ZZ HOOK CATH 1/5/65/035
|
Facility
OP
|
$53.87
|
|
Hospital Charge Code |
41567246
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$18.85 |
Max. Negotiated Rate |
$43.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.63
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.94
|
Rate for Payer: Aetna Government |
$26.94
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.63
|
Rate for Payer: Group Health Inc Commercial |
$26.94
|
Rate for Payer: Group Health Inc Medicare |
$18.85
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.94
|
|
ZZ HP THREE WY STPCK #179779
|
Facility
OP
|
$4.34
|
|
Hospital Charge Code |
41569002
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1.52 |
Max. Negotiated Rate |
$3.47 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.39
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
Rate for Payer: Aetna Government |
$2.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.47
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.95
|
Rate for Payer: Group Health Inc Commercial |
$2.17
|
Rate for Payer: Group Health Inc Medicare |
$1.52
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.17
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2.17
|
|
ZZ HP THREE WY STPCK #PTWSC 2FLL
|
Facility
OP
|
$4.34
|
|
Hospital Charge Code |
41569003
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1.52 |
Max. Negotiated Rate |
$3.47 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.39
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
Rate for Payer: Aetna Government |
$2.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.47
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.95
|
Rate for Payer: Group Health Inc Commercial |
$2.17
|
Rate for Payer: Group Health Inc Medicare |
$1.52
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.17
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2.17
|
|
ZZ H/S CATHETER SET
|
Facility
OP
|
$55.88
|
|
Service Code
|
HCPCS C1726
|
Hospital Charge Code |
41567757
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.43 |
Max. Negotiated Rate |
$58.67 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.73
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.43
|
Rate for Payer: Aetna Government |
$17.43
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.13
|
Rate for Payer: Fidelis Medicare Advantage |
$58.67
|
Rate for Payer: Group Health Inc Commercial |
$27.94
|
Rate for Payer: Group Health Inc Medicare |
$19.56
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$27.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.32
|
|
ZZ H/S CATHETER SET
|
Facility
IP
|
$55.88
|
|
Service Code
|
HCPCS C1726
|
Hospital Charge Code |
41567757
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$27.94 |
Max. Negotiated Rate |
$27.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$27.94
|
|
ZZ HYDR COT 5/100/SIM2/38
|
Facility
OP
|
$159.82
|
|
Hospital Charge Code |
41567242
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$55.94 |
Max. Negotiated Rate |
$127.86 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.91
|
Rate for Payer: Aetna Government |
$79.91
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$127.86
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.68
|
Rate for Payer: Group Health Inc Commercial |
$79.91
|
Rate for Payer: Group Health Inc Medicare |
$55.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.91
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$79.91
|
|
ZZ HYDRO COAT 5/100/AT/38
|
Facility
OP
|
$159.82
|
|
Hospital Charge Code |
41567239
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$55.94 |
Max. Negotiated Rate |
$127.86 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.91
|
Rate for Payer: Aetna Government |
$79.91
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$127.86
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.68
|
Rate for Payer: Group Health Inc Commercial |
$79.91
|
Rate for Payer: Group Health Inc Medicare |
$55.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.91
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$79.91
|
|
ZZ HYDRO COAT CTH C1/5/65
|
Facility
IP
|
$159.82
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567240
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$79.91 |
Max. Negotiated Rate |
$79.91 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.91
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$79.91
|
|
ZZ HYDRO COAT CTH C1/5/65
|
Facility
OP
|
$159.82
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567240
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$167.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.90
|
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 |
$79.91
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.90
|
Rate for Payer: Fidelis Medicare Advantage |
$167.81
|
Rate for Payer: Group Health Inc Commercial |
$79.91
|
Rate for Payer: Group Health Inc Medicare |
$55.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.91
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$79.91
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.88
|
|
ZZ HYDRO COAT CTH C2/5/65
|
Facility
OP
|
$159.82
|
|
Hospital Charge Code |
41567241
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$55.94 |
Max. Negotiated Rate |
$127.86 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.91
|
Rate for Payer: Aetna Government |
$79.91
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$127.86
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.68
|
Rate for Payer: Group Health Inc Commercial |
$79.91
|
Rate for Payer: Group Health Inc Medicare |
$55.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.91
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$79.91
|
|
ZZ HYSTEROSALPINGOGRAM TRAY
|
Facility
OP
|
$50.60
|
|
Hospital Charge Code |
41561895
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$17.71 |
Max. Negotiated Rate |
$40.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.83
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.30
|
Rate for Payer: Aetna Government |
$25.30
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.48
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.41
|
Rate for Payer: Group Health Inc Commercial |
$25.30
|
Rate for Payer: Group Health Inc Medicare |
$17.71
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$25.30
|
|
ZZ IMAGE TORQ CATH 65 NO S
|
Facility
IP
|
$53.87
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567247
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$26.94 |
Max. Negotiated Rate |
$26.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.94
|
|
ZZ IMAGE TORQ CATH 65 NO S
|
Facility
OP
|
$53.87
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567247
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$18.85 |
Max. Negotiated Rate |
$56.56 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.63
|
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 |
$26.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.98
|
Rate for Payer: Fidelis Medicare Advantage |
$56.56
|
Rate for Payer: Group Health Inc Commercial |
$26.94
|
Rate for Payer: Group Health Inc Medicare |
$18.85
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.02
|
|
ZZ INFLATION DEVICE
|
Facility
OP
|
$147.78
|
|
Hospital Charge Code |
41569515
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$51.72 |
Max. Negotiated Rate |
$118.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.28
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.89
|
Rate for Payer: Aetna Government |
$73.89
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$118.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.49
|
Rate for Payer: Group Health Inc Commercial |
$73.89
|
Rate for Payer: Group Health Inc Medicare |
$51.72
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.89
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$73.89
|
|
ZZ INFLATOR
|
Facility
OP
|
$130.41
|
|
Hospital Charge Code |
41567500
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$45.64 |
Max. Negotiated Rate |
$104.33 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.73
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.20
|
Rate for Payer: Aetna Government |
$65.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.33
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.68
|
Rate for Payer: Group Health Inc Commercial |
$65.20
|
Rate for Payer: Group Health Inc Medicare |
$45.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$65.20
|
|
ZZ INFUSION CATH/FASTRACKER-18
|
Facility
IP
|
$627.25
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569517
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$313.62 |
Max. Negotiated Rate |
$313.62 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.62
|
|
ZZ INFUSION CATH/FASTRACKER-18
|
Facility
OP
|
$627.25
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569517
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$658.61 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$344.99
|
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 |
$313.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.67
|
Rate for Payer: Fidelis Medicare Advantage |
$658.61
|
Rate for Payer: Group Health Inc Commercial |
$313.62
|
Rate for Payer: Group Health Inc Medicare |
$219.54
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$313.62
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.71
|
|
ZZ INTERLOCK 2D OCCLU. SYST.
|
Facility
OP
|
$794.00
|
|
Hospital Charge Code |
41569962
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$277.90 |
Max. Negotiated Rate |
$635.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$436.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$397.00
|
Rate for Payer: Aetna Government |
$397.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$635.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$539.92
|
Rate for Payer: Group Health Inc Commercial |
$397.00
|
Rate for Payer: Group Health Inc Medicare |
$277.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$397.00
|
|
ZZ INTRACOIL STENT
|
Facility
IP
|
$3,402.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41560055
|
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 INTRACOIL STENT
|
Facility
OP
|
$3,402.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41560055
|
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 INTRACOIL STENT 4X40
|
Facility
IP
|
$3,402.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569660
|
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 INTRACOIL STENT 4X40
|
Facility
OP
|
$3,402.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569660
|
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 INTRACOIL STENT 5X40
|
Facility
IP
|
$3,402.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569658
|
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 INTRACOIL STENT 5X40
|
Facility
OP
|
$3,402.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569658
|
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 INTRACOIL STENT 5X60
|
Facility
IP
|
$3,402.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569661
|
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
|
|