ZZ STENT/WALLSTENT/SCHNEIDER 1068
|
Facility
OP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569251
|
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/SCHNEIDER 1068
|
Facility
IP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569251
|
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/SCHNEIDER1260
|
Facility
IP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569253
|
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/SCHNEIDER1260
|
Facility
OP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569253
|
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/SCHNEIDER1455
|
Facility
OP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569191
|
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/SCHNEIDER1455
|
Facility
IP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569191
|
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/SCHNEIDER1660
|
Facility
OP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569192
|
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/SCHNEIDER1660
|
Facility
IP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569192
|
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/SCHNEIDER860
|
Facility
IP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569193
|
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/SCHNEIDER860
|
Facility
OP
|
$2,400.54
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
41569193
|
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 STEREOTACTIC NEEDLE PROBE
|
Facility
OP
|
$520.00
|
|
Hospital Charge Code |
41569935
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$182.00 |
Max. Negotiated Rate |
$416.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$286.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$260.00
|
Rate for Payer: Aetna Government |
$260.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$416.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$353.60
|
Rate for Payer: Group Health Inc Commercial |
$260.00
|
Rate for Payer: Group Health Inc Medicare |
$182.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$260.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$260.00
|
|
ZZ STEREOTACTIC TISSUE MARKER
|
Facility
OP
|
$166.00
|
|
Hospital Charge Code |
41569936
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$58.10 |
Max. Negotiated Rate |
$132.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.00
|
Rate for Payer: Aetna Government |
$83.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.88
|
Rate for Payer: Group Health Inc Commercial |
$83.00
|
Rate for Payer: Group Health Inc Medicare |
$58.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$83.00
|
|
ZZ STERI DRAPE 1012
|
Facility
OP
|
$12.76
|
|
Hospital Charge Code |
41567005
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.47 |
Max. Negotiated Rate |
$10.21 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.02
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.38
|
Rate for Payer: Aetna Government |
$6.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.21
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.68
|
Rate for Payer: Group Health Inc Commercial |
$6.38
|
Rate for Payer: Group Health Inc Medicare |
$4.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.38
|
|
ZZ STERI DRAPE 1092
|
Facility
OP
|
$6.73
|
|
Hospital Charge Code |
41567006
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$2.36 |
Max. Negotiated Rate |
$5.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
Rate for Payer: Aetna Government |
$3.36
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
Rate for Payer: Group Health Inc Commercial |
$3.36
|
Rate for Payer: Group Health Inc Medicare |
$2.36
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
|
ZZ STERO. 11GA APERTURE SLEEVE
|
Facility
OP
|
$30.00
|
|
Hospital Charge Code |
41568715
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$10.50 |
Max. Negotiated Rate |
$24.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.00
|
Rate for Payer: Aetna Government |
$15.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
Rate for Payer: Group Health Inc Commercial |
$15.00
|
Rate for Payer: Group Health Inc Medicare |
$10.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
|
ZZ STERO. 11GA MAMMOTOME PROBE
|
Facility
OP
|
$488.00
|
|
Hospital Charge Code |
41568713
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$170.80 |
Max. Negotiated Rate |
$390.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$268.40
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$244.00
|
Rate for Payer: Aetna Government |
$244.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$390.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$331.84
|
Rate for Payer: Group Health Inc Commercial |
$244.00
|
Rate for Payer: Group Health Inc Medicare |
$170.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$244.00
|
|
ZZ STERO. 11GA MAMMOTOME PROBE GU
|
Facility
OP
|
$14.40
|
|
Hospital Charge Code |
41568712
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$5.04 |
Max. Negotiated Rate |
$11.52 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.92
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.20
|
Rate for Payer: Aetna Government |
$7.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.52
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.79
|
Rate for Payer: Group Health Inc Commercial |
$7.20
|
Rate for Payer: Group Health Inc Medicare |
$5.04
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.20
|
|
ZZ STERO. 11GA MARK SITE-SING SIT
|
Facility
OP
|
$174.00
|
|
Hospital Charge Code |
41568714
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$60.90 |
Max. Negotiated Rate |
$139.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.00
|
Rate for Payer: Aetna Government |
$87.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$139.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$118.32
|
Rate for Payer: Group Health Inc Commercial |
$87.00
|
Rate for Payer: Group Health Inc Medicare |
$60.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$87.00
|
|
ZZ STERO. 1200CC VACUUM CANNISTER
|
Facility
OP
|
$12.25
|
|
Hospital Charge Code |
41568718
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.29 |
Max. Negotiated Rate |
$9.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.12
|
Rate for Payer: Aetna Government |
$6.12
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.33
|
Rate for Payer: Group Health Inc Commercial |
$6.12
|
Rate for Payer: Group Health Inc Medicare |
$4.29
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.12
|
|
ZZ STERO 27GA, 1.5 INCH NEEDLES
|
Facility
OP
|
$0.10
|
|
Hospital Charge Code |
41568719
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.08 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
Rate for Payer: Aetna Government |
$0.05
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
Rate for Payer: Group Health Inc Commercial |
$0.05
|
Rate for Payer: Group Health Inc Medicare |
$0.04
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
|
ZZ STERO. 8GA APERTURE SLEEVE
|
Facility
OP
|
$30.00
|
|
Hospital Charge Code |
41568711
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$10.50 |
Max. Negotiated Rate |
$24.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.00
|
Rate for Payer: Aetna Government |
$15.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
Rate for Payer: Group Health Inc Commercial |
$15.00
|
Rate for Payer: Group Health Inc Medicare |
$10.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
|
ZZ STERO 8GA MAMMOTOME PROBE GUID
|
Facility
OP
|
$14.40
|
|
Hospital Charge Code |
41568708
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$5.04 |
Max. Negotiated Rate |
$11.52 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.92
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.20
|
Rate for Payer: Aetna Government |
$7.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.52
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.79
|
Rate for Payer: Group Health Inc Commercial |
$7.20
|
Rate for Payer: Group Health Inc Medicare |
$5.04
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.20
|
|
ZZ STERO. 8GA MARK SITE-SING SITE
|
Facility
OP
|
$174.00
|
|
Hospital Charge Code |
41568710
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$60.90 |
Max. Negotiated Rate |
$139.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.00
|
Rate for Payer: Aetna Government |
$87.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$139.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$118.32
|
Rate for Payer: Group Health Inc Commercial |
$87.00
|
Rate for Payer: Group Health Inc Medicare |
$60.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$87.00
|
|
ZZ STERO. 8GA MMAMOTOME PROBE
|
Facility
OP
|
$530.00
|
|
Hospital Charge Code |
41568709
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$185.50 |
Max. Negotiated Rate |
$424.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.00
|
Rate for Payer: Aetna Government |
$265.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$424.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.40
|
Rate for Payer: Group Health Inc Commercial |
$265.00
|
Rate for Payer: Group Health Inc Medicare |
$185.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$265.00
|
|
ZZ STERO. CORETAINERS FOR SPECIME
|
Facility
OP
|
$41.00
|
|
Hospital Charge Code |
41568720
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$14.35 |
Max. Negotiated Rate |
$32.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.50
|
Rate for Payer: Aetna Government |
$20.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.88
|
Rate for Payer: Group Health Inc Commercial |
$20.50
|
Rate for Payer: Group Health Inc Medicare |
$14.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$20.50
|
|