CATHETER, 24FR 3-WAY IR
|
Facility
OP
|
$53.03
|
|
Hospital Charge Code |
64904014
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$18.56 |
Max. Negotiated Rate |
$42.42 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.52
|
Rate for Payer: Aetna Government |
$26.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.42
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.06
|
Rate for Payer: Group Health Inc Commercial |
$26.52
|
Rate for Payer: Group Health Inc Medicare |
$18.56
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.52
|
|
CATHETER < 400
|
Facility
OP
|
$357.37
|
|
Hospital Charge Code |
40203064
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$125.08 |
Max. Negotiated Rate |
$285.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$178.68
|
Rate for Payer: Aetna Government |
$178.68
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$285.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$243.01
|
Rate for Payer: Group Health Inc Commercial |
$178.68
|
Rate for Payer: Group Health Inc Medicare |
$125.08
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$178.68
|
|
CATHETER > 400
|
Facility
OP
|
$1,096.67
|
|
Hospital Charge Code |
40203065
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$383.83 |
Max. Negotiated Rate |
$877.34 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$603.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$548.34
|
Rate for Payer: Aetna Government |
$548.34
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$877.34
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$745.74
|
Rate for Payer: Group Health Inc Commercial |
$548.34
|
Rate for Payer: Group Health Inc Medicare |
$383.83
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$548.34
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$548.34
|
|
CATHETER 5FR OPENEND URO
|
Facility
OP
|
$24.19
|
|
Hospital Charge Code |
64903037
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$8.47 |
Max. Negotiated Rate |
$19.35 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.10
|
Rate for Payer: Aetna Government |
$12.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.35
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.45
|
Rate for Payer: Group Health Inc Commercial |
$12.10
|
Rate for Payer: Group Health Inc Medicare |
$8.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$12.10
|
|
CATHETER ACC KUMPE
|
Facility
OP
|
$62.00
|
|
Hospital Charge Code |
64907362
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$21.70 |
Max. Negotiated Rate |
$49.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.00
|
Rate for Payer: Aetna Government |
$31.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.16
|
Rate for Payer: Group Health Inc Commercial |
$31.00
|
Rate for Payer: Group Health Inc Medicare |
$21.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$31.00
|
|
CATHETER ASH SPLIT 14FR 28CM
|
Facility
OP
|
$1,075.00
|
|
Hospital Charge Code |
64902950
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$376.25 |
Max. Negotiated Rate |
$860.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$591.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$537.50
|
Rate for Payer: Aetna Government |
$537.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$860.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$731.00
|
Rate for Payer: Group Health Inc Commercial |
$537.50
|
Rate for Payer: Group Health Inc Medicare |
$376.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$537.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$537.50
|
|
CATHETER BALLOON DBL LMN
|
Facility
OP
|
$253.50
|
|
Service Code
|
HCPCS C1726
|
Hospital Charge Code |
64906893
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17.43 |
Max. Negotiated Rate |
$266.18 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.42
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.43
|
Rate for Payer: Aetna Government |
$17.43
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$126.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$145.76
|
Rate for Payer: Fidelis Medicare Advantage |
$266.18
|
Rate for Payer: Group Health Inc Commercial |
$126.75
|
Rate for Payer: Group Health Inc Medicare |
$88.72
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.78
|
|
CATHETER BALLOON DBL LMN
|
Facility
IP
|
$253.50
|
|
Service Code
|
HCPCS C1726
|
Hospital Charge Code |
64906893
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$126.75 |
Max. Negotiated Rate |
$126.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.75
|
|
CATHETER, COUDE TIP 14FR 5CC
|
Facility
OP
|
$20.63
|
|
Hospital Charge Code |
64903177
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$7.22 |
Max. Negotiated Rate |
$16.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.32
|
Rate for Payer: Aetna Government |
$10.32
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.03
|
Rate for Payer: Group Health Inc Commercial |
$10.32
|
Rate for Payer: Group Health Inc Medicare |
$7.22
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.32
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
|
CATHETER, COUDE TIP 20FR 5CC
|
Facility
OP
|
$20.63
|
|
Hospital Charge Code |
64903181
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$7.22 |
Max. Negotiated Rate |
$16.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.32
|
Rate for Payer: Aetna Government |
$10.32
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.03
|
Rate for Payer: Group Health Inc Commercial |
$10.32
|
Rate for Payer: Group Health Inc Medicare |
$7.22
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.32
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
|
CATHETER, COUDE TIP 22FR 5CC
|
Facility
OP
|
$22.21
|
|
Hospital Charge Code |
64903183
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$7.77 |
Max. Negotiated Rate |
$17.77 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.10
|
Rate for Payer: Aetna Government |
$11.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.77
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.10
|
Rate for Payer: Group Health Inc Commercial |
$11.10
|
Rate for Payer: Group Health Inc Medicare |
$7.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11.10
|
|
CATHETER, COUDE TIP 24FR 5CC
|
Facility
OP
|
$22.21
|
|
Hospital Charge Code |
64903184
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$7.77 |
Max. Negotiated Rate |
$17.77 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.10
|
Rate for Payer: Aetna Government |
$11.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.77
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.10
|
Rate for Payer: Group Health Inc Commercial |
$11.10
|
Rate for Payer: Group Health Inc Medicare |
$7.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11.10
|
|
CATHETER COUNCILL 16FR 5CC
|
Facility
OP
|
$29.76
|
|
Hospital Charge Code |
64903967
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$10.42 |
Max. Negotiated Rate |
$23.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.37
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.88
|
Rate for Payer: Aetna Government |
$14.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.81
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.24
|
Rate for Payer: Group Health Inc Commercial |
$14.88
|
Rate for Payer: Group Health Inc Medicare |
$10.42
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14.88
|
|
CATHETER COUNCILL 18FR 5CC
|
Facility
OP
|
$29.75
|
|
Hospital Charge Code |
64903970
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$10.41 |
Max. Negotiated Rate |
$23.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.36
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.88
|
Rate for Payer: Aetna Government |
$14.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.23
|
Rate for Payer: Group Health Inc Commercial |
$14.88
|
Rate for Payer: Group Health Inc Medicare |
$10.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14.88
|
|
CATHETER COUNCILL 20FR 5CC
|
Facility
OP
|
$2.70
|
|
Hospital Charge Code |
64904234
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$0.95 |
Max. Negotiated Rate |
$2.16 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.48
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.35
|
Rate for Payer: Aetna Government |
$1.35
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.16
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.84
|
Rate for Payer: Group Health Inc Commercial |
$1.35
|
Rate for Payer: Group Health Inc Medicare |
$0.95
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.35
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.35
|
|
CATHETER DIALYSIS 23 CM
|
Facility
OP
|
$5,522.00
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
40200683
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.85 |
Max. Negotiated Rate |
$5,798.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,037.10
|
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 |
$2,761.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,175.15
|
Rate for Payer: Fidelis Medicare Advantage |
$5,798.10
|
Rate for Payer: Group Health Inc Commercial |
$2,761.00
|
Rate for Payer: Group Health Inc Medicare |
$1,932.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,761.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,761.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,589.30
|
|
CATHETER DIALYSIS 23 CM
|
Facility
IP
|
$5,522.00
|
|
Service Code
|
HCPCS C1725
|
Hospital Charge Code |
40200683
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,761.00 |
Max. Negotiated Rate |
$2,761.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,761.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,761.00
|
|
CATHETER DIALYSIS PERITONEAL
|
Facility
OP
|
$106.00
|
|
Hospital Charge Code |
40201052
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$37.10 |
Max. Negotiated Rate |
$84.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.00
|
Rate for Payer: Aetna Government |
$53.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.08
|
Rate for Payer: Group Health Inc Commercial |
$53.00
|
Rate for Payer: Group Health Inc Medicare |
$37.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$53.00
|
|
CATHETER DUAL LUMEN KT 14.5FR
|
Facility
OP
|
$737.50
|
|
Hospital Charge Code |
64904090
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$258.12 |
Max. Negotiated Rate |
$590.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$405.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$368.75
|
Rate for Payer: Aetna Government |
$368.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$590.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$501.50
|
Rate for Payer: Group Health Inc Commercial |
$368.75
|
Rate for Payer: Group Health Inc Medicare |
$258.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$368.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$368.75
|
|
CATHETER,FOLEY,COUDE,16FR,5CC
|
Facility
OP
|
$22.05
|
|
Service Code
|
HCPCS C1758
|
Hospital Charge Code |
64903178
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$2.97 |
Max. Negotiated Rate |
$17.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.13
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
Rate for Payer: Aetna Government |
$2.97
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.64
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.99
|
Rate for Payer: Group Health Inc Commercial |
$11.02
|
Rate for Payer: Group Health Inc Medicare |
$7.72
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.02
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11.02
|
|
CATHETER,FOLEY,COUDE,18FR,5CC
|
Facility
OP
|
$20.63
|
|
Service Code
|
HCPCS C1758
|
Hospital Charge Code |
64903180
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$2.97 |
Max. Negotiated Rate |
$16.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
Rate for Payer: Aetna Government |
$2.97
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.03
|
Rate for Payer: Group Health Inc Commercial |
$10.32
|
Rate for Payer: Group Health Inc Medicare |
$7.22
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.32
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
|
CATHETER HEMATURIA 20FR
|
Facility
OP
|
$48.00
|
|
Hospital Charge Code |
40201053
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$16.80 |
Max. Negotiated Rate |
$38.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.00
|
Rate for Payer: Aetna Government |
$24.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.64
|
Rate for Payer: Group Health Inc Commercial |
$24.00
|
Rate for Payer: Group Health Inc Medicare |
$16.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$24.00
|
|
CATHETER HEMATURIA 22FR
|
Facility
OP
|
$48.00
|
|
Hospital Charge Code |
40201054
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$16.80 |
Max. Negotiated Rate |
$38.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.00
|
Rate for Payer: Aetna Government |
$24.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.64
|
Rate for Payer: Group Health Inc Commercial |
$24.00
|
Rate for Payer: Group Health Inc Medicare |
$16.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$24.00
|
|
CATHETER INTRODUCER SUPRA
|
Facility
OP
|
$182.98
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
64906924
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3.21 |
Max. Negotiated Rate |
$192.13 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.64
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
Rate for Payer: Aetna Government |
$3.21
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$91.49
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.21
|
Rate for Payer: Fidelis Medicare Advantage |
$192.13
|
Rate for Payer: Group Health Inc Commercial |
$91.49
|
Rate for Payer: Group Health Inc Medicare |
$64.04
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.49
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$91.49
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.94
|
|
CATHETER INTRODUCER SUPRA
|
Facility
IP
|
$182.98
|
|
Service Code
|
HCPCS C1887
|
Hospital Charge Code |
64906924
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$91.49 |
Max. Negotiated Rate |
$91.49 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.49
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$91.49
|
|