|
ZZ LOCM 300-399MG/ML IODINE 1ML
|
Facility
OP
|
$92.85
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
41569590
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$74.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$46.42
|
| Rate for Payer: Group Health Inc Medicare |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.35
|
|
|
ZZ LOCM 300-399MG/ML IODINE 1ML
|
Facility
OP
|
$92.85
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
41569592
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$74.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$46.42
|
| Rate for Payer: Group Health Inc Medicare |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.35
|
|
|
ZZ LOCM 300-399MG/ML IODINE 1ML
|
Facility
OP
|
$40.54
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
41569596
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$32.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$20.27
|
| Rate for Payer: Group Health Inc Medicare |
$14.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.35
|
|
|
ZZ LOCM 300-399MG/ML IODINE 1ML
|
Facility
OP
|
$50.33
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
41569594
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$40.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$25.16
|
| Rate for Payer: Group Health Inc Medicare |
$17.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.71
|
|
|
ZZ LONG SH 8.5 38 45 J RB
|
Facility
OP
|
$119.78
|
|
| Hospital Charge Code |
41567041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$95.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.89
|
| Rate for Payer: Aetna Government |
$59.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$95.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.45
|
| Rate for Payer: Group Health Inc Commercial |
$59.89
|
| Rate for Payer: Group Health Inc Medicare |
$41.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.89
|
|
|
ZZ LONG SHTH 6 38 35 J RB
|
Facility
OP
|
$119.78
|
|
| Hospital Charge Code |
41567038
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$95.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.89
|
| Rate for Payer: Aetna Government |
$59.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$95.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.45
|
| Rate for Payer: Group Health Inc Commercial |
$59.89
|
| Rate for Payer: Group Health Inc Medicare |
$41.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.89
|
|
|
ZZ LONG SHTH 7 38 45 J RB
|
Facility
OP
|
$119.78
|
|
| Hospital Charge Code |
41567039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$95.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.89
|
| Rate for Payer: Aetna Government |
$59.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$95.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.45
|
| Rate for Payer: Group Health Inc Commercial |
$59.89
|
| Rate for Payer: Group Health Inc Medicare |
$41.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.89
|
|
|
ZZ LONG SHTH 8 38 45 J RB
|
Facility
OP
|
$119.78
|
|
| Hospital Charge Code |
41567040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$95.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.89
|
| Rate for Payer: Aetna Government |
$59.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$95.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.45
|
| Rate for Payer: Group Health Inc Commercial |
$59.89
|
| Rate for Payer: Group Health Inc Medicare |
$41.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.89
|
|
|
ZZ LOW DOSE IRIDIUM SEEDS/ RIBBON
|
Facility
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS C1719
|
| Hospital Charge Code |
41569953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.30 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,402.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$422.88
|
| Rate for Payer: Aetna Government |
$422.88
|
| Rate for Payer: Cash Price |
$422.88
|
| Rate for Payer: Cash Price |
$422.88
|
| Rate for Payer: Cash Price |
$422.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,275.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,466.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$422.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.88
|
| Rate for Payer: Group Health Inc Commercial |
$422.88
|
| Rate for Payer: Group Health Inc Medicare |
$422.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,275.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.45
|
| Rate for Payer: Healthfirst QHP |
$422.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,657.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$338.30
|
|
|
ZZ LOW DOSE IRIDIUM SEEDS/ RIBBON
|
Facility
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS C1719
|
| Hospital Charge Code |
41569953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Cash Price |
$422.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,275.00
|
|
|
ZZ LUMAXGRF 70-073-80CM
|
Facility
OP
|
$352.96
|
|
| Hospital Charge Code |
41569823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$282.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$194.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$176.48
|
| Rate for Payer: Aetna Government |
$176.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$282.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$240.01
|
| Rate for Payer: Group Health Inc Commercial |
$176.48
|
| Rate for Payer: Group Health Inc Medicare |
$123.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.48
|
|
|
ZZ LUMAXGRF 80-086-80CM
|
Facility
OP
|
$325.89
|
|
| Hospital Charge Code |
41569821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.06 |
| Max. Negotiated Rate |
$260.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$162.94
|
| Rate for Payer: Aetna Government |
$162.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$260.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$221.61
|
| Rate for Payer: Group Health Inc Commercial |
$162.94
|
| Rate for Payer: Group Health Inc Medicare |
$114.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.94
|
|
|
ZZ LUMINEX STENT 10X40 6F
|
Facility
OP
|
$4,394.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$4,613.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,416.84
|
| 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 |
$2,197.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,526.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,613.96
|
| Rate for Payer: Group Health Inc Commercial |
$2,197.12
|
| Rate for Payer: Group Health Inc Medicare |
$1,537.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,197.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,197.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,856.26
|
|
|
ZZ LUMINEX STENT 10X40 6F
|
Facility
IP
|
$4,394.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,197.12 |
| Max. Negotiated Rate |
$2,197.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,197.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,197.12
|
|
|
ZZ LUMINEX STENT 10X60 6F
|
Facility
IP
|
$4,521.83
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.92 |
| Max. Negotiated Rate |
$2,260.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,260.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,260.92
|
|
|
ZZ LUMINEX STENT 10X60 6F
|
Facility
OP
|
$4,521.83
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$4,747.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,487.01
|
| 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 |
$2,260.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,600.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,747.92
|
| Rate for Payer: Group Health Inc Commercial |
$2,260.92
|
| Rate for Payer: Group Health Inc Medicare |
$1,582.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,260.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,260.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,939.19
|
|
|
ZZ LUMINEX STENT 10X80
|
Facility
IP
|
$5,386.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41569652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.25 |
| Max. Negotiated Rate |
$2,693.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,693.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,693.25
|
|
|
ZZ LUMINEX STENT 10X80
|
Facility
OP
|
$5,386.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
41569652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$5,655.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,962.58
|
| 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 |
$2,693.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,097.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,655.82
|
| Rate for Payer: Group Health Inc Commercial |
$2,693.25
|
| Rate for Payer: Group Health Inc Medicare |
$1,885.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,693.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,693.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,501.22
|
|
|
ZZ LUMINEX STENT 10X80 6F
|
Facility
IP
|
$5,528.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.12 |
| Max. Negotiated Rate |
$2,764.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,764.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,764.12
|
|
|
ZZ LUMINEX STENT 10X80 6F
|
Facility
OP
|
$5,528.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$5,804.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,040.54
|
| 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 |
$2,764.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,178.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,804.66
|
| Rate for Payer: Group Health Inc Commercial |
$2,764.12
|
| Rate for Payer: Group Health Inc Medicare |
$1,934.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,764.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,764.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,593.36
|
|
|
ZZ LUMINEX STENT 12X40 6F
|
Facility
IP
|
$4,394.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,197.12 |
| Max. Negotiated Rate |
$2,197.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,197.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,197.12
|
|
|
ZZ LUMINEX STENT 12X40 6F
|
Facility
OP
|
$4,394.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$4,613.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,416.84
|
| 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 |
$2,197.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,526.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,613.96
|
| Rate for Payer: Group Health Inc Commercial |
$2,197.12
|
| Rate for Payer: Group Health Inc Medicare |
$1,537.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,197.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,197.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,856.26
|
|
|
ZZ LUMINEX STENT 12X60 6F
|
Facility
OP
|
$4,521.83
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$4,747.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,487.01
|
| 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 |
$2,260.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,600.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,747.92
|
| Rate for Payer: Group Health Inc Commercial |
$2,260.92
|
| Rate for Payer: Group Health Inc Medicare |
$1,582.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,260.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,260.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,939.19
|
|
|
ZZ LUMINEX STENT 12X60 6F
|
Facility
IP
|
$4,521.83
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.92 |
| Max. Negotiated Rate |
$2,260.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,260.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,260.92
|
|
|
ZZ LUMINEX STENT 6X30 6F
|
Facility
OP
|
$4,110.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
41569751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$4,316.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,260.91
|
| 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 |
$2,055.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,363.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,316.29
|
| Rate for Payer: Group Health Inc Commercial |
$2,055.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,438.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,055.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,055.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,671.99
|
|
