ZZ COIL/.018 HILAL/6-7
|
Facility
IP
|
$142.46
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569055
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$71.23 |
Max. Negotiated Rate |
$71.23 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.23
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$71.23
|
|
ZZ COIL/.018 HILAL/6-7
|
Facility
OP
|
$142.46
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569055
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$49.86 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$78.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.23
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.91
|
Rate for Payer: Fidelis Medicare Advantage |
$149.58
|
Rate for Payer: Group Health Inc Commercial |
$71.23
|
Rate for Payer: Group Health Inc Medicare |
$49.86
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.23
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$71.23
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.60
|
|
ZZ COIL/.018 TORNADO/3-2
|
Facility
OP
|
$156.74
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569056
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$54.86 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.21
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.37
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.13
|
Rate for Payer: Fidelis Medicare Advantage |
$164.58
|
Rate for Payer: Group Health Inc Commercial |
$78.37
|
Rate for Payer: Group Health Inc Medicare |
$54.86
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.37
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.37
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.88
|
|
ZZ COIL/.018 TORNADO/3-2
|
Facility
IP
|
$156.74
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569056
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$78.37 |
Max. Negotiated Rate |
$78.37 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.37
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.37
|
|
ZZ COIL/.018 TORNADO/4-2
|
Facility
IP
|
$156.74
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569057
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$78.37 |
Max. Negotiated Rate |
$78.37 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.37
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.37
|
|
ZZ COIL/.018 TORNADO/4-2
|
Facility
OP
|
$156.74
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569057
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$54.86 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.21
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.37
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.13
|
Rate for Payer: Fidelis Medicare Advantage |
$164.58
|
Rate for Payer: Group Health Inc Commercial |
$78.37
|
Rate for Payer: Group Health Inc Medicare |
$54.86
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.37
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.37
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.88
|
|
ZZ COIL/.018 TORNADO/5-2
|
Facility
OP
|
$156.74
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569059
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$54.86 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.21
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.37
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.13
|
Rate for Payer: Fidelis Medicare Advantage |
$164.58
|
Rate for Payer: Group Health Inc Commercial |
$78.37
|
Rate for Payer: Group Health Inc Medicare |
$54.86
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.37
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.37
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.88
|
|
ZZ COIL/.018 TORNADO/5-2
|
Facility
IP
|
$156.74
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569059
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$78.37 |
Max. Negotiated Rate |
$78.37 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.37
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.37
|
|
ZZ COIL/.018 TORNADO/6-2
|
Facility
OP
|
$156.74
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569058
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$54.86 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.21
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.37
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.13
|
Rate for Payer: Fidelis Medicare Advantage |
$164.58
|
Rate for Payer: Group Health Inc Commercial |
$78.37
|
Rate for Payer: Group Health Inc Medicare |
$54.86
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.37
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.37
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.88
|
|
ZZ COIL/.018 TORNADO/6-2
|
Facility
IP
|
$156.74
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569058
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$78.37 |
Max. Negotiated Rate |
$78.37 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.37
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$78.37
|
|
ZZ COIL/.025 STANDARD/1.2-2
|
Facility
OP
|
$92.82
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569060
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$32.49 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.41
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.37
|
Rate for Payer: Fidelis Medicare Advantage |
$97.46
|
Rate for Payer: Group Health Inc Commercial |
$46.41
|
Rate for Payer: Group Health Inc Medicare |
$32.49
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.33
|
|
ZZ COIL/.025 STANDARD/1.2-2
|
Facility
IP
|
$92.82
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569060
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$46.41 |
Max. Negotiated Rate |
$46.41 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
|
ZZ COIL/.025 STANDARD/2-3
|
Facility
IP
|
$92.82
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569061
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$46.41 |
Max. Negotiated Rate |
$46.41 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
|
ZZ COIL/.025 STANDARD/2-3
|
Facility
OP
|
$92.82
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569061
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$32.49 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.41
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.37
|
Rate for Payer: Fidelis Medicare Advantage |
$97.46
|
Rate for Payer: Group Health Inc Commercial |
$46.41
|
Rate for Payer: Group Health Inc Medicare |
$32.49
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.33
|
|
ZZ COIL/.025 STANDARD/2.5-2
|
Facility
IP
|
$92.82
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569062
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$46.41 |
Max. Negotiated Rate |
$46.41 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
|
ZZ COIL/.025 STANDARD/2.5-2
|
Facility
OP
|
$92.82
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569062
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$32.49 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.41
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.37
|
Rate for Payer: Fidelis Medicare Advantage |
$97.46
|
Rate for Payer: Group Health Inc Commercial |
$46.41
|
Rate for Payer: Group Health Inc Medicare |
$32.49
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.33
|
|
ZZ COIL/.025 STANDARD/3-5
|
Facility
OP
|
$92.82
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569063
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$32.49 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.41
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.37
|
Rate for Payer: Fidelis Medicare Advantage |
$97.46
|
Rate for Payer: Group Health Inc Commercial |
$46.41
|
Rate for Payer: Group Health Inc Medicare |
$32.49
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.33
|
|
ZZ COIL/.025 STANDARD/3-5
|
Facility
IP
|
$92.82
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569063
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$46.41 |
Max. Negotiated Rate |
$46.41 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
|
ZZ COIL/.025 STANDARD/4-3
|
Facility
OP
|
$92.82
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569065
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$32.49 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.41
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.37
|
Rate for Payer: Fidelis Medicare Advantage |
$97.46
|
Rate for Payer: Group Health Inc Commercial |
$46.41
|
Rate for Payer: Group Health Inc Medicare |
$32.49
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.33
|
|
ZZ COIL/.025 STANDARD/4-3
|
Facility
IP
|
$92.82
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569065
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$46.41 |
Max. Negotiated Rate |
$46.41 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
|
ZZ COIL/.035 DETACHABLE
|
Facility
IP
|
$108.30
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41560053
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$54.15 |
Max. Negotiated Rate |
$54.15 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$54.15
|
|
ZZ COIL/.035 DETACHABLE
|
Facility
OP
|
$108.30
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41560053
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$37.90 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.56
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.15
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.27
|
Rate for Payer: Fidelis Medicare Advantage |
$113.72
|
Rate for Payer: Group Health Inc Commercial |
$54.15
|
Rate for Payer: Group Health Inc Medicare |
$37.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$54.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.40
|
|
ZZ COIL/.035 DETACHABLE/3-4
|
Facility
IP
|
$108.30
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569066
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$54.15 |
Max. Negotiated Rate |
$54.15 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$54.15
|
|
ZZ COIL/.035 DETACHABLE/3-4
|
Facility
OP
|
$108.30
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569066
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$37.90 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.56
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.15
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.27
|
Rate for Payer: Fidelis Medicare Advantage |
$113.72
|
Rate for Payer: Group Health Inc Commercial |
$54.15
|
Rate for Payer: Group Health Inc Medicare |
$37.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$54.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.40
|
|
ZZ COIL/.035 DETACHABLE/3-5
|
Facility
OP
|
$108.30
|
|
Service Code
|
HCPCS C1884
|
Hospital Charge Code |
41569067
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$37.90 |
Max. Negotiated Rate |
$180.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.56
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.07
|
Rate for Payer: Aetna Government |
$180.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.15
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.27
|
Rate for Payer: Fidelis Medicare Advantage |
$113.72
|
Rate for Payer: Group Health Inc Commercial |
$54.15
|
Rate for Payer: Group Health Inc Medicare |
$37.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.15
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$54.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.40
|
|