ZZ WIRES 10/42 7F 75 110
|
Facility
OP
|
$3,504.77
|
|
Hospital Charge Code |
41567353
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,226.67 |
Max. Negotiated Rate |
$2,803.82 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,927.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,752.38
|
Rate for Payer: Aetna Government |
$1,752.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,803.82
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,383.24
|
Rate for Payer: Group Health Inc Commercial |
$1,752.38
|
Rate for Payer: Group Health Inc Medicare |
$1,226.67
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,752.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,752.38
|
|
ZZ WIRES 10/68 7F 135 160
|
Facility
OP
|
$3,896.00
|
|
Hospital Charge Code |
41567356
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,363.60 |
Max. Negotiated Rate |
$3,116.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,142.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,948.00
|
Rate for Payer: Aetna Government |
$1,948.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,116.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,649.28
|
Rate for Payer: Group Health Inc Commercial |
$1,948.00
|
Rate for Payer: Group Health Inc Medicare |
$1,363.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,948.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,948.00
|
|
ZZ WIRES 10/68 7F 75 110
|
Facility
OP
|
$3,504.77
|
|
Hospital Charge Code |
41567354
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,226.67 |
Max. Negotiated Rate |
$2,803.82 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,927.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,752.38
|
Rate for Payer: Aetna Government |
$1,752.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,803.82
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,383.24
|
Rate for Payer: Group Health Inc Commercial |
$1,752.38
|
Rate for Payer: Group Health Inc Medicare |
$1,226.67
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,752.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,752.38
|
|
ZZ WIRES 10/94 7F 75 110
|
Facility
OP
|
$5,623.94
|
|
Hospital Charge Code |
41567357
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,968.38 |
Max. Negotiated Rate |
$4,499.15 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,093.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,811.97
|
Rate for Payer: Aetna Government |
$2,811.97
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,499.15
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,824.28
|
Rate for Payer: Group Health Inc Commercial |
$2,811.97
|
Rate for Payer: Group Health Inc Medicare |
$1,968.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,811.97
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,811.97
|
|
ZZ WIRES 12/60 7F 75 110
|
Facility
OP
|
$3,504.77
|
|
Hospital Charge Code |
41567358
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,226.67 |
Max. Negotiated Rate |
$2,803.82 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,927.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,752.38
|
Rate for Payer: Aetna Government |
$1,752.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,803.82
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,383.24
|
Rate for Payer: Group Health Inc Commercial |
$1,752.38
|
Rate for Payer: Group Health Inc Medicare |
$1,226.67
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,752.38
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,752.38
|
|
ZZ WIRES 12/90 7F 75 110
|
Facility
OP
|
$5,623.94
|
|
Hospital Charge Code |
41567359
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,968.38 |
Max. Negotiated Rate |
$4,499.15 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,093.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,811.97
|
Rate for Payer: Aetna Government |
$2,811.97
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,499.15
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,824.28
|
Rate for Payer: Group Health Inc Commercial |
$2,811.97
|
Rate for Payer: Group Health Inc Medicare |
$1,968.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,811.97
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,811.97
|
|
ZZ WIRE TAD II 035-145
|
Facility
IP
|
$255.15
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569675
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$127.58 |
Max. Negotiated Rate |
$127.58 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.58
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$127.58
|
|
ZZ WIRE TAD II 035-145
|
Facility
OP
|
$255.15
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41569675
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$267.91 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.33
|
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 |
$127.58
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.71
|
Rate for Payer: Fidelis Medicare Advantage |
$267.91
|
Rate for Payer: Group Health Inc Commercial |
$127.58
|
Rate for Payer: Group Health Inc Medicare |
$89.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.58
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$127.58
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.85
|
|
ZZ WIRE/TIP DEFLECTING/10CM
|
Facility
OP
|
$77.35
|
|
Hospital Charge Code |
41569186
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$27.07 |
Max. Negotiated Rate |
$61.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.54
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.68
|
Rate for Payer: Aetna Government |
$38.68
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$61.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$52.60
|
Rate for Payer: Group Health Inc Commercial |
$38.68
|
Rate for Payer: Group Health Inc Medicare |
$27.07
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$38.68
|
|
ZZ WIRE/TIP DEFLECTING/5CM
|
Facility
OP
|
$90.91
|
|
Hospital Charge Code |
41569187
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$31.82 |
Max. Negotiated Rate |
$72.73 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.46
|
Rate for Payer: Aetna Government |
$45.46
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.73
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.82
|
Rate for Payer: Group Health Inc Commercial |
$45.46
|
Rate for Payer: Group Health Inc Medicare |
$31.82
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.46
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$45.46
|
|
ZZ XCELA DUAL PICC 5F
|
Facility
OP
|
$390.00
|
|
Hospital Charge Code |
41561938
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$136.50 |
Max. Negotiated Rate |
$312.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$195.00
|
Rate for Payer: Aetna Government |
$195.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$312.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$265.20
|
Rate for Payer: Group Health Inc Commercial |
$195.00
|
Rate for Payer: Group Health Inc Medicare |
$136.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
ZZ XCELA POWER PORT 6.6F
|
Facility
OP
|
$680.00
|
|
Hospital Charge Code |
41561934
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$238.00 |
Max. Negotiated Rate |
$544.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$374.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$340.00
|
Rate for Payer: Aetna Government |
$340.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$544.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$462.40
|
Rate for Payer: Group Health Inc Commercial |
$340.00
|
Rate for Payer: Group Health Inc Medicare |
$238.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$340.00
|
|
ZZ XCELA POWER PORT 8F
|
Facility
OP
|
$680.00
|
|
Hospital Charge Code |
41561935
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$238.00 |
Max. Negotiated Rate |
$544.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$374.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$340.00
|
Rate for Payer: Aetna Government |
$340.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$544.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$462.40
|
Rate for Payer: Group Health Inc Commercial |
$340.00
|
Rate for Payer: Group Health Inc Medicare |
$238.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$340.00
|
|
ZZ XCELA POWER PORT 9.6F
|
Facility
OP
|
$1,600.00
|
|
Hospital Charge Code |
41561936
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$560.00 |
Max. Negotiated Rate |
$1,280.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$880.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$800.00
|
Rate for Payer: Aetna Government |
$800.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,280.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,088.00
|
Rate for Payer: Group Health Inc Commercial |
$800.00
|
Rate for Payer: Group Health Inc Medicare |
$560.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
|
ZZ XCELA SINGLE PICC 5F
|
Facility
OP
|
$210.00
|
|
Hospital Charge Code |
41561937
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$73.50 |
Max. Negotiated Rate |
$168.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.00
|
Rate for Payer: Aetna Government |
$105.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.80
|
Rate for Payer: Group Health Inc Commercial |
$105.00
|
Rate for Payer: Group Health Inc Medicare |
$73.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
|
ZZ XPEEDIOR 135 CM
|
Facility
IP
|
$2,847.05
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569774
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,423.52 |
Max. Negotiated Rate |
$1,423.52 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,423.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,423.52
|
|
ZZ XPEEDIOR 135 CM
|
Facility
OP
|
$2,847.05
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569774
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$2,989.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,565.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,423.52
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,637.05
|
Rate for Payer: Fidelis Medicare Advantage |
$2,989.40
|
Rate for Payer: Group Health Inc Commercial |
$1,423.52
|
Rate for Payer: Group Health Inc Medicare |
$996.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,423.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,423.52
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,850.58
|
|
ZZ XPEEDIOR 140 CM
|
Facility
OP
|
$2,841.38
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569775
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$2,983.45 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,562.76
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,420.69
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,633.79
|
Rate for Payer: Fidelis Medicare Advantage |
$2,983.45
|
Rate for Payer: Group Health Inc Commercial |
$1,420.69
|
Rate for Payer: Group Health Inc Medicare |
$994.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,420.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,420.69
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,846.90
|
|
ZZ XPEEDIOR 140 CM
|
Facility
IP
|
$2,841.38
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
41569775
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,420.69 |
Max. Negotiated Rate |
$1,420.69 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,420.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,420.69
|
|
ZZ XXL BALOON 14-4/5.8/75
|
Facility
OP
|
$961.78
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567276
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$1,009.87 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$528.98
|
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 |
$480.89
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$553.02
|
Rate for Payer: Fidelis Medicare Advantage |
$1,009.87
|
Rate for Payer: Group Health Inc Commercial |
$480.89
|
Rate for Payer: Group Health Inc Medicare |
$336.62
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$480.89
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$480.89
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$625.16
|
|
ZZ XXL BALOON 14-4/5.8/75
|
Facility
IP
|
$961.78
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567276
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$480.89 |
Max. Negotiated Rate |
$480.89 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$480.89
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$480.89
|
|
ZZ XXL BALOON 16-4/5.8/75
|
Facility
OP
|
$1,059.59
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567277
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$1,112.57 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$582.77
|
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 |
$529.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$609.26
|
Rate for Payer: Fidelis Medicare Advantage |
$1,112.57
|
Rate for Payer: Group Health Inc Commercial |
$529.80
|
Rate for Payer: Group Health Inc Medicare |
$370.86
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$529.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$529.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$688.73
|
|
ZZ XXL BALOON 16-4/5.8/75
|
Facility
IP
|
$1,059.59
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
41567277
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$529.80 |
Max. Negotiated Rate |
$529.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$529.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$529.80
|
|