St. Barnabas Hospital

All Charges

Charge

Type

Price

BIOTRON ETRINSA 8 DR-T 394931

Facility OP

$8,300.00

Service Code	HCPCS C1785
Hospital Charge Code	66573341
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$8,715.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,565.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,772.50
Rate for Payer: Fidelis Medicare Advantage	$8,715.00
Rate for Payer: Group Health Inc Commercial	$4,150.00
Rate for Payer: Group Health Inc Medicare	$2,905.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,395.00

BIOTRONIK ACTICOR VR

Facility IP

$32,500.00

Service Code	HCPCS C1722
Hospital Charge Code	66571492
Hospital Revenue Code	278
Min. Negotiated Rate	$16,250.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16,250.00

BIOTRONIK ACTICOR VR

Facility OP

$32,500.00

Service Code	HCPCS C1722
Hospital Charge Code	66571492
Hospital Revenue Code	278
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$34,125.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17,875.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$18,687.50
Rate for Payer: Fidelis Medicare Advantage	$34,125.00
Rate for Payer: Group Health Inc Commercial	$16,250.00
Rate for Payer: Group Health Inc Medicare	$11,375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,125.00

BIOTRONIK EDORA 8 DR-T 407145

Facility OP

$10,950.00

Service Code	HCPCS C1785
Hospital Charge Code	66573149
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$11,497.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,022.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,475.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,296.25
Rate for Payer: Fidelis Medicare Advantage	$11,497.50
Rate for Payer: Group Health Inc Commercial	$5,475.00
Rate for Payer: Group Health Inc Medicare	$3,832.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,475.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,475.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,117.50

BIOTRONIK ILIVIA 7 DR-T 404623

Facility OP

$28,500.00

Service Code	HCPCS C1721
Hospital Charge Code	66573165
Hospital Revenue Code	275
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$29,925.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15,675.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,000.00
Rate for Payer: Aetna Government	$5,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16,387.50
Rate for Payer: Fidelis Medicare Advantage	$29,925.00
Rate for Payer: Group Health Inc Commercial	$14,250.00
Rate for Payer: Group Health Inc Medicare	$9,975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18,525.00

BIOTRONIK INTICA ICD

Facility OP

$40,000.00

Service Code	HCPCS C1882
Hospital Charge Code	66571498
Hospital Revenue Code	275
Min. Negotiated Rate	$4,752.01
Max. Negotiated Rate	$42,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,000.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,752.01
Rate for Payer: Aetna Government	$4,752.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$23,000.00
Rate for Payer: Fidelis Medicare Advantage	$42,000.00
Rate for Payer: Group Health Inc Commercial	$20,000.00
Rate for Payer: Group Health Inc Medicare	$14,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26,000.00

BIOTRONIK IPERIA ICD 392423

Facility OP

$28,500.00

Service Code	HCPCS C1721
Hospital Charge Code	66576688
Hospital Revenue Code	275
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$29,925.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15,675.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,000.00
Rate for Payer: Aetna Government	$5,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$16,387.50
Rate for Payer: Fidelis Medicare Advantage	$29,925.00
Rate for Payer: Group Health Inc Commercial	$14,250.00
Rate for Payer: Group Health Inc Medicare	$9,975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18,525.00

BIOTRONIK IPERIA VR-T 393032

Facility OP

$39,669.12

Service Code	HCPCS C1722
Hospital Charge Code	66576680
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$41,652.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21,818.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19,834.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,809.74
Rate for Payer: Fidelis Medicare Advantage	$41,652.58
Rate for Payer: Group Health Inc Commercial	$19,834.56
Rate for Payer: Group Health Inc Medicare	$13,884.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,834.56
Rate for Payer: Hamaspik Choice Inc Medicare	$19,834.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25,784.93

BIOTRONIK IVENTRA VRT-DX 399436

Facility OP

$26,600.00

Service Code	HCPCS C1722
Hospital Charge Code	66576690
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$27,930.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,630.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15,295.00
Rate for Payer: Fidelis Medicare Advantage	$27,930.00
Rate for Payer: Group Health Inc Commercial	$13,300.00
Rate for Payer: Group Health Inc Medicare	$9,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$13,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17,290.00

BIOTRONIK LINOX SMART S 65CM

Facility OP

$6,700.00

Service Code	HCPCS C1777
Hospital Charge Code	66573258
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$7,035.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,685.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,852.50
Rate for Payer: Fidelis Medicare Advantage	$7,035.00
Rate for Payer: Group Health Inc Commercial	$3,350.00
Rate for Payer: Group Health Inc Medicare	$2,345.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,355.00

BIOTRONIK PK PAPYRUS COVERD STENT

Facility OP

$7,500.00

Service Code	HCPCS C1874
Hospital Charge Code	66521180
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$7,875.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,125.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,312.50
Rate for Payer: Fidelis Medicare Advantage	$7,875.00
Rate for Payer: Group Health Inc Commercial	$3,750.00
Rate for Payer: Group Health Inc Medicare	$2,625.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,875.00

BIOTRONIK PK PAPYRUS COVERD STENT

Facility IP

$7,500.00

Service Code	HCPCS C1874
Hospital Charge Code	66521180
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,750.00

BIOTRONIK PLEXA MRI S65 402266

Facility OP

$7,100.00

Service Code	HCPCS C1777
Hospital Charge Code	66573164
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$7,455.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,905.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,082.50
Rate for Payer: Fidelis Medicare Advantage	$7,455.00
Rate for Payer: Group Health Inc Commercial	$3,550.00
Rate for Payer: Group Health Inc Medicare	$2,485.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,615.00

BIOTRONIK PROTEGO S65 LEAD 379969

Facility OP

$6,700.00

Service Code	HCPCS C1722
Hospital Charge Code	66576689
Hospital Revenue Code	275
Min. Negotiated Rate	$2,345.00
Max. Negotiated Rate	$7,035.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,685.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,852.50
Rate for Payer: Fidelis Medicare Advantage	$7,035.00
Rate for Payer: Group Health Inc Commercial	$3,350.00
Rate for Payer: Group Health Inc Medicare	$2,345.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,355.00

BIOTRONIK SMART S DX 65/15 365500

Facility OP

$6,700.00

Service Code	HCPCS C1777
Hospital Charge Code	66576681
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$7,035.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,685.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,852.50
Rate for Payer: Fidelis Medicare Advantage	$7,035.00
Rate for Payer: Group Health Inc Commercial	$3,350.00
Rate for Payer: Group Health Inc Medicare	$2,345.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,355.00

BIOTRONIK SOLIA JT 45CM LEAD

Facility OP

$1,000.00

Service Code	HCPCS C1898
Hospital Charge Code	66570269
Hospital Revenue Code	278
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$1,050.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$575.00
Rate for Payer: Fidelis Medicare Advantage	$1,050.00
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$650.00

BIOTRONIK SOLIA JT 45CM LEAD

Facility IP

$1,000.00

Service Code	HCPCS C1898
Hospital Charge Code	66570269
Hospital Revenue Code	278
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

BIOTRON ILIVIA 7 VR-T ICD 404626

Facility OP

$25,550.00

Service Code	HCPCS C1722
Hospital Charge Code	66573146
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$26,827.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,052.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12,775.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,691.25
Rate for Payer: Fidelis Medicare Advantage	$26,827.50
Rate for Payer: Group Health Inc Commercial	$12,775.00
Rate for Payer: Group Health Inc Medicare	$8,942.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12,775.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16,607.50

BIOTRON ITREVIA 7 DR-T ICD 392412

Facility OP

$27,500.00

Service Code	HCPCS C1721
Hospital Charge Code	66576678
Hospital Revenue Code	275
Min. Negotiated Rate	$5,000.00
Max. Negotiated Rate	$28,875.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15,125.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5,000.00
Rate for Payer: Aetna Government	$5,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15,812.50
Rate for Payer: Fidelis Medicare Advantage	$28,875.00
Rate for Payer: Group Health Inc Commercial	$13,750.00
Rate for Payer: Group Health Inc Medicare	$9,625.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$13,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$13,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17,875.00

BIOTRON ITREVIA 7HF-T-ICD 393014

Facility OP

$35,000.00

Service Code	HCPCS C1882
Hospital Charge Code	66576692
Hospital Revenue Code	275
Min. Negotiated Rate	$4,752.01
Max. Negotiated Rate	$36,750.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19,250.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,752.01
Rate for Payer: Aetna Government	$4,752.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20,125.00
Rate for Payer: Fidelis Medicare Advantage	$36,750.00
Rate for Payer: Group Health Inc Commercial	$17,500.00
Rate for Payer: Group Health Inc Medicare	$12,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22,750.00

BIOTRON LLIVIA 7 VR-T ICD 40626

Facility OP

$25,550.00

Service Code	HCPCS C1722
Hospital Charge Code	66573483
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$26,827.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,052.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12,775.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,691.25
Rate for Payer: Fidelis Medicare Advantage	$26,827.50
Rate for Payer: Group Health Inc Commercial	$12,775.00
Rate for Payer: Group Health Inc Medicare	$8,942.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12,775.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16,607.50

BIOTRON PLEXA DX 65/15 ICD LEAD

Facility OP

$7,100.00

Service Code	HCPCS C1777
Hospital Charge Code	66573143
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$7,455.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,905.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,082.50
Rate for Payer: Fidelis Medicare Advantage	$7,455.00
Rate for Payer: Group Health Inc Commercial	$3,550.00
Rate for Payer: Group Health Inc Medicare	$2,485.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,615.00

BIOTRON PLEXA S 65 LEAD 402266

Facility OP

$7,100.00

Service Code	HCPCS C1777
Hospital Charge Code	66573147
Hospital Revenue Code	275
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$7,455.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,905.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,082.50
Rate for Payer: Fidelis Medicare Advantage	$7,455.00
Rate for Payer: Group Health Inc Commercial	$3,550.00
Rate for Payer: Group Health Inc Medicare	$2,485.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,615.00

BIOTRON SETROX S53 LEAD 350974

Facility OP

$900.00

Service Code	HCPCS C1898
Hospital Charge Code	66573251
Hospital Revenue Code	275
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$945.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$517.50
Rate for Payer: Fidelis Medicare Advantage	$945.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$585.00

BIOTRON SETROX S60 LEAD 350975

Facility OP

$900.00

Service Code	HCPCS C1898
Hospital Charge Code	66573252
Hospital Revenue Code	275
Min. Negotiated Rate	$98.92
Max. Negotiated Rate	$945.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.92
Rate for Payer: Aetna Government	$98.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$517.50
Rate for Payer: Fidelis Medicare Advantage	$945.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$585.00

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