CC CORDIS AVIATOR 6.0MM X 20MM
|
Facility
OP
|
$354.20
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528557
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$123.97 |
Max. Negotiated Rate |
$398.18 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$194.81
|
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 |
$177.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$203.66
|
Rate for Payer: Fidelis Medicare Advantage |
$371.91
|
Rate for Payer: Group Health Inc Commercial |
$177.10
|
Rate for Payer: Group Health Inc Medicare |
$123.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$177.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.23
|
|
CC CORDIS AVIATOR 6.0MM X 20MM
|
Facility
IP
|
$354.20
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528557
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$177.10 |
Max. Negotiated Rate |
$177.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$177.10
|
|
CC CORDIS AVIATOR 7.0MM X 15MM
|
Facility
IP
|
$354.20
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528556
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$177.10 |
Max. Negotiated Rate |
$177.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$177.10
|
|
CC CORDIS AVIATOR 7.0MM X 15MM
|
Facility
OP
|
$354.20
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528556
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$123.97 |
Max. Negotiated Rate |
$398.18 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$194.81
|
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 |
$177.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$203.66
|
Rate for Payer: Fidelis Medicare Advantage |
$371.91
|
Rate for Payer: Group Health Inc Commercial |
$177.10
|
Rate for Payer: Group Health Inc Medicare |
$123.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$177.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.23
|
|
CC CORDIS AVIATOR 7.0MM X 20MM
|
Facility
IP
|
$354.20
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528555
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$177.10 |
Max. Negotiated Rate |
$177.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$177.10
|
|
CC CORDIS AVIATOR 7.0MM X 20MM
|
Facility
OP
|
$354.20
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528555
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$123.97 |
Max. Negotiated Rate |
$398.18 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$194.81
|
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 |
$177.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$203.66
|
Rate for Payer: Fidelis Medicare Advantage |
$371.91
|
Rate for Payer: Group Health Inc Commercial |
$177.10
|
Rate for Payer: Group Health Inc Medicare |
$123.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$177.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.23
|
|
CC CORDIS EM 035 FIXED CORE PTFE
|
Facility
OP
|
$44.20
|
|
Hospital Charge Code |
66528409
|
Hospital Revenue Code
|
480
|
Min. Negotiated Rate |
$15.47 |
Max. Negotiated Rate |
$35.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.31
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.10
|
Rate for Payer: Aetna Government |
$22.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.06
|
Rate for Payer: Group Health Inc Commercial |
$22.10
|
Rate for Payer: Group Health Inc Medicare |
$15.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$22.10
|
|
CC CORDIS EM. 035 STD JTIP 260CM
|
Facility
OP
|
$44.20
|
|
Hospital Charge Code |
66529930
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$15.47 |
Max. Negotiated Rate |
$35.36 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.31
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.10
|
Rate for Payer: Aetna Government |
$22.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.06
|
Rate for Payer: Group Health Inc Commercial |
$22.10
|
Rate for Payer: Group Health Inc Medicare |
$15.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$22.10
|
|
CC CORDIS EMERAL .035 JTIP 150CM
|
Facility
OP
|
$20.60
|
|
Hospital Charge Code |
66528259
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$7.21 |
Max. Negotiated Rate |
$16.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.33
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.30
|
Rate for Payer: Aetna Government |
$10.30
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.48
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.01
|
Rate for Payer: Group Health Inc Commercial |
$10.30
|
Rate for Payer: Group Health Inc Medicare |
$7.21
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$10.30
|
|
CC CORDIS EMERALD .035X260CM
|
Facility
IP
|
$42.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
66528502
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$21.00 |
Max. Negotiated Rate |
$21.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
|
CC CORDIS EMERALD .035X260CM
|
Facility
OP
|
$42.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
66528502
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$44.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
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 |
$21.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.15
|
Rate for Payer: Fidelis Medicare Advantage |
$44.10
|
Rate for Payer: Group Health Inc Commercial |
$21.00
|
Rate for Payer: Group Health Inc Medicare |
$14.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.30
|
|
CC CORDIS GENESIS 5MM X 12MM
|
Facility
IP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528554
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,180.00 |
Max. Negotiated Rate |
$1,180.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
|
CC CORDIS GENESIS 5MM X 12MM
|
Facility
OP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528554
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,478.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.00
|
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 |
$1,180.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,357.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,478.00
|
Rate for Payer: Group Health Inc Commercial |
$1,180.00
|
Rate for Payer: Group Health Inc Medicare |
$826.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,534.00
|
|
CC CORDIS GENESIS 5MM X 15MM
|
Facility
IP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528553
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,180.00 |
Max. Negotiated Rate |
$1,180.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
|
CC CORDIS GENESIS 5MM X 15MM
|
Facility
OP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528553
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,478.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.00
|
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 |
$1,180.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,357.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,478.00
|
Rate for Payer: Group Health Inc Commercial |
$1,180.00
|
Rate for Payer: Group Health Inc Medicare |
$826.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,534.00
|
|
CC CORDIS GENESIS 5MM X 18MM
|
Facility
IP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528552
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,180.00 |
Max. Negotiated Rate |
$1,180.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
|
CC CORDIS GENESIS 5MM X 18MM
|
Facility
OP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528552
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,478.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.00
|
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 |
$1,180.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,357.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,478.00
|
Rate for Payer: Group Health Inc Commercial |
$1,180.00
|
Rate for Payer: Group Health Inc Medicare |
$826.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,534.00
|
|
CC CORDIS GENESIS 6MM X 12MM
|
Facility
IP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528551
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,180.00 |
Max. Negotiated Rate |
$1,180.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
|
CC CORDIS GENESIS 6MM X 12MM
|
Facility
OP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528551
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,478.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.00
|
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 |
$1,180.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,357.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,478.00
|
Rate for Payer: Group Health Inc Commercial |
$1,180.00
|
Rate for Payer: Group Health Inc Medicare |
$826.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,534.00
|
|
CC CORDIS GENESIS 6MM X 15MM
|
Facility
IP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528550
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,180.00 |
Max. Negotiated Rate |
$1,180.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
|
CC CORDIS GENESIS 6MM X 15MM
|
Facility
OP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528550
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,478.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.00
|
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 |
$1,180.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,357.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,478.00
|
Rate for Payer: Group Health Inc Commercial |
$1,180.00
|
Rate for Payer: Group Health Inc Medicare |
$826.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,534.00
|
|
CC CORDIS GENESIS 6MM X 18MM
|
Facility
IP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528549
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,180.00 |
Max. Negotiated Rate |
$1,180.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
|
CC CORDIS GENESIS 6MM X 18MM
|
Facility
OP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528549
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,478.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.00
|
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 |
$1,180.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,357.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,478.00
|
Rate for Payer: Group Health Inc Commercial |
$1,180.00
|
Rate for Payer: Group Health Inc Medicare |
$826.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,534.00
|
|
CC CORDIS GENESIS 7MM X 12MM
|
Facility
OP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528548
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$398.18 |
Max. Negotiated Rate |
$2,478.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.00
|
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 |
$1,180.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,357.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,478.00
|
Rate for Payer: Group Health Inc Commercial |
$1,180.00
|
Rate for Payer: Group Health Inc Medicare |
$826.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,534.00
|
|
CC CORDIS GENESIS 7MM X 12MM
|
Facility
IP
|
$2,360.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
66528548
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,180.00 |
Max. Negotiated Rate |
$1,180.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
|