ZZ ASP & IRRIG DEVICE
|
Facility
OP
|
$635.75
|
|
Hospital Charge Code |
41567290
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$222.51 |
Max. Negotiated Rate |
$508.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.66
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$317.88
|
Rate for Payer: Aetna Government |
$317.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$508.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.31
|
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
|
|
ZZ ATHERECTOMY CATHETER
|
Facility
OP
|
$2,575.60
|
|
Hospital Charge Code |
41567196
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$901.46 |
Max. Negotiated Rate |
$2,060.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,416.58
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,287.80
|
Rate for Payer: Aetna Government |
$1,287.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,060.48
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,751.41
|
Rate for Payer: Group Health Inc Commercial |
$1,287.80
|
Rate for Payer: Group Health Inc Medicare |
$901.46
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,287.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,287.80
|
|
ZZ BACKUP MEIER GUIDEWIRE .035
|
Facility
OP
|
$192.78
|
|
Hospital Charge Code |
41569818
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$67.47 |
Max. Negotiated Rate |
$154.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$106.03
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.39
|
Rate for Payer: Aetna Government |
$96.39
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$154.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$131.09
|
Rate for Payer: Group Health Inc Commercial |
$96.39
|
Rate for Payer: Group Health Inc Medicare |
$67.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.39
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$96.39
|
|
ZZ BAL CTH 6MM X 4CM(40CM)
|
Facility
OP
|
$766.16
|
|
Hospital Charge Code |
41567512
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$268.16 |
Max. Negotiated Rate |
$612.93 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.39
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.08
|
Rate for Payer: Aetna Government |
$383.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.93
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.99
|
Rate for Payer: Group Health Inc Commercial |
$383.08
|
Rate for Payer: Group Health Inc Medicare |
$268.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$383.08
|
|
ZZ BALKIN U&O 5.5 38 40
|
Facility
OP
|
$101.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
41567016
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.82 |
Max. Negotiated Rate |
$106.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
Rate for Payer: Aetna Government |
$0.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.08
|
Rate for Payer: Fidelis Medicare Advantage |
$106.05
|
Rate for Payer: Group Health Inc Commercial |
$50.50
|
Rate for Payer: Group Health Inc Medicare |
$35.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.65
|
|
ZZ BALKIN U&O 5.5 38 40
|
Facility
IP
|
$101.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
41567016
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$50.50 |
Max. Negotiated Rate |
$50.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
|
ZZ BALKIN U&O 6 38 40
|
Facility
OP
|
$101.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
41567018
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.82 |
Max. Negotiated Rate |
$106.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
Rate for Payer: Aetna Government |
$0.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.08
|
Rate for Payer: Fidelis Medicare Advantage |
$106.05
|
Rate for Payer: Group Health Inc Commercial |
$50.50
|
Rate for Payer: Group Health Inc Medicare |
$35.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.65
|
|
ZZ BALKIN U&O 6 38 40
|
Facility
IP
|
$101.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
41567018
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$50.50 |
Max. Negotiated Rate |
$50.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
|
ZZ BALKIN U&O 7 38 40
|
Facility
IP
|
$101.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
41567019
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$50.50 |
Max. Negotiated Rate |
$50.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
|
ZZ BALKIN U&O 7 38 40
|
Facility
OP
|
$101.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
41567019
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.82 |
Max. Negotiated Rate |
$106.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
Rate for Payer: Aetna Government |
$0.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.08
|
Rate for Payer: Fidelis Medicare Advantage |
$106.05
|
Rate for Payer: Group Health Inc Commercial |
$50.50
|
Rate for Payer: Group Health Inc Medicare |
$35.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.65
|
|
ZZ BALKIN U&O 8 38 40
|
Facility
IP
|
$101.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
41567017
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$50.50 |
Max. Negotiated Rate |
$50.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
|
ZZ BALKIN U&O 8 38 40
|
Facility
OP
|
$101.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
41567017
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.82 |
Max. Negotiated Rate |
$106.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
Rate for Payer: Aetna Government |
$0.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.08
|
Rate for Payer: Fidelis Medicare Advantage |
$106.05
|
Rate for Payer: Group Health Inc Commercial |
$50.50
|
Rate for Payer: Group Health Inc Medicare |
$35.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.65
|
|
ZZ BALLON/UT/DIAMOND/8-4-40
|
Facility
IP
|
$370.00
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567755
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$185.00 |
Max. Negotiated Rate |
$185.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$185.00
|
|
ZZ BALLON/UT/DIAMOND/8-4-40
|
Facility
OP
|
$370.00
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567755
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$388.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$203.50
|
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 |
$185.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$212.75
|
Rate for Payer: Fidelis Medicare Advantage |
$388.50
|
Rate for Payer: Group Health Inc Commercial |
$185.00
|
Rate for Payer: Group Health Inc Medicare |
$129.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$185.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$240.50
|
|
ZZ BALLOON/5-2/90CM/5F/MARSHALL
|
Facility
OP
|
$542.20
|
|
Hospital Charge Code |
41569133
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$189.77 |
Max. Negotiated Rate |
$433.76 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$298.21
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$271.10
|
Rate for Payer: Aetna Government |
$271.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$433.76
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$368.70
|
Rate for Payer: Group Health Inc Commercial |
$271.10
|
Rate for Payer: Group Health Inc Medicare |
$189.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.10
|
|
ZZ BALLOON/6-2/90CM/5F/MARSHALL
|
Facility
OP
|
$542.20
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569134
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$569.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$298.21
|
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 |
$271.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$311.76
|
Rate for Payer: Fidelis Medicare Advantage |
$569.31
|
Rate for Payer: Group Health Inc Commercial |
$271.10
|
Rate for Payer: Group Health Inc Medicare |
$189.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.43
|
|
ZZ BALLOON/6-2/90CM/5F/MARSHALL
|
Facility
IP
|
$542.20
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569134
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$271.10 |
Max. Negotiated Rate |
$271.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.10
|
|
ZZ BALLOON/6-4/90CM/5F/MARSHALL
|
Facility
IP
|
$542.20
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569135
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$271.10 |
Max. Negotiated Rate |
$271.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.10
|
|
ZZ BALLOON/6-4/90CM/5F/MARSHALL
|
Facility
OP
|
$542.20
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569135
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$569.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$298.21
|
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 |
$271.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$311.76
|
Rate for Payer: Fidelis Medicare Advantage |
$569.31
|
Rate for Payer: Group Health Inc Commercial |
$271.10
|
Rate for Payer: Group Health Inc Medicare |
$189.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.43
|
|
ZZ BALLOON/7-4/90CM/6F/MARSHALL
|
Facility
OP
|
$542.20
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569136
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$569.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$298.21
|
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 |
$271.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$311.76
|
Rate for Payer: Fidelis Medicare Advantage |
$569.31
|
Rate for Payer: Group Health Inc Commercial |
$271.10
|
Rate for Payer: Group Health Inc Medicare |
$189.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.43
|
|
ZZ BALLOON/7-4/90CM/6F/MARSHALL
|
Facility
IP
|
$542.20
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569136
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$271.10 |
Max. Negotiated Rate |
$271.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.10
|
|
ZZ BALLOON/8-2/90CM/6F/MARSHALL
|
Facility
OP
|
$542.20
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569137
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$569.31 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$298.21
|
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 |
$271.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$311.76
|
Rate for Payer: Fidelis Medicare Advantage |
$569.31
|
Rate for Payer: Group Health Inc Commercial |
$271.10
|
Rate for Payer: Group Health Inc Medicare |
$189.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.43
|
|
ZZ BALLOON/8-2/90CM/6F/MARSHALL
|
Facility
IP
|
$542.20
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569137
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$271.10 |
Max. Negotiated Rate |
$271.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.10
|
|
ZZ BALLOON/8-3/BLUEMAX/75
|
Facility
OP
|
$550.70
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569138
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$578.24 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.88
|
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 |
$275.35
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$316.65
|
Rate for Payer: Fidelis Medicare Advantage |
$578.24
|
Rate for Payer: Group Health Inc Commercial |
$275.35
|
Rate for Payer: Group Health Inc Medicare |
$192.74
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$275.35
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$357.96
|
|
ZZ BALLOON/8-3/BLUEMAX/75
|
Facility
IP
|
$550.70
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569138
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$275.35 |
Max. Negotiated Rate |
$275.35 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$275.35
|
|