ZZ SHEATH/CHECK-FLO/9F
|
Facility
OP
|
$94.88
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569477
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$99.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.18
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
Rate for Payer: Aetna Government |
$0.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.56
|
Rate for Payer: Fidelis Medicare Advantage |
$99.62
|
Rate for Payer: Group Health Inc Commercial |
$47.44
|
Rate for Payer: Group Health Inc Medicare |
$33.21
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$47.44
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.67
|
|
ZZ SHEATH LUNDERQUIST
|
Facility
OP
|
$53.16
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569472
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$55.82 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.24
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
Rate for Payer: Aetna Government |
$0.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.58
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.57
|
Rate for Payer: Fidelis Medicare Advantage |
$55.82
|
Rate for Payer: Group Health Inc Commercial |
$26.58
|
Rate for Payer: Group Health Inc Medicare |
$18.61
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.58
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.58
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.55
|
|
ZZ SHEATH LUNDERQUIST
|
Facility
IP
|
$53.16
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569472
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$26.58 |
Max. Negotiated Rate |
$26.58 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.58
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.58
|
|
ZZ SHEATH/PINNACLE/10F/10CM
|
Facility
IP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569478
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$196.68 |
Max. Negotiated Rate |
$196.68 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
|
ZZ SHEATH/PINNACLE/10F/10CM
|
Facility
OP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569478
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$413.03 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
Rate for Payer: Aetna Government |
$0.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.18
|
Rate for Payer: Fidelis Medicare Advantage |
$413.03
|
Rate for Payer: Group Health Inc Commercial |
$196.68
|
Rate for Payer: Group Health Inc Medicare |
$137.68
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.68
|
|
ZZ SHEATH/PINNACLE/4F/10CM
|
Facility
IP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569479
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$196.68 |
Max. Negotiated Rate |
$196.68 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
|
ZZ SHEATH/PINNACLE/4F/10CM
|
Facility
OP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569479
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$413.03 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
Rate for Payer: Aetna Government |
$0.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.18
|
Rate for Payer: Fidelis Medicare Advantage |
$413.03
|
Rate for Payer: Group Health Inc Commercial |
$196.68
|
Rate for Payer: Group Health Inc Medicare |
$137.68
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.68
|
|
ZZ SHEATH/PINNACLE/5F/10CM
|
Facility
IP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569480
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$196.68 |
Max. Negotiated Rate |
$196.68 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
|
ZZ SHEATH/PINNACLE/5F/10CM
|
Facility
OP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569480
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$413.03 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
Rate for Payer: Aetna Government |
$0.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.18
|
Rate for Payer: Fidelis Medicare Advantage |
$413.03
|
Rate for Payer: Group Health Inc Commercial |
$196.68
|
Rate for Payer: Group Health Inc Medicare |
$137.68
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.68
|
|
ZZ SHEATH/PINNACLE/6F/10CM
|
Facility
OP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569481
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$413.03 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
Rate for Payer: Aetna Government |
$0.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.18
|
Rate for Payer: Fidelis Medicare Advantage |
$413.03
|
Rate for Payer: Group Health Inc Commercial |
$196.68
|
Rate for Payer: Group Health Inc Medicare |
$137.68
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.68
|
|
ZZ SHEATH/PINNACLE/6F/10CM
|
Facility
IP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569481
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$196.68 |
Max. Negotiated Rate |
$196.68 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
|
ZZ SHEATH/PINNACLE/7F/10CM
|
Facility
OP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569482
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$413.03 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
Rate for Payer: Aetna Government |
$0.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.18
|
Rate for Payer: Fidelis Medicare Advantage |
$413.03
|
Rate for Payer: Group Health Inc Commercial |
$196.68
|
Rate for Payer: Group Health Inc Medicare |
$137.68
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.68
|
|
ZZ SHEATH/PINNACLE/7F/10CM
|
Facility
IP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569482
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$196.68 |
Max. Negotiated Rate |
$196.68 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
|
ZZ SHEATH/PINNACLE/9F/10CM
|
Facility
OP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569483
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$413.03 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
Rate for Payer: Aetna Government |
$0.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.18
|
Rate for Payer: Fidelis Medicare Advantage |
$413.03
|
Rate for Payer: Group Health Inc Commercial |
$196.68
|
Rate for Payer: Group Health Inc Medicare |
$137.68
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.68
|
|
ZZ SHEATH/PINNACLE/9F/10CM
|
Facility
IP
|
$393.36
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569483
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$196.68 |
Max. Negotiated Rate |
$196.68 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$196.68
|
|
ZZ SHEATH/STRAIGHT/7-30CM/RB
|
Facility
OP
|
$77.87
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569484
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$81.76 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.83
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
Rate for Payer: Aetna Government |
$0.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.94
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.78
|
Rate for Payer: Fidelis Medicare Advantage |
$81.76
|
Rate for Payer: Group Health Inc Commercial |
$38.94
|
Rate for Payer: Group Health Inc Medicare |
$27.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$38.94
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.62
|
|
ZZ SHEATH/STRAIGHT/7-30CM/RB
|
Facility
IP
|
$77.87
|
|
Service Code
|
HCPCS C1892
|
Hospital Charge Code |
41569484
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$38.94 |
Max. Negotiated Rate |
$38.94 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.94
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$38.94
|
|
ZZ SIM GLIDCTH 4FR 100 CM
|
Facility
OP
|
$779.63
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567519
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$818.61 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$428.80
|
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 |
$389.82
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$448.29
|
Rate for Payer: Fidelis Medicare Advantage |
$818.61
|
Rate for Payer: Group Health Inc Commercial |
$389.82
|
Rate for Payer: Group Health Inc Medicare |
$272.87
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$389.82
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$389.82
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$506.76
|
|
ZZ SIM GLIDCTH 4FR 100 CM
|
Facility
IP
|
$779.63
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567519
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$389.82 |
Max. Negotiated Rate |
$389.82 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$389.82
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$389.82
|
|
ZZ SIMMONS SIDEWIN CATH 5
|
Facility
IP
|
$48.91
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567166
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$24.46 |
Max. Negotiated Rate |
$24.46 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
|
ZZ SIMMONS SIDEWIN CATH 5
|
Facility
OP
|
$48.91
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567166
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.12 |
Max. Negotiated Rate |
$51.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
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 |
$24.46
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.12
|
Rate for Payer: Fidelis Medicare Advantage |
$51.36
|
Rate for Payer: Group Health Inc Commercial |
$24.46
|
Rate for Payer: Group Health Inc Medicare |
$17.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.79
|
|
ZZ SIMM SIDEWINDER CTH
|
Facility
IP
|
$48.91
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567164
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$24.46 |
Max. Negotiated Rate |
$24.46 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
|
ZZ SIMM SIDEWINDER CTH
|
Facility
OP
|
$48.91
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567164
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.12 |
Max. Negotiated Rate |
$51.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
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 |
$24.46
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.12
|
Rate for Payer: Fidelis Medicare Advantage |
$51.36
|
Rate for Payer: Group Health Inc Commercial |
$24.46
|
Rate for Payer: Group Health Inc Medicare |
$17.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.79
|
|
ZZ SLK BRAID/3.5 MTRIC #K 834
|
Facility
IP
|
$102.51
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569012
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$51.26 |
Max. Negotiated Rate |
$51.26 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$51.26
|
|
ZZ SLK BRAID/3.5 MTRIC #K 834
|
Facility
OP
|
$102.51
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569012
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$35.88 |
Max. Negotiated Rate |
$107.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.38
|
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 |
$51.26
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.94
|
Rate for Payer: Fidelis Medicare Advantage |
$107.64
|
Rate for Payer: Group Health Inc Commercial |
$51.26
|
Rate for Payer: Group Health Inc Medicare |
$35.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$51.26
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.63
|
|