|
ZZ BS DIREXION MICROCATHETER
|
Facility
OP
|
$1,225.00
|
|
| Hospital Charge Code |
41561359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.75 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$673.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$612.50
|
| Rate for Payer: Aetna Government |
$612.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$980.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$833.00
|
| Rate for Payer: Group Health Inc Commercial |
$612.50
|
| Rate for Payer: Group Health Inc Medicare |
$428.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$612.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$612.50
|
|
|
ZZ BS MUSTANG 5F 6.0MMX40MM
|
Facility
OP
|
$700.00
|
|
| Hospital Charge Code |
41561942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$350.00
|
| Rate for Payer: Aetna Government |
$350.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$560.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$476.00
|
| Rate for Payer: Group Health Inc Commercial |
$350.00
|
| Rate for Payer: Group Health Inc Medicare |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
|
|
ZZ BS MUSTANG 5F 6.0MMX40MM
|
Facility
OP
|
$700.00
|
|
| Hospital Charge Code |
41561943
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$350.00
|
| Rate for Payer: Aetna Government |
$350.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$560.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$476.00
|
| Rate for Payer: Group Health Inc Commercial |
$350.00
|
| Rate for Payer: Group Health Inc Medicare |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
|
|
ZZ BS POLARCATH 5.5F 5.0MMX40MM
|
Facility
OP
|
$2,170.00
|
|
| Hospital Charge Code |
41561941
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$759.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,193.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,085.00
|
| Rate for Payer: Aetna Government |
$1,085.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,736.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,475.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,085.00
|
| Rate for Payer: Group Health Inc Medicare |
$759.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,085.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,085.00
|
|
|
ZZ BS POLARCATH INFLATION UNIT
|
Facility
OP
|
$1,920.00
|
|
| Hospital Charge Code |
41561940
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,056.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$960.00
|
| Rate for Payer: Aetna Government |
$960.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,536.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,305.60
|
| Rate for Payer: Group Health Inc Commercial |
$960.00
|
| Rate for Payer: Group Health Inc Medicare |
$672.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$960.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$960.00
|
|
|
ZZ BS STERLING 4F 4.0MMX40MM
|
Facility
OP
|
$668.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41561946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$701.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$367.40
|
| 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 |
$334.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$384.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$701.40
|
| Rate for Payer: Group Health Inc Commercial |
$334.00
|
| Rate for Payer: Group Health Inc Medicare |
$233.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$334.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$434.20
|
|
|
ZZ BS STERLING 4F 4.0MMX40MM
|
Facility
IP
|
$668.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41561946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$334.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$334.00
|
|
|
ZZ BS STERLING 4F 5.0MMX40MM
|
Facility
OP
|
$668.00
|
|
| Hospital Charge Code |
41561945
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$233.80 |
| Max. Negotiated Rate |
$534.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$367.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$334.00
|
| Rate for Payer: Aetna Government |
$334.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$534.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$454.24
|
| Rate for Payer: Group Health Inc Commercial |
$334.00
|
| Rate for Payer: Group Health Inc Medicare |
$233.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$334.00
|
|
|
ZZ BS STERLING 4F 6.0MMX40MM
|
Facility
OP
|
$668.00
|
|
| Hospital Charge Code |
41561944
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$233.80 |
| Max. Negotiated Rate |
$534.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$367.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$334.00
|
| Rate for Payer: Aetna Government |
$334.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$534.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$454.24
|
| Rate for Payer: Group Health Inc Commercial |
$334.00
|
| Rate for Payer: Group Health Inc Medicare |
$233.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$334.00
|
|
|
ZZ BS TRANSEND 0.018IN165CM
|
Facility
OP
|
$484.00
|
|
| Hospital Charge Code |
41561902
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$387.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$266.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.00
|
| Rate for Payer: Aetna Government |
$242.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$387.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$329.12
|
| Rate for Payer: Group Health Inc Commercial |
$242.00
|
| Rate for Payer: Group Health Inc Medicare |
$169.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.00
|
|
|
ZZ BS V-14 C/W 0.014INX300CM
|
Facility
OP
|
$440.00
|
|
| Hospital Charge Code |
41561939
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$242.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$220.00
|
| Rate for Payer: Aetna Government |
$220.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$352.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$299.20
|
| Rate for Payer: Group Health Inc Commercial |
$220.00
|
| Rate for Payer: Group Health Inc Medicare |
$154.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.00
|
|
|
ZZ BS V-18 CONTROL WIRE
|
Facility
OP
|
$192.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
41561885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$201.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$105.73
|
| 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 |
$96.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.85
|
| Rate for Payer: Group Health Inc Commercial |
$96.12
|
| Rate for Payer: Group Health Inc Medicare |
$67.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.96
|
|
|
ZZ BS V-18 CONTROL WIRE
|
Facility
IP
|
$192.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
41561885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.12 |
| Max. Negotiated Rate |
$96.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.12
|
|
|
ZZ BS V-18 C/W 0.018INX150CM
|
Facility
OP
|
$182.46
|
|
| Hospital Charge Code |
41561905
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.86 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Government |
$91.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$145.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.07
|
| Rate for Payer: Group Health Inc Commercial |
$91.23
|
| Rate for Payer: Group Health Inc Medicare |
$63.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.23
|
|
|
ZZ BS V-18 C/W 0.018INX200CM
|
Facility
OP
|
$192.24
|
|
| Hospital Charge Code |
41561907
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.28 |
| Max. Negotiated Rate |
$153.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$105.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.12
|
| Rate for Payer: Aetna Government |
$96.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$153.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$130.72
|
| Rate for Payer: Group Health Inc Commercial |
$96.12
|
| Rate for Payer: Group Health Inc Medicare |
$67.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.12
|
|
|
ZZ BS V-18 C/W 0.81IN165CM
|
Facility
OP
|
$424.00
|
|
| Hospital Charge Code |
41561903
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$339.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.00
|
| Rate for Payer: Aetna Government |
$212.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$339.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.32
|
| Rate for Payer: Group Health Inc Commercial |
$212.00
|
| Rate for Payer: Group Health Inc Medicare |
$148.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.00
|
|
|
ZZ BS WALLSTENT 10X90
|
Facility
OP
|
$1,805.76
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41541111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$1,896.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$993.17
|
| 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 |
$902.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,038.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,896.05
|
| Rate for Payer: Group Health Inc Commercial |
$902.88
|
| Rate for Payer: Group Health Inc Medicare |
$632.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$902.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$902.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,173.74
|
|
|
ZZ BS WALLSTENT 10X90
|
Facility
IP
|
$1,805.76
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41541111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.88 |
| Max. Negotiated Rate |
$902.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$902.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$902.88
|
|
|
ZZ BS WALLSTENT 16X60
|
Facility
OP
|
$1,063.92
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41540619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$1,117.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$585.16
|
| 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 |
$531.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$611.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,117.12
|
| Rate for Payer: Group Health Inc Commercial |
$531.96
|
| Rate for Payer: Group Health Inc Medicare |
$372.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$691.55
|
|
|
ZZ BS WALLSTENT 16X60
|
Facility
OP
|
$1,063.92
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41541113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$1,117.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$585.16
|
| 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 |
$531.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$611.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,117.12
|
| Rate for Payer: Group Health Inc Commercial |
$531.96
|
| Rate for Payer: Group Health Inc Medicare |
$372.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$691.55
|
|
|
ZZ BS WALLSTENT 16X60
|
Facility
IP
|
$1,063.92
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41541113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.96 |
| Max. Negotiated Rate |
$531.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.96
|
|
|
ZZ BS WALLSTENT 16X60
|
Facility
IP
|
$1,063.92
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41540619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.96 |
| Max. Negotiated Rate |
$531.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.96
|
|
|
ZZ BS WALLSTENT 18X90
|
Facility
IP
|
$1,805.76
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41540618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.88 |
| Max. Negotiated Rate |
$902.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$902.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$902.88
|
|
|
ZZ BS WALLSTENT 18X90
|
Facility
OP
|
$1,805.76
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41540618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$1,896.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$993.17
|
| 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 |
$902.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,038.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,896.05
|
| Rate for Payer: Group Health Inc Commercial |
$902.88
|
| Rate for Payer: Group Health Inc Medicare |
$632.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$902.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$902.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,173.74
|
|
|
ZZ BS WALLSTENT ENDOPROSTHESIS
|
Facility
OP
|
$1,182.72
|
|
| Hospital Charge Code |
41540612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$413.95 |
| Max. Negotiated Rate |
$946.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$650.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$591.36
|
| Rate for Payer: Aetna Government |
$591.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$946.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$804.25
|
| Rate for Payer: Group Health Inc Commercial |
$591.36
|
| Rate for Payer: Group Health Inc Medicare |
$413.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$591.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$591.36
|
|
