ZZ IVC FILTER (BARD) FEMORAL ECLY
|
Facility
OP
|
$3,118.00
|
|
Hospital Charge Code |
40207739
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,091.30 |
Max. Negotiated Rate |
$2,494.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,714.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,559.00
|
Rate for Payer: Aetna Government |
$1,559.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,494.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,120.24
|
Rate for Payer: Group Health Inc Commercial |
$1,559.00
|
Rate for Payer: Group Health Inc Medicare |
$1,091.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,559.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,559.00
|
|
ZZ IVC FILTER (BARD) JUGULAR ECLY
|
Facility
OP
|
$3,118.00
|
|
Hospital Charge Code |
41567740
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,091.30 |
Max. Negotiated Rate |
$2,494.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,714.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,559.00
|
Rate for Payer: Aetna Government |
$1,559.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,494.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,120.24
|
Rate for Payer: Group Health Inc Commercial |
$1,559.00
|
Rate for Payer: Group Health Inc Medicare |
$1,091.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,559.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,559.00
|
|
ZZ IVC FILTER FEMORAL(GUNTHER TUL
|
Facility
IP
|
$3,124.17
|
|
Service Code
|
HCPCS C1880
|
Hospital Charge Code |
41569802
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,562.08 |
Max. Negotiated Rate |
$1,562.08 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,562.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,562.08
|
|
ZZ IVC FILTER FEMORAL(GUNTHER TUL
|
Facility
OP
|
$3,124.17
|
|
Service Code
|
HCPCS C1880
|
Hospital Charge Code |
41569802
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$57.08 |
Max. Negotiated Rate |
$3,280.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,718.29
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.08
|
Rate for Payer: Aetna Government |
$57.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,562.08
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,796.40
|
Rate for Payer: Fidelis Medicare Advantage |
$3,280.38
|
Rate for Payer: Group Health Inc Commercial |
$1,562.08
|
Rate for Payer: Group Health Inc Medicare |
$1,093.46
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,562.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,562.08
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,030.71
|
|
ZZ IVC FILTER JUGULAR(GUNTHER TUL
|
Facility
OP
|
$3,124.17
|
|
Service Code
|
HCPCS C1880
|
Hospital Charge Code |
41569803
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$57.08 |
Max. Negotiated Rate |
$3,280.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,718.29
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.08
|
Rate for Payer: Aetna Government |
$57.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,562.08
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,796.40
|
Rate for Payer: Fidelis Medicare Advantage |
$3,280.38
|
Rate for Payer: Group Health Inc Commercial |
$1,562.08
|
Rate for Payer: Group Health Inc Medicare |
$1,093.46
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,562.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,562.08
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,030.71
|
|
ZZ IVC FILTER JUGULAR(GUNTHER TUL
|
Facility
IP
|
$3,124.17
|
|
Service Code
|
HCPCS C1880
|
Hospital Charge Code |
41569803
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,562.08 |
Max. Negotiated Rate |
$1,562.08 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,562.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,562.08
|
|
ZZ JACKSON PRATT 100M #SH130 1305
|
Facility
OP
|
$98.24
|
|
Hospital Charge Code |
41569035
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$34.38 |
Max. Negotiated Rate |
$78.59 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.03
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.12
|
Rate for Payer: Aetna Government |
$49.12
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.59
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.80
|
Rate for Payer: Group Health Inc Commercial |
$49.12
|
Rate for Payer: Group Health Inc Medicare |
$34.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$49.12
|
|
ZZ J & J CLINCHER ANOT DEVICE
|
Facility
OP
|
$56.70
|
|
Hospital Charge Code |
41569536
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$19.84 |
Max. Negotiated Rate |
$45.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.18
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.35
|
Rate for Payer: Aetna Government |
$28.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.56
|
Rate for Payer: Group Health Inc Commercial |
$28.35
|
Rate for Payer: Group Health Inc Medicare |
$19.84
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.35
|
|
ZZ J & J CLISER PERCLOSE
|
Facility
OP
|
$637.88
|
|
Hospital Charge Code |
41569535
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$223.26 |
Max. Negotiated Rate |
$510.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$350.83
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$318.94
|
Rate for Payer: Aetna Government |
$318.94
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$510.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$433.76
|
Rate for Payer: Group Health Inc Commercial |
$318.94
|
Rate for Payer: Group Health Inc Medicare |
$223.26
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$318.94
|
|
ZZ J & J SUARES ANOT PUSHER
|
Facility
OP
|
$56.70
|
|
Hospital Charge Code |
41569537
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$19.84 |
Max. Negotiated Rate |
$45.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.18
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.35
|
Rate for Payer: Aetna Government |
$28.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.56
|
Rate for Payer: Group Health Inc Commercial |
$28.35
|
Rate for Payer: Group Health Inc Medicare |
$19.84
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.35
|
|
ZZ J TIP 10/25
|
Facility
OP
|
$257.63
|
|
Hospital Charge Code |
41567231
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$90.17 |
Max. Negotiated Rate |
$206.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$141.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$128.82
|
Rate for Payer: Aetna Government |
$128.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.19
|
Rate for Payer: Group Health Inc Commercial |
$128.82
|
Rate for Payer: Group Health Inc Medicare |
$90.17
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.82
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$128.82
|
|
ZZ J TIP 8/25 LOOP
|
Facility
OP
|
$257.63
|
|
Hospital Charge Code |
41567232
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$90.17 |
Max. Negotiated Rate |
$206.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$141.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$128.82
|
Rate for Payer: Aetna Government |
$128.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.19
|
Rate for Payer: Group Health Inc Commercial |
$128.82
|
Rate for Payer: Group Health Inc Medicare |
$90.17
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.82
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$128.82
|
|
ZZ J WIRES 35-145-1.5 BH
|
Facility
OP
|
$37.92
|
|
Hospital Charge Code |
41567105
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$13.27 |
Max. Negotiated Rate |
$30.34 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.86
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.96
|
Rate for Payer: Aetna Government |
$18.96
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.34
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.79
|
Rate for Payer: Group Health Inc Commercial |
$18.96
|
Rate for Payer: Group Health Inc Medicare |
$13.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.96
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$18.96
|
|
ZZ J WIRES 35-145-15 BH
|
Facility
OP
|
$37.92
|
|
Hospital Charge Code |
41567104
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$13.27 |
Max. Negotiated Rate |
$30.34 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.86
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.96
|
Rate for Payer: Aetna Government |
$18.96
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.34
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.79
|
Rate for Payer: Group Health Inc Commercial |
$18.96
|
Rate for Payer: Group Health Inc Medicare |
$13.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.96
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$18.96
|
|
ZZ J WIRES 35-145-3 BH
|
Facility
OP
|
$37.92
|
|
Hospital Charge Code |
41567106
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$13.27 |
Max. Negotiated Rate |
$30.34 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.86
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.96
|
Rate for Payer: Aetna Government |
$18.96
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.34
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.79
|
Rate for Payer: Group Health Inc Commercial |
$18.96
|
Rate for Payer: Group Health Inc Medicare |
$13.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.96
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$18.96
|
|
ZZ J WIRES 35-145 BH
|
Facility
OP
|
$30.83
|
|
Hospital Charge Code |
41567103
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$10.79 |
Max. Negotiated Rate |
$24.66 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.96
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.42
|
Rate for Payer: Aetna Government |
$15.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.66
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.96
|
Rate for Payer: Group Health Inc Commercial |
$15.42
|
Rate for Payer: Group Health Inc Medicare |
$10.79
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.42
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$15.42
|
|
ZZ KATZEN CORE WIRE
|
Facility
OP
|
$75.13
|
|
Hospital Charge Code |
41567255
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$26.30 |
Max. Negotiated Rate |
$60.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.32
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.56
|
Rate for Payer: Aetna Government |
$37.56
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$60.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.09
|
Rate for Payer: Group Health Inc Commercial |
$37.56
|
Rate for Payer: Group Health Inc Medicare |
$26.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$37.56
|
|
ZZ KATZEN INF WIRES 35/3
|
Facility
OP
|
$570.55
|
|
Hospital Charge Code |
41567252
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$199.69 |
Max. Negotiated Rate |
$456.44 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$313.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.28
|
Rate for Payer: Aetna Government |
$285.28
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$456.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$387.97
|
Rate for Payer: Group Health Inc Commercial |
$285.28
|
Rate for Payer: Group Health Inc Medicare |
$199.69
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.28
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$285.28
|
|
ZZ KATZEN INF WIRES 35/6
|
Facility
OP
|
$570.55
|
|
Hospital Charge Code |
41567253
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$199.69 |
Max. Negotiated Rate |
$456.44 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$313.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.28
|
Rate for Payer: Aetna Government |
$285.28
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$456.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$387.97
|
Rate for Payer: Group Health Inc Commercial |
$285.28
|
Rate for Payer: Group Health Inc Medicare |
$199.69
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.28
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$285.28
|
|
ZZ KATZEN INF WIRES 35/9
|
Facility
OP
|
$570.55
|
|
Hospital Charge Code |
41567254
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$199.69 |
Max. Negotiated Rate |
$456.44 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$313.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.28
|
Rate for Payer: Aetna Government |
$285.28
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$456.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$387.97
|
Rate for Payer: Group Health Inc Commercial |
$285.28
|
Rate for Payer: Group Health Inc Medicare |
$199.69
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.28
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$285.28
|
|
ZZ KC GASTROSTOMY FEEDING TUBE
|
Facility
OP
|
$66.28
|
|
Hospital Charge Code |
41561900
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$23.20 |
Max. Negotiated Rate |
$53.02 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.45
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.14
|
Rate for Payer: Aetna Government |
$33.14
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.02
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$45.07
|
Rate for Payer: Group Health Inc Commercial |
$33.14
|
Rate for Payer: Group Health Inc Medicare |
$23.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.14
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$33.14
|
|
ZZ KC GASTROSTOMY FEEDING TUBE
|
Facility
OP
|
$66.28
|
|
Hospital Charge Code |
30301900
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$23.20 |
Max. Negotiated Rate |
$53.02 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.45
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.14
|
Rate for Payer: Aetna Government |
$33.14
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.02
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$45.07
|
Rate for Payer: Group Health Inc Commercial |
$33.14
|
Rate for Payer: Group Health Inc Medicare |
$23.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.14
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$33.14
|
|
ZZ KC TRANSGASTRIC FEEDING KIT
|
Facility
OP
|
$66.28
|
|
Hospital Charge Code |
41561901
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$23.20 |
Max. Negotiated Rate |
$53.02 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.45
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.14
|
Rate for Payer: Aetna Government |
$33.14
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.02
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$45.07
|
Rate for Payer: Group Health Inc Commercial |
$33.14
|
Rate for Payer: Group Health Inc Medicare |
$23.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.14
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$33.14
|
|
ZZ KIT INTRO SURG 6 FR 150 20
|
Facility
OP
|
$187.50
|
|
Hospital Charge Code |
41568091
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$65.62 |
Max. Negotiated Rate |
$150.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.12
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.75
|
Rate for Payer: Aetna Government |
$93.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.50
|
Rate for Payer: Group Health Inc Commercial |
$93.75
|
Rate for Payer: Group Health Inc Medicare |
$65.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
|
ZZ KIT MIDLINE 2 LMN 5.5F
|
Facility
OP
|
$397.50
|
|
Hospital Charge Code |
41568092
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$139.12 |
Max. Negotiated Rate |
$318.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$218.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$198.75
|
Rate for Payer: Aetna Government |
$198.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.30
|
Rate for Payer: Group Health Inc Commercial |
$198.75
|
Rate for Payer: Group Health Inc Medicare |
$139.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$198.75
|
|