|
CC G/CATH JL 4.5 7FMED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JL 5.0 6F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JL 5.0 6F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JL 5.0 7F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JL 5.0 7F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JL SH 3.5 6F MED L
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JL SH 3.5 6F MED L
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JL SH 4.0 6F MED LAUNCH
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JL SH 4.0 6F MED LAUNCH
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JR 3.0 6F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JR 3.0 6F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JR 3.0 7F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JR 3.0 7F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JR 3.5 6F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JR 3.5 6F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JR 3.5 7F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JR 3.5 7F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JR 4.0 6F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JR 4.0 6F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JR 4.0 7F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JR 4.0 7F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JR 4.5 6F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC G/CATH JR 4.5 6F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JR 4.5 7F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC G/CATH JR 4.5 7F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| 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 |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
