|
BOSTON POL ULTRA 6F 2.0MMX26CM
|
Facility
OP
|
$324.52
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
40008273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$259.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.49
|
| 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 |
$259.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$220.67
|
| Rate for Payer: Group Health Inc Commercial |
$162.26
|
| Rate for Payer: Group Health Inc Medicare |
$113.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.26
|
|
|
BOSTON SCI ACCOLADE DR MODEL L301
|
Facility
OP
|
$12,900.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
66572893
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$13,545.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,095.00
|
| 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 |
$6,450.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,417.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,545.00
|
| Rate for Payer: Group Health Inc Commercial |
$6,450.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,515.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,450.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,450.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,385.00
|
|
|
BOSTON SCI ACCOLADE PACEMAKE L331
|
Facility
OP
|
$12,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
66576694
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$12,600.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,600.00
|
| 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 |
$6,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,900.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,600.00
|
| Rate for Payer: Group Health Inc Commercial |
$6,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,000.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,800.00
|
|
|
BOSTON SCI ACCOLAD MRI EL DR L331
|
Facility
OP
|
$10,250.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
66573168
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$10,762.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,637.50
|
| 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 |
$5,125.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,893.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,762.50
|
| Rate for Payer: Group Health Inc Commercial |
$5,125.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,587.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,125.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,662.50
|
|
|
BOSTON SCI. AUTOTOME CAN. DEVICE
|
Facility
OP
|
$554.00
|
|
| Hospital Charge Code |
40009344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$443.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$304.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$277.00
|
| Rate for Payer: Aetna Government |
$277.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$443.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$376.72
|
| Rate for Payer: Group Health Inc Commercial |
$277.00
|
| Rate for Payer: Group Health Inc Medicare |
$193.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.00
|
|
|
BOSTON SCI. AUTOTOME CAN. DEVICE
|
Facility
OP
|
$554.00
|
|
| Hospital Charge Code |
40203361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$443.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$304.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$277.00
|
| Rate for Payer: Aetna Government |
$277.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$443.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$376.72
|
| Rate for Payer: Group Health Inc Commercial |
$277.00
|
| Rate for Payer: Group Health Inc Medicare |
$193.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.00
|
|
|
BOSTON SCI. CATH. BALLOON 18FR
|
Facility
OP
|
$463.32
|
|
| Hospital Charge Code |
40009359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.16 |
| Max. Negotiated Rate |
$370.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.66
|
| Rate for Payer: Aetna Government |
$231.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$370.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$315.06
|
| Rate for Payer: Group Health Inc Commercial |
$231.66
|
| Rate for Payer: Group Health Inc Medicare |
$162.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.66
|
|
|
BOSTON SCI. CATH. BALLOON 18FR
|
Facility
OP
|
$463.32
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40203375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$370.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.83
|
| 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 |
$370.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$315.06
|
| Rate for Payer: Group Health Inc Commercial |
$231.66
|
| Rate for Payer: Group Health Inc Medicare |
$162.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.66
|
|
|
BOSTON SCI. CATH HEMASTASIS GOLD
|
Facility
OP
|
$363.12
|
|
| Hospital Charge Code |
40203364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.09 |
| Max. Negotiated Rate |
$290.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$199.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$181.56
|
| Rate for Payer: Aetna Government |
$181.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$290.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$246.92
|
| Rate for Payer: Group Health Inc Commercial |
$181.56
|
| Rate for Payer: Group Health Inc Medicare |
$127.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.56
|
|
|
BOSTON SCI.CATH HEMASTASIS GOLD
|
Facility
OP
|
$363.12
|
|
| Hospital Charge Code |
40009347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.09 |
| Max. Negotiated Rate |
$290.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$199.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$181.56
|
| Rate for Payer: Aetna Government |
$181.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$290.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$246.92
|
| Rate for Payer: Group Health Inc Commercial |
$181.56
|
| Rate for Payer: Group Health Inc Medicare |
$127.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.56
|
|
|
BOSTON SCI DYNAGEN EL VR ICD D150
|
Facility
OP
|
$40,500.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
66572894
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,988.80 |
| Max. Negotiated Rate |
$42,525.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,275.00
|
| 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 |
$20,250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,287.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$42,525.00
|
| Rate for Payer: Group Health Inc Commercial |
$20,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$14,175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,325.00
|
|
|
BOSTON SCI EMBLEM MRI S-ICD A219
|
Facility
OP
|
$45,400.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
66573276
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,988.80 |
| Max. Negotiated Rate |
$47,670.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,970.00
|
| 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 |
$22,700.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,105.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$47,670.00
|
| Rate for Payer: Group Health Inc Commercial |
$22,700.00
|
| Rate for Payer: Group Health Inc Medicare |
$15,890.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,700.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,510.00
|
|
|
BOSTON SCI EMBLEM SICD LEAD 3501
|
Facility
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
66573277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.11 |
| Max. Negotiated Rate |
$10,500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,500.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,139.11
|
| Rate for Payer: Aetna Government |
$3,139.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,750.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,500.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,000.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,500.00
|
|
|
BOSTON SCI EMBLEM SICD LEAD 3501
|
Facility
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
66573277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,000.00
|
|
|
BOSTON SCI ENERGEN ICD- E142
|
Facility
OP
|
$39,000.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
66573505
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$40,950.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,450.00
|
| 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 |
$19,500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,425.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$40,950.00
|
| Rate for Payer: Group Health Inc Commercial |
$19,500.00
|
| Rate for Payer: Group Health Inc Medicare |
$13,650.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,500.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,350.00
|
|
|
BOSTON SCIENTIFIC DIAL WIRE BLLN
|
Facility
OP
|
$598.00
|
|
| Hospital Charge Code |
40205612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$209.30 |
| Max. Negotiated Rate |
$478.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$328.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$299.00
|
| Rate for Payer: Aetna Government |
$299.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$478.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$406.64
|
| Rate for Payer: Group Health Inc Commercial |
$299.00
|
| Rate for Payer: Group Health Inc Medicare |
$209.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$299.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$299.00
|
|
|
BOSTON SCIENTIFIC INCEPTA ICDE160
|
Facility
OP
|
$36,220.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
66573201
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,988.80 |
| Max. Negotiated Rate |
$38,031.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,921.00
|
| 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 |
$18,110.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,826.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,031.00
|
| Rate for Payer: Group Health Inc Commercial |
$18,110.00
|
| Rate for Payer: Group Health Inc Medicare |
$12,677.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,110.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,543.00
|
|
|
BOSTON SCIENTIFIC PERIVAC- 4305
|
Facility
OP
|
$300.00
|
|
| Hospital Charge Code |
66526607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.00
|
| Rate for Payer: Aetna Government |
$150.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
| Rate for Payer: Group Health Inc Commercial |
$150.00
|
| Rate for Payer: Group Health Inc Medicare |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
|
|
BOSTON SCIENTIFIC UROMAX 20
|
Facility
OP
|
$473.62
|
|
| Hospital Charge Code |
40009320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.77 |
| Max. Negotiated Rate |
$378.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$260.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$236.81
|
| Rate for Payer: Aetna Government |
$236.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$378.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$322.06
|
| Rate for Payer: Group Health Inc Commercial |
$236.81
|
| Rate for Payer: Group Health Inc Medicare |
$165.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.81
|
|
|
BOSTON SCIENTIFIC UROMAX 20
|
Facility
OP
|
$473.62
|
|
| Hospital Charge Code |
40203338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.77 |
| Max. Negotiated Rate |
$378.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$260.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$236.81
|
| Rate for Payer: Aetna Government |
$236.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$378.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$322.06
|
| Rate for Payer: Group Health Inc Commercial |
$236.81
|
| Rate for Payer: Group Health Inc Medicare |
$165.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.81
|
|
|
BOSTON SCI ESSENT PACEMAKER L100
|
Facility
OP
|
$11,600.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
66573210
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,116.69 |
| Max. Negotiated Rate |
$12,180.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,380.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,116.69
|
| Rate for Payer: Aetna Government |
$1,116.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,800.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,670.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,180.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,800.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,060.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,800.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,540.00
|
|
|
BOSTON SCI INGEVITY 7741-52
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66576696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
|
|
BOSTON SCI INGEVITY 7741-52
|
Facility
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66576696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| 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 |
$600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,260.00
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$780.00
|
|
|
BOSTON SCI INGEVITY MODEL 7742-59
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66576693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
|
|
BOSTON SCI INGEVITY MODEL 7742-59
|
Facility
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66576693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| 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 |
$600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,260.00
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$780.00
|
|
