ZZ STENT/PALMAZ/PREMOUNT/P3008
|
Facility
IP
|
$2,158.15
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569232
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,079.08 |
Max. Negotiated Rate |
$1,079.08 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,079.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,079.08
|
|
ZZ STENT/PALMAZ/PREMOUNT/P3907
|
Facility
IP
|
$2,158.15
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569241
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,079.08 |
Max. Negotiated Rate |
$1,079.08 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,079.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,079.08
|
|
ZZ STENT/PALMAZ/PREMOUNT/P3907
|
Facility
OP
|
$2,158.15
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569241
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,266.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,186.98
|
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 |
$1,079.08
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,240.94
|
Rate for Payer: Fidelis Medicare Advantage |
$2,266.06
|
Rate for Payer: Group Health Inc Commercial |
$1,079.08
|
Rate for Payer: Group Health Inc Medicare |
$755.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,079.08
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,079.08
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,402.80
|
|
ZZ STENT/PALMEZ/NONMOUNT/P204M
|
Facility
OP
|
$1,743.53
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569228
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$1,830.71 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$958.94
|
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 |
$871.76
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,002.53
|
Rate for Payer: Fidelis Medicare Advantage |
$1,830.71
|
Rate for Payer: Group Health Inc Commercial |
$871.76
|
Rate for Payer: Group Health Inc Medicare |
$610.24
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$871.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$871.76
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,133.29
|
|
ZZ STENT/PALMEZ/NONMOUNT/P204M
|
Facility
IP
|
$1,743.53
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569228
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$871.76 |
Max. Negotiated Rate |
$871.76 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$871.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$871.76
|
|
ZZ STENT/SYMPHOMY/10MM*40MM
|
Facility
IP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569243
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,239.60 |
Max. Negotiated Rate |
$1,239.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
|
ZZ STENT/SYMPHOMY/10MM*40MM
|
Facility
OP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569243
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,603.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,363.57
|
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 |
$1,239.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,425.55
|
Rate for Payer: Fidelis Medicare Advantage |
$2,603.17
|
Rate for Payer: Group Health Inc Commercial |
$1,239.60
|
Rate for Payer: Group Health Inc Medicare |
$867.72
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,611.49
|
|
ZZ STENT/SYMPHOMY/6MM*40MM
|
Facility
IP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569245
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,239.60 |
Max. Negotiated Rate |
$1,239.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
|
ZZ STENT/SYMPHOMY/6MM*40MM
|
Facility
OP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569245
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,603.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,363.57
|
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 |
$1,239.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,425.55
|
Rate for Payer: Fidelis Medicare Advantage |
$2,603.17
|
Rate for Payer: Group Health Inc Commercial |
$1,239.60
|
Rate for Payer: Group Health Inc Medicare |
$867.72
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,611.49
|
|
ZZ STENT/SYMPHOMY/7MM*40MM
|
Facility
OP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569246
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,603.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,363.57
|
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 |
$1,239.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,425.55
|
Rate for Payer: Fidelis Medicare Advantage |
$2,603.17
|
Rate for Payer: Group Health Inc Commercial |
$1,239.60
|
Rate for Payer: Group Health Inc Medicare |
$867.72
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,611.49
|
|
ZZ STENT/SYMPHOMY/7MM*40MM
|
Facility
IP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569246
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,239.60 |
Max. Negotiated Rate |
$1,239.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
|
ZZ STENT/SYMPHOMY/8*23/7F/75CM
|
Facility
IP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569248
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,239.60 |
Max. Negotiated Rate |
$1,239.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
|
ZZ STENT/SYMPHOMY/8*23/7F/75CM
|
Facility
OP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569248
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,603.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,363.57
|
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 |
$1,239.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,425.55
|
Rate for Payer: Fidelis Medicare Advantage |
$2,603.17
|
Rate for Payer: Group Health Inc Commercial |
$1,239.60
|
Rate for Payer: Group Health Inc Medicare |
$867.72
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,611.49
|
|
ZZ STENT/SYMPHOMY/8MM*60MM
|
Facility
IP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569247
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,239.60 |
Max. Negotiated Rate |
$1,239.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
|
ZZ STENT/SYMPHOMY/8MM*60MM
|
Facility
OP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569247
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,603.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,363.57
|
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 |
$1,239.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,425.55
|
Rate for Payer: Fidelis Medicare Advantage |
$2,603.17
|
Rate for Payer: Group Health Inc Commercial |
$1,239.60
|
Rate for Payer: Group Health Inc Medicare |
$867.72
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,611.49
|
|
ZZ STENT/SYMPHONY/10MM*60MM
|
Facility
IP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569244
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,239.60 |
Max. Negotiated Rate |
$1,239.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
|
ZZ STENT/SYMPHONY/10MM*60MM
|
Facility
OP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569244
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,603.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,363.57
|
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 |
$1,239.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,425.55
|
Rate for Payer: Fidelis Medicare Advantage |
$2,603.17
|
Rate for Payer: Group Health Inc Commercial |
$1,239.60
|
Rate for Payer: Group Health Inc Medicare |
$867.72
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,611.49
|
|
ZZ STENT/SYMPHONY/8MM*44MM
|
Facility
OP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569242
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,603.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,363.57
|
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 |
$1,239.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,425.55
|
Rate for Payer: Fidelis Medicare Advantage |
$2,603.17
|
Rate for Payer: Group Health Inc Commercial |
$1,239.60
|
Rate for Payer: Group Health Inc Medicare |
$867.72
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,611.49
|
|
ZZ STENT/SYMPHONY/8MM*44MM
|
Facility
IP
|
$2,479.21
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569242
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,239.60 |
Max. Negotiated Rate |
$1,239.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,239.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,239.60
|
|
ZZ STENT/WALLSTENT/0840
|
Facility
OP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569249
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,520.57 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,320.30
|
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 |
$1,200.27
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,380.31
|
Rate for Payer: Fidelis Medicare Advantage |
$2,520.57
|
Rate for Payer: Group Health Inc Commercial |
$1,200.27
|
Rate for Payer: Group Health Inc Medicare |
$840.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,200.27
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,200.27
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,560.35
|
|
ZZ STENT/WALLSTENT/0840
|
Facility
IP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569249
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,200.27 |
Max. Negotiated Rate |
$1,200.27 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,200.27
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,200.27
|
|
ZZ STENT/WALLSTENT/5MM*55MM/7F
|
Facility
IP
|
$2,668.45
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569250
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,334.22 |
Max. Negotiated Rate |
$1,334.22 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,334.22
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,334.22
|
|
ZZ STENT/WALLSTENT/5MM*55MM/7F
|
Facility
OP
|
$2,668.45
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569250
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,801.87 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,467.65
|
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 |
$1,334.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,534.36
|
Rate for Payer: Fidelis Medicare Advantage |
$2,801.87
|
Rate for Payer: Group Health Inc Commercial |
$1,334.22
|
Rate for Payer: Group Health Inc Medicare |
$933.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,334.22
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,334.22
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,734.49
|
|
ZZ STENT/WALLSTENT/SCHNEIDER1042
|
Facility
OP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569252
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,520.57 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,320.30
|
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 |
$1,200.27
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,380.31
|
Rate for Payer: Fidelis Medicare Advantage |
$2,520.57
|
Rate for Payer: Group Health Inc Commercial |
$1,200.27
|
Rate for Payer: Group Health Inc Medicare |
$840.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,200.27
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,200.27
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,560.35
|
|
ZZ STENT/WALLSTENT/SCHNEIDER1042
|
Facility
IP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569252
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,200.27 |
Max. Negotiated Rate |
$1,200.27 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,200.27
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,200.27
|
|