ZZ AMPLATZ SP STIF 35-260
|
Facility
OP
|
$136.79
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567124
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$143.63 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$75.23
|
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 |
$68.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.65
|
Rate for Payer: Fidelis Medicare Advantage |
$143.63
|
Rate for Payer: Group Health Inc Commercial |
$68.40
|
Rate for Payer: Group Health Inc Medicare |
$47.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$68.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.91
|
|
ZZ AMPLATZ SP STIF 35-260
|
Facility
IP
|
$136.79
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567124
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$68.40 |
Max. Negotiated Rate |
$68.40 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$68.40
|
|
ZZ AMPLATZ SP STIF 35-75
|
Facility
OP
|
$84.69
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567126
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$88.92 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.58
|
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 |
$42.34
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.70
|
Rate for Payer: Fidelis Medicare Advantage |
$88.92
|
Rate for Payer: Group Health Inc Commercial |
$42.34
|
Rate for Payer: Group Health Inc Medicare |
$29.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.34
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$42.34
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.05
|
|
ZZ AMPLATZ SP STIF 35-75
|
Facility
IP
|
$84.69
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567126
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$42.34 |
Max. Negotiated Rate |
$42.34 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.34
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$42.34
|
|
ZZ AMPLATZ SP STIF 35/755
|
Facility
OP
|
$81.51
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567125
|
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 35/755
|
Facility
IP
|
$81.51
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41567125
|
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 AMPLT SS GDW 032/145
|
Facility
OP
|
$70.88
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569776
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$74.42 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.98
|
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 |
$35.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.76
|
Rate for Payer: Fidelis Medicare Advantage |
$74.42
|
Rate for Payer: Group Health Inc Commercial |
$35.44
|
Rate for Payer: Group Health Inc Medicare |
$24.81
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$35.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.07
|
|
ZZ AMPLT SS GDW 032/145
|
Facility
IP
|
$70.88
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569776
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$35.44 |
Max. Negotiated Rate |
$35.44 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$35.44
|
|
ZZ ANGIODYN 5F OMNFLUSH
|
Facility
OP
|
$45.08
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569600
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$15.78 |
Max. Negotiated Rate |
$47.33 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.79
|
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 |
$22.54
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.92
|
Rate for Payer: Fidelis Medicare Advantage |
$47.33
|
Rate for Payer: Group Health Inc Commercial |
$22.54
|
Rate for Payer: Group Health Inc Medicare |
$15.78
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$22.54
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.30
|
|
ZZ ANGIODYN 5F OMNFLUSH
|
Facility
IP
|
$45.08
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569600
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$22.54 |
Max. Negotiated Rate |
$22.54 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.54
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$22.54
|
|
ZZ ANGIODYN 5F STRFLUSH
|
Facility
IP
|
$35.44
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569601
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.72 |
Max. Negotiated Rate |
$17.72 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.72
|
|
ZZ ANGIODYN 5F STRFLUSH
|
Facility
OP
|
$35.44
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569601
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$12.40 |
Max. Negotiated Rate |
$44.85 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.49
|
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 |
$17.72
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.38
|
Rate for Payer: Fidelis Medicare Advantage |
$37.21
|
Rate for Payer: Group Health Inc Commercial |
$17.72
|
Rate for Payer: Group Health Inc Medicare |
$12.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.72
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.04
|
|
ZZ ANGIOGRAPHY KIT
|
Facility
OP
|
$89.66
|
|
Hospital Charge Code |
41567000
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$31.38 |
Max. Negotiated Rate |
$71.73 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.31
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.83
|
Rate for Payer: Aetna Government |
$44.83
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.73
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.97
|
Rate for Payer: Group Health Inc Commercial |
$44.83
|
Rate for Payer: Group Health Inc Medicare |
$31.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.83
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$44.83
|
|
ZZ ANGIO-SEAL 6F
|
Facility
IP
|
$580.00
|
|
Service Code
|
HCPCS C1760
|
Hospital Charge Code |
41561951
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$290.00 |
Max. Negotiated Rate |
$290.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$290.00
|
|
ZZ ANGIO-SEAL 6F
|
Facility
OP
|
$580.00
|
|
Service Code
|
HCPCS C1760
|
Hospital Charge Code |
41561951
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$73.50 |
Max. Negotiated Rate |
$609.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$319.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.50
|
Rate for Payer: Aetna Government |
$73.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$290.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$333.50
|
Rate for Payer: Fidelis Medicare Advantage |
$609.00
|
Rate for Payer: Group Health Inc Commercial |
$290.00
|
Rate for Payer: Group Health Inc Medicare |
$203.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$290.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.00
|
|
ZZ ANGIOTECH NEEDLE GUIDE
|
Facility
OP
|
$26.00
|
|
Hospital Charge Code |
41564610
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$9.10 |
Max. Negotiated Rate |
$20.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.00
|
Rate for Payer: Aetna Government |
$13.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.68
|
Rate for Payer: Group Health Inc Commercial |
$13.00
|
Rate for Payer: Group Health Inc Medicare |
$9.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$13.00
|
|
ZZ ANGULAR BOLSTER ENDURA
|
Facility
OP
|
$344.81
|
|
Hospital Charge Code |
41567311
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$120.68 |
Max. Negotiated Rate |
$275.85 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$189.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$172.40
|
Rate for Payer: Aetna Government |
$172.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$275.85
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.47
|
Rate for Payer: Group Health Inc Commercial |
$172.40
|
Rate for Payer: Group Health Inc Medicare |
$120.68
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.40
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$172.40
|
|
ZZ AP DRNG 10F
|
Facility
OP
|
$212.77
|
|
Hospital Charge Code |
41569639
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$74.47 |
Max. Negotiated Rate |
$170.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.02
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$106.38
|
Rate for Payer: Aetna Government |
$106.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$170.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.68
|
Rate for Payer: Group Health Inc Commercial |
$106.38
|
Rate for Payer: Group Health Inc Medicare |
$74.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$106.38
|
|
ZZ ARGON CLEANER 6F X 65CM
|
Facility
OP
|
$500.00
|
|
Hospital Charge Code |
41563507
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$175.00 |
Max. Negotiated Rate |
$400.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$250.00
|
Rate for Payer: Aetna Government |
$250.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.00
|
Rate for Payer: Group Health Inc Commercial |
$250.00
|
Rate for Payer: Group Health Inc Medicare |
$175.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
ZZ ARGON CO-AX INTRO NEEDLE
|
Facility
OP
|
$15.52
|
|
Hospital Charge Code |
41540610
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$5.43 |
Max. Negotiated Rate |
$12.42 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.54
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.76
|
Rate for Payer: Aetna Government |
$7.76
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.42
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.55
|
Rate for Payer: Group Health Inc Commercial |
$7.76
|
Rate for Payer: Group Health Inc Medicare |
$5.43
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.76
|
|
ZZ ARGON FULL CORE BX INSTRUMENT
|
Facility
OP
|
$47.00
|
|
Hospital Charge Code |
41540609
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$16.45 |
Max. Negotiated Rate |
$37.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.85
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.50
|
Rate for Payer: Aetna Government |
$23.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.96
|
Rate for Payer: Group Health Inc Commercial |
$23.50
|
Rate for Payer: Group Health Inc Medicare |
$16.45
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$23.50
|
|
ZZ ARGON SUPERCORE BX INSTRUMENT
|
Facility
OP
|
$80.00
|
|
Hospital Charge Code |
41563212
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$28.00 |
Max. Negotiated Rate |
$64.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
Rate for Payer: Aetna Government |
$40.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.40
|
Rate for Payer: Group Health Inc Commercial |
$40.00
|
Rate for Payer: Group Health Inc Medicare |
$28.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
|
ZZ ARGON VENA CAVA FILTER
|
Facility
OP
|
$2,400.00
|
|
Service Code
|
HCPCS C1880
|
Hospital Charge Code |
66520352
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$57.08 |
Max. Negotiated Rate |
$2,520.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,320.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.08
|
Rate for Payer: Aetna Government |
$57.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,200.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,380.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,520.00
|
Rate for Payer: Group Health Inc Commercial |
$1,200.00
|
Rate for Payer: Group Health Inc Medicare |
$840.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,200.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,200.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,560.00
|
|
ZZ ARGON VENA CAVA FILTER
|
Facility
IP
|
$2,400.00
|
|
Service Code
|
HCPCS C1880
|
Hospital Charge Code |
66520352
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,200.00 |
Max. Negotiated Rate |
$1,200.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,200.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,200.00
|
|
ZZ ARROW-TREROTOLA PTD KIT
|
Facility
OP
|
$1,200.00
|
|
Hospital Charge Code |
41568615
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$420.00 |
Max. Negotiated Rate |
$960.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$600.00
|
Rate for Payer: Aetna Government |
$600.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$960.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$816.00
|
Rate for Payer: Group Health Inc Commercial |
$600.00
|
Rate for Payer: Group Health Inc Medicare |
$420.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
|