|
ZZ BARDSPORT SLIM TITM SNG LUMEN
|
Facility
OP
|
$840.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41569832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$462.00
|
| 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 |
$420.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$483.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$882.00
|
| Rate for Payer: Group Health Inc Commercial |
$420.00
|
| Rate for Payer: Group Health Inc Medicare |
$294.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$420.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$546.00
|
|
|
ZZ BARD STENT FLEXX
|
Facility
IP
|
$3,402.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41569540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,701.00 |
| Max. Negotiated Rate |
$1,701.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,701.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,701.00
|
|
|
ZZ BARD STENT FLEXX
|
Facility
OP
|
$3,402.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41569540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$3,572.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,871.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$398.18
|
| Rate for Payer: Aetna Government |
$398.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,701.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,956.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,572.10
|
| Rate for Payer: Group Health Inc Commercial |
$1,701.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,190.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,701.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,701.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,211.30
|
|
|
ZZ BARD TRACHEOBRONC STENT GRAFT
|
Facility
OP
|
$5,700.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66520353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$5,985.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,135.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,850.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,277.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,985.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,850.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,995.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,850.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,850.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,705.00
|
|
|
ZZ BARD TRACHEOBRONC STENT GRAFT
|
Facility
IP
|
$5,700.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66520353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,850.00 |
| Max. Negotiated Rate |
$2,850.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,850.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,850.00
|
|
|
ZZ BARD UNIV DRAINAGE BAG
|
Facility
OP
|
$22.18
|
|
| Hospital Charge Code |
41569881
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.09
|
| Rate for Payer: Aetna Government |
$11.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.08
|
| Rate for Payer: Group Health Inc Commercial |
$11.09
|
| Rate for Payer: Group Health Inc Medicare |
$7.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.09
|
|
|
ZZ BARD X-PORT 6FR
|
Facility
OP
|
$661.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41567895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$694.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$363.82
|
| 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 |
$330.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$380.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$694.58
|
| Rate for Payer: Group Health Inc Commercial |
$330.75
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$429.98
|
|
|
ZZ BARD X-PORT 6FR
|
Facility
IP
|
$661.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41567895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.75
|
|
|
ZZ BARIUM SULFATE GM 50ML VIAL
|
Facility
OP
|
$198.45
|
|
| Hospital Charge Code |
41569724
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.46 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.22
|
| Rate for Payer: Aetna Government |
$99.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$158.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$134.95
|
| Rate for Payer: Group Health Inc Commercial |
$99.22
|
| Rate for Payer: Group Health Inc Medicare |
$69.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.22
|
|
|
ZZ BASKET/1.5CM/3CM LENGHT/8 WIRE
|
Facility
OP
|
$422.30
|
|
| Hospital Charge Code |
41569453
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$337.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$232.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$211.15
|
| Rate for Payer: Aetna Government |
$211.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$337.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$287.16
|
| Rate for Payer: Group Health Inc Commercial |
$211.15
|
| Rate for Payer: Group Health Inc Medicare |
$147.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.15
|
|
|
ZZ BASKET/6.3F/55CM/BIL/STONE
|
Facility
OP
|
$487.24
|
|
| Hospital Charge Code |
41569454
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$170.53 |
| Max. Negotiated Rate |
$389.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$267.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$243.62
|
| Rate for Payer: Aetna Government |
$243.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$389.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$331.32
|
| Rate for Payer: Group Health Inc Commercial |
$243.62
|
| Rate for Payer: Group Health Inc Medicare |
$170.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.62
|
|
|
ZZ BASKET/6.5F/55CM/BIL/STONE
|
Facility
OP
|
$487.24
|
|
| Hospital Charge Code |
41569456
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$170.53 |
| Max. Negotiated Rate |
$389.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$267.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$243.62
|
| Rate for Payer: Aetna Government |
$243.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$389.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$331.32
|
| Rate for Payer: Group Health Inc Commercial |
$243.62
|
| Rate for Payer: Group Health Inc Medicare |
$170.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.62
|
|
|
ZZ BASKET/HELICAL/2.5F/115CM
|
Facility
OP
|
$214.49
|
|
| Hospital Charge Code |
41569457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.07 |
| Max. Negotiated Rate |
$171.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$107.24
|
| Rate for Payer: Aetna Government |
$107.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$171.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$145.85
|
| Rate for Payer: Group Health Inc Commercial |
$107.24
|
| Rate for Payer: Group Health Inc Medicare |
$75.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.24
|
|
|
ZZ BAXTER ADHERENT CLOT CATH
|
Facility
OP
|
$552.83
|
|
| Hospital Charge Code |
41569625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$193.49 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$304.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$276.42
|
| Rate for Payer: Aetna Government |
$276.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$442.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.92
|
| Rate for Payer: Group Health Inc Commercial |
$276.42
|
| Rate for Payer: Group Health Inc Medicare |
$193.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.42
|
|
|
ZZ BD NEXIVA DIFFUSICS
|
Facility
OP
|
$20.00
|
|
| Hospital Charge Code |
66520350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.00
|
| Rate for Payer: Aetna Government |
$10.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
|
|
ZZ BELLY BAG/BILATERAL
|
Facility
OP
|
$25.26
|
|
| Hospital Charge Code |
41569458
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$20.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.63
|
| Rate for Payer: Aetna Government |
$12.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.18
|
| Rate for Payer: Group Health Inc Commercial |
$12.63
|
| Rate for Payer: Group Health Inc Medicare |
$8.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.63
|
|
|
ZZ BELLY BAG/UNILATERAL
|
Facility
OP
|
$23.21
|
|
| Hospital Charge Code |
41569459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$18.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.60
|
| Rate for Payer: Aetna Government |
$11.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.78
|
| Rate for Payer: Group Health Inc Commercial |
$11.60
|
| Rate for Payer: Group Health Inc Medicare |
$8.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.60
|
|
|
ZZ BERENSTEIN CATH 5 40
|
Facility
IP
|
$48.91
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41567170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$24.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
|
|
ZZ BERENSTEIN CATH 5 40
|
Facility
OP
|
$48.91
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41567170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$51.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| 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 |
$24.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.36
|
| Rate for Payer: Group Health Inc Commercial |
$24.46
|
| Rate for Payer: Group Health Inc Medicare |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.79
|
|
|
ZZ BERENSTEIN CATH 5 65
|
Facility
IP
|
$48.91
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41567169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$24.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
|
|
ZZ BERENSTEIN CATH 5 65
|
Facility
OP
|
$48.91
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41567169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$51.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| 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 |
$24.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.36
|
| Rate for Payer: Group Health Inc Commercial |
$24.46
|
| Rate for Payer: Group Health Inc Medicare |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.79
|
|
|
ZZ BETSON WR TSFB 35 145
|
Facility
IP
|
$49.97
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
41567092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$24.98 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.98
|
|
|
ZZ BETSON WR TSFB 35 145
|
Facility
OP
|
$49.97
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
41567092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$52.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.48
|
| 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 |
$24.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.47
|
| Rate for Payer: Group Health Inc Commercial |
$24.98
|
| Rate for Payer: Group Health Inc Medicare |
$17.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.48
|
|
|
ZZ BILIAR CTH AMPLA 10/30
|
Facility
IP
|
$231.41
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41567223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.70 |
| Max. Negotiated Rate |
$115.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.70
|
|
|
ZZ BILIAR CTH AMPLA 10/30
|
Facility
OP
|
$231.41
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41567223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$242.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$127.28
|
| 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 |
$115.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$133.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.98
|
| Rate for Payer: Group Health Inc Commercial |
$115.70
|
| Rate for Payer: Group Health Inc Medicare |
$80.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.42
|
|
