ ACCESS BEREN 5/.035140
|
Facility
OP
|
$53.87
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567245
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$18.85 |
Max. Negotiated Rate |
$56.56 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.63
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
Rate for Payer: Aetna Government |
$44.85
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.98
|
Rate for Payer: Fidelis Medicare Advantage |
$56.56
|
Rate for Payer: Group Health Inc Commercial |
$26.94
|
Rate for Payer: Group Health Inc Medicare |
$18.85
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.02
|
|
ZZ ACCUSTICK-INTRO SYSTEM
|
Facility
OP
|
$238.14
|
|
Hospital Charge Code |
41567015
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$83.35 |
Max. Negotiated Rate |
$190.51 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.98
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$119.07
|
Rate for Payer: Aetna Government |
$119.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.51
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.94
|
Rate for Payer: Group Health Inc Commercial |
$119.07
|
Rate for Payer: Group Health Inc Medicare |
$83.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.07
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$119.07
|
|
ZZ AD BIOFLO MIDLINE
|
Facility
OP
|
$180.00
|
|
Hospital Charge Code |
41563213
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$63.00 |
Max. Negotiated Rate |
$144.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$90.00
|
Rate for Payer: Aetna Government |
$90.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.40
|
Rate for Payer: Group Health Inc Commercial |
$90.00
|
Rate for Payer: Group Health Inc Medicare |
$63.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
|
ZZ AGA VASCU PLUG 4
|
Facility
OP
|
$2,100.00
|
|
Hospital Charge Code |
41561334
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$735.00 |
Max. Negotiated Rate |
$1,680.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,155.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,050.00
|
Rate for Payer: Aetna Government |
$1,050.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,680.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,428.00
|
Rate for Payer: Group Health Inc Commercial |
$1,050.00
|
Rate for Payer: Group Health Inc Medicare |
$735.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,050.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,050.00
|
|
ZZ ALLEGRM BPSY NDL ACT
|
Facility
OP
|
$110.78
|
|
Hospital Charge Code |
41569564
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$38.77 |
Max. Negotiated Rate |
$88.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.93
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.39
|
Rate for Payer: Aetna Government |
$55.39
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.33
|
Rate for Payer: Group Health Inc Commercial |
$55.39
|
Rate for Payer: Group Health Inc Medicare |
$38.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.39
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$55.39
|
|
ZZ ALL PURP DRA CTH W/GLID
|
Facility
OP
|
$225.03
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567198
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$236.28 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.77
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
Rate for Payer: Aetna Government |
$44.85
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.52
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.39
|
Rate for Payer: Fidelis Medicare Advantage |
$236.28
|
Rate for Payer: Group Health Inc Commercial |
$112.52
|
Rate for Payer: Group Health Inc Medicare |
$78.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$112.52
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.27
|
|
ZZ ALL PURP DRA CTH W/GLID
|
Facility
IP
|
$225.03
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567198
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$112.52 |
Max. Negotiated Rate |
$112.52 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$112.52
|
|
ZZ AMPLATZER VASCULAR PLUG 2
|
Facility
OP
|
$2,200.00
|
|
Hospital Charge Code |
41563133
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$770.00 |
Max. Negotiated Rate |
$1,760.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,100.00
|
Rate for Payer: Aetna Government |
$1,100.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,760.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,496.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ZZ AMPLATZ EX WR 38/S/260
|
Facility
OP
|
$81.51
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567121
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$85.59 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.83
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.76
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.87
|
Rate for Payer: Fidelis Medicare Advantage |
$85.59
|
Rate for Payer: Group Health Inc Commercial |
$40.76
|
Rate for Payer: Group Health Inc Medicare |
$28.53
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.76
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.98
|
|
ZZ AMPLATZ EX WR 38/S/260
|
Facility
IP
|
$81.51
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567121
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.76 |
Max. Negotiated Rate |
$40.76 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.76
|
|
ZZ AMPLATZ GSNECK MCR KIT
|
Facility
IP
|
$1,548.62
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567279
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$774.31 |
Max. Negotiated Rate |
$774.31 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$774.31
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$774.31
|
|
ZZ AMPLATZ GSNECK MCR KIT
|
Facility
OP
|
$1,548.62
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567279
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$1,626.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$851.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$774.31
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$890.46
|
Rate for Payer: Fidelis Medicare Advantage |
$1,626.05
|
Rate for Payer: Group Health Inc Commercial |
$774.31
|
Rate for Payer: Group Health Inc Medicare |
$542.02
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$774.31
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$774.31
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,006.60
|
|
ZZ AMPLATZ RETV DEV GSNEC
|
Facility
OP
|
$635.75
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567278
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$667.54 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.66
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$317.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$365.56
|
Rate for Payer: Fidelis Medicare Advantage |
$667.54
|
Rate for Payer: Group Health Inc Commercial |
$317.88
|
Rate for Payer: Group Health Inc Medicare |
$222.51
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$317.88
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.24
|
|
ZZ AMPLATZ RETV DEV GSNEC
|
Facility
IP
|
$635.75
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567278
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$317.88 |
Max. Negotiated Rate |
$317.88 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$317.88
|
|
ZZ AMPLATZ SP STIF 35-145
|
Facility
IP
|
$81.51
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567122
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.76 |
Max. Negotiated Rate |
$40.76 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.76
|
|
ZZ AMPLATZ SP STIF 35-145
|
Facility
OP
|
$81.51
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567122
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$85.59 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.83
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.76
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.87
|
Rate for Payer: Fidelis Medicare Advantage |
$85.59
|
Rate for Payer: Group Health Inc Commercial |
$40.76
|
Rate for Payer: Group Health Inc Medicare |
$28.53
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.76
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.98
|
|
ZZ AMPLATZ SP STIF 35-180
|
Facility
OP
|
$133.60
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567123
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$140.28 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73.48
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.82
|
Rate for Payer: Fidelis Medicare Advantage |
$140.28
|
Rate for Payer: Group Health Inc Commercial |
$66.80
|
Rate for Payer: Group Health Inc Medicare |
$46.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$66.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.84
|
|
ZZ AMPLATZ SP STIF 35-180
|
Facility
IP
|
$133.60
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567123
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$66.80 |
Max. Negotiated Rate |
$66.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$66.80
|
|