|
CC BS QUANT MAV 3.5MM X 15MM BALL
|
Facility
OP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522073
|
|
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 BS QUANT MAV 3.5MMX8MM BALL
|
Facility
OP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522075
|
|
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 BS QUANT MAV 3.5MMX8MM BALL
|
Facility
IP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522075
|
|
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 BS QUANT MAV 3.75MMX12MM BALL
|
Facility
IP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522079
|
|
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 BS QUANT MAV 3.75MMX12MM BALL
|
Facility
OP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522079
|
|
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 BS QUANT MAV 3.75MMX15MM BALL
|
Facility
IP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522083
|
|
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 BS QUANT MAV 3.75MMX15MM BALL
|
Facility
OP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522083
|
|
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 BS QUANT MAV 3.75MM X 8MM BALL
|
Facility
IP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522085
|
|
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 BS QUANT MAV 3.75MM X 8MM BALL
|
Facility
OP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522085
|
|
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 BS QUANT MAV 4.0MM X 8MM BALL
|
Facility
OP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522089
|
|
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 BS QUANT MAV 4.0MM X 8MM BALL
|
Facility
IP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522089
|
|
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 BS QUANT MAV 4.0MM X 8MM BALL
|
Facility
IP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522087
|
|
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 BS QUANT MAV 4.0MM X 8MM BALL
|
Facility
OP
|
$470.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522087
|
|
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 CABLE 5833L 5PK SURG DISP 12FT
|
Facility
OP
|
$135.00
|
|
| Hospital Charge Code |
66526888
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.50
|
| Rate for Payer: Aetna Government |
$67.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.80
|
| Rate for Payer: Group Health Inc Commercial |
$67.50
|
| Rate for Payer: Group Health Inc Medicare |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
|
|
CC CARDIAC OUTPUT TUBING
|
Facility
OP
|
$614.00
|
|
| Hospital Charge Code |
66540238
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$214.90 |
| Max. Negotiated Rate |
$491.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$337.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$307.00
|
| Rate for Payer: Aetna Government |
$307.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$491.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$417.52
|
| Rate for Payer: Group Health Inc Commercial |
$307.00
|
| Rate for Payer: Group Health Inc Medicare |
$214.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.00
|
|
|
CC CARDIOPULMONARY RESUSCITATION
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
66528381
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$192.53 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| 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: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
CC CARDIOVERSION , ELECTIVE
|
Facility
OP
|
$1,624.80
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
66528380
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$114.08 |
| Max. Negotiated Rate |
$1,299.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$893.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$752.63
|
| Rate for Payer: Aetna Government |
$752.63
|
| Rate for Payer: Cash Price |
$752.63
|
| Rate for Payer: Cash Price |
$752.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$752.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,299.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,104.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$752.63
|
| Rate for Payer: EmblemHealth Commercial |
$752.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$639.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$669.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$752.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$669.84
|
| Rate for Payer: Group Health Inc Commercial |
$752.63
|
| Rate for Payer: Group Health Inc Medicare |
$752.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$812.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$752.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$639.74
|
| Rate for Payer: Healthfirst QHP |
$752.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$752.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$752.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$602.10
|
| Rate for Payer: Wellcare Medicare |
$715.00
|
|
|
CC CARDIOVERSION, ELECTIVE, INT
|
Facility
OP
|
$1,624.80
|
|
|
Service Code
|
HCPCS 92961
|
| Hospital Charge Code |
66528670
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$752.63
|
| Rate for Payer: Aetna Government |
$752.63
|
| Rate for Payer: Cash Price |
$752.63
|
| Rate for Payer: Cash Price |
$752.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$752.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,299.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,104.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$752.63
|
| Rate for Payer: EmblemHealth Commercial |
$752.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$274.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$639.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$669.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$752.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$669.84
|
| Rate for Payer: Group Health Inc Commercial |
$752.63
|
| Rate for Payer: Group Health Inc Medicare |
$752.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$812.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$752.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$639.74
|
| Rate for Payer: Healthfirst QHP |
$752.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$752.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$752.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$602.10
|
| Rate for Payer: Wellcare Medicare |
$715.00
|
|
|
CC CARTOID ANGIO, SEL BILAT INJ
|
Facility
OP
|
$1,796.70
|
|
|
Service Code
|
HCPCS 36100
|
| Hospital Charge Code |
66528397
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.63 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$172.63
|
| Rate for Payer: Aetna Government |
$172.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.68
|
| Rate for Payer: Group Health Inc Commercial |
$898.35
|
| Rate for Payer: Group Health Inc Medicare |
$628.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$898.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$898.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.98
|
|
|
CC CARTOID ANGIO, SELECTIVE BILAT
|
Facility
OP
|
$1,872.25
|
|
|
Service Code
|
HCPCS 36227
|
| Hospital Charge Code |
66528396
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.38 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.38
|
| Rate for Payer: Aetna Government |
$127.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.62
|
| Rate for Payer: Group Health Inc Commercial |
$936.12
|
| Rate for Payer: Group Health Inc Medicare |
$655.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$936.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$936.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.24
|
|
|
CC CATH 5F 100CM AR MOD H749
|
Facility
OP
|
$719.03
|
|
| Hospital Charge Code |
66520131
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$251.66 |
| Max. Negotiated Rate |
$575.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$395.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$359.52
|
| Rate for Payer: Aetna Government |
$359.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$575.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$488.94
|
| Rate for Payer: Group Health Inc Commercial |
$359.52
|
| Rate for Payer: Group Health Inc Medicare |
$251.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$359.52
|
|
|
CC CATH 5F 100CM FL4.5 H749
|
Facility
OP
|
$298.20
|
|
| Hospital Charge Code |
66520133
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$238.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$164.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$149.10
|
| Rate for Payer: Aetna Government |
$149.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$238.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$202.78
|
| Rate for Payer: Group Health Inc Commercial |
$149.10
|
| Rate for Payer: Group Health Inc Medicare |
$104.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.10
|
|
|
CC CATH 5F 100CM FL5 H749
|
Facility
OP
|
$715.88
|
|
| Hospital Charge Code |
66520132
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$250.56 |
| Max. Negotiated Rate |
$572.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$357.94
|
| Rate for Payer: Aetna Government |
$357.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$572.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$486.80
|
| Rate for Payer: Group Health Inc Commercial |
$357.94
|
| Rate for Payer: Group Health Inc Medicare |
$250.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$357.94
|
|
|
CC CATH CARON DIAG RAD TIG 4.0 5
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66520201
|
|
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 CARON DIAG RAD TIG 4.0 5
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66520201
|
|
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
|
|
