|
CC CATH CONTAMINATION SHIELD ARRO
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
66528267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$17.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.00
|
| Rate for Payer: Aetna Government |
$11.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.96
|
| Rate for Payer: Group Health Inc Commercial |
$11.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.00
|
|
|
CC CATH CORON DIAG RAD CRV 4.0 6
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66520204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| 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 |
$110.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.00
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.00
|
|
|
CC CATH CORON DIAG RAD CRV 4.0 6
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66520204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
|
|
CC CATH CORON DIAG RAD TIG 4.5 5
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66520202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| 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 |
$110.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.00
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.00
|
|
|
CC CATH CORON DIAG RAD TIG 4.5 5
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66520202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
|
|
CC CATH CORON DIA RAD CRV 3.5 5F
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66520203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
|
|
CC CATH CORON DIA RAD CRV 3.5 5F
|
Facility
OP
|
$220.00
|
|
| Hospital Charge Code |
66520126
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.00
|
| Rate for Payer: Aetna Government |
$110.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$149.60
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
|
|
CC CATH CORON DIA RAD CRV 3.5 5F
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66520203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| 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 |
$110.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.00
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.00
|
|
|
CC CATHERS JL 4.0 5F
|
Facility
OP
|
$400.00
|
|
| Hospital Charge Code |
66528807
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$200.00
|
| Rate for Payer: Aetna Government |
$200.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$272.00
|
| Rate for Payer: Group Health Inc Commercial |
$200.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
|
|
CC CATHETER 5FR AR2 100CM
|
Facility
OP
|
$224.00
|
|
| Hospital Charge Code |
66520208
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$112.00
|
| Rate for Payer: Aetna Government |
$112.00
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,959.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,215.78
|
| Rate for Payer: Group Health Inc Commercial |
$112.00
|
| Rate for Payer: Group Health Inc Medicare |
$78.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.00
|
|
|
CC CATHETERS JR 4 5F
|
Facility
OP
|
$44.80
|
|
| Hospital Charge Code |
66528812
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$35.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.40
|
| Rate for Payer: Aetna Government |
$22.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.46
|
| Rate for Payer: Group Health Inc Commercial |
$22.40
|
| Rate for Payer: Group Health Inc Medicare |
$15.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.40
|
|
|
CC CATH JL 4 5F
|
Facility
OP
|
$160.00
|
|
| Hospital Charge Code |
66528865
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.00
|
| Rate for Payer: Aetna Government |
$80.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$128.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.80
|
| Rate for Payer: Group Health Inc Commercial |
$80.00
|
| Rate for Payer: Group Health Inc Medicare |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
|
|
CC CATH LAB LINEAR 7.5FR 25CC
|
Facility
OP
|
$2,238.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$2,349.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,230.90
|
| 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 |
$1,119.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,286.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,349.90
|
| Rate for Payer: Group Health Inc Commercial |
$1,119.00
|
| Rate for Payer: Group Health Inc Medicare |
$783.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,119.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,454.70
|
|
|
CC CATH LAB LINEAR 7.5FR 25CC
|
Facility
IP
|
$2,238.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.00 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,119.00
|
|
|
CC CATH LAB LINEAR 7.5FR 34CC
|
Facility
IP
|
$2,238.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.00 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,119.00
|
|
|
CC CATH LAB LINEAR 7.5FR 34CC
|
Facility
OP
|
$2,238.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$2,349.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,230.90
|
| 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 |
$1,119.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,286.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,349.90
|
| Rate for Payer: Group Health Inc Commercial |
$1,119.00
|
| Rate for Payer: Group Health Inc Medicare |
$783.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,119.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,454.70
|
|
|
CC CATH LAB LINEAR 7.5FR 40CC
|
Facility
IP
|
$2,238.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.00 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,119.00
|
|
|
CC CATH LAB LINEAR 7.5FR 40CC
|
Facility
OP
|
$2,238.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$2,349.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,230.90
|
| 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 |
$1,119.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,286.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,349.90
|
| Rate for Payer: Group Health Inc Commercial |
$1,119.00
|
| Rate for Payer: Group Health Inc Medicare |
$783.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,119.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,454.70
|
|
|
CC CATH MAVR BALL 4.0X9MM
|
Facility
IP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.00 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
|
|
CC CATH MAVR BALL 4.0X9MM
|
Facility
OP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.50
|
| 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 |
$235.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$493.50
|
| Rate for Payer: Group Health Inc Commercial |
$235.00
|
| Rate for Payer: Group Health Inc Medicare |
$164.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.50
|
|
|
CC CATH MAVRK MONO BALL 2.0X12MM
|
Facility
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$1,623.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$850.30
|
| 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 |
$773.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$888.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,623.30
|
| Rate for Payer: Group Health Inc Commercial |
$773.00
|
| Rate for Payer: Group Health Inc Medicare |
$541.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$773.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$773.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,004.90
|
|
|
CC CATH MAVRK MONO BALL 2.0X12MM
|
Facility
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$773.00 |
| Max. Negotiated Rate |
$773.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$773.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$773.00
|
|
|
CC CATH MAVRK MONO BALL 2.0X9MM
|
Facility
IP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.00 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
|
|
CC CATH MAVRK MONO BALL 2.0X9MM
|
Facility
OP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.50
|
| 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 |
$235.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$493.50
|
| Rate for Payer: Group Health Inc Commercial |
$235.00
|
| Rate for Payer: Group Health Inc Medicare |
$164.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.50
|
|
|
CC CATH MAVRK MONO BALL 2.5X9MM
|
Facility
IP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.00 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
|
