|
CC D/G/WIRE CORDIS EMERALD .025
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.00
|
|
|
CC D IS-1 BI POS/FIX RA/RV 53CM
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
66528869
|
|
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
|
|
|
CC D IS-1 BI POS/FIX RA/RV 53CM
|
Facility
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
66528869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$3,139.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| 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 |
$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
|
|
|
CC D IS-1BI POS/FIX RA/RV 53CM
|
Facility
OP
|
$1,200.00
|
|
| Hospital Charge Code |
40208869
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$600.00
|
| Rate for Payer: Aetna Government |
$600.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$960.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$816.00
|
| 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
|
|
|
CC DISPOSABLE HAND CONTROLLER
|
Facility
OP
|
$24.48
|
|
| Hospital Charge Code |
66520247
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.24
|
| Rate for Payer: Aetna Government |
$12.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.65
|
| Rate for Payer: Group Health Inc Commercial |
$12.24
|
| Rate for Payer: Group Health Inc Medicare |
$8.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.24
|
|
|
CC DISPOSABLE SINGL SET LONG
|
Facility
OP
|
$65.16
|
|
| Hospital Charge Code |
66521929
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$52.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.58
|
| Rate for Payer: Aetna Government |
$32.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.31
|
| Rate for Payer: Group Health Inc Commercial |
$32.58
|
| Rate for Payer: Group Health Inc Medicare |
$22.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.58
|
|
|
CC DISPOSIABLE TRANSDUCER
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
66520240
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.50
|
| Rate for Payer: Aetna Government |
$11.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.64
|
| Rate for Payer: Group Health Inc Commercial |
$11.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.50
|
|
|
CC DRUG ADMIN & HEMODYNMIC MEAS
|
Facility
OP
|
$308.35
|
|
|
Service Code
|
HCPCS 93463
|
| Hospital Charge Code |
66528901
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.10
|
| Rate for Payer: Aetna Government |
$85.10
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$102.25
|
| Rate for Payer: Group Health Inc Commercial |
$154.18
|
| Rate for Payer: Group Health Inc Medicare |
$107.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.61
|
|
|
CC DX BRONCHOSCOPE/WASH
|
Facility
OP
|
$4,535.55
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
66581566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.96 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,962.76
|
| Rate for Payer: Aetna Government |
$1,962.76
|
| Rate for Payer: Cash Price |
$1,962.76
|
| Rate for Payer: Cash Price |
$1,962.76
|
| Rate for Payer: Cash Price |
$1,962.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,962.76
|
| 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: Elderplan Medicare Advantage |
$1,962.76
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,668.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,746.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,962.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,746.86
|
| Rate for Payer: Group Health Inc Commercial |
$1,962.76
|
| Rate for Payer: Group Health Inc Medicare |
$1,962.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,267.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,962.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,668.35
|
| Rate for Payer: Healthfirst QHP |
$1,962.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,962.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,962.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,570.21
|
| Rate for Payer: Wellcare Medicare |
$1,864.62
|
|
|
CC EA AICD, DC WO REPROG
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93283 26
|
| Hospital Charge Code |
66528662
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.90
|
| Rate for Payer: Aetna Government |
$54.90
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.85
|
| Rate for Payer: Group Health Inc Commercial |
$54.90
|
| Rate for Payer: Group Health Inc Medicare |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.17
|
|
|
CC EA AICD, DC W REPROG
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93283 TC
|
| Hospital Charge Code |
66528663
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.90
|
| Rate for Payer: Aetna Government |
$54.90
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.38
|
| Rate for Payer: Group Health Inc Commercial |
$54.90
|
| Rate for Payer: Group Health Inc Medicare |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.76
|
|
|
CC EA AICD, SC WO REPROG
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93282 26
|
| Hospital Charge Code |
66528660
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.90
|
| Rate for Payer: Aetna Government |
$54.90
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.76
|
| Rate for Payer: Group Health Inc Commercial |
$54.90
|
| Rate for Payer: Group Health Inc Medicare |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.51
|
|
|
CC EA AICD, SC W REPROG
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93282 26
|
| Hospital Charge Code |
66528661
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.90
|
| Rate for Payer: Aetna Government |
$54.90
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.76
|
| Rate for Payer: Group Health Inc Commercial |
$54.90
|
| Rate for Payer: Group Health Inc Medicare |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.51
|
|
|
CC EA ANTITACHY PACEMAKER SYS
|
Facility
OP
|
$820.53
|
|
|
Service Code
|
HCPCS 93724 TC
|
| Hospital Charge Code |
66528673
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$656.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$451.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$410.26
|
| Rate for Payer: Aetna Government |
$410.26
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$656.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$557.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.71
|
| Rate for Payer: Group Health Inc Commercial |
$410.26
|
| Rate for Payer: Group Health Inc Medicare |
$287.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$410.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.46
|
|
|
CC EBU GUIDE CATHETER
|
Facility
OP
|
$102.00
|
|
| Hospital Charge Code |
66529916
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.00
|
| Rate for Payer: Aetna Government |
$51.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.36
|
| 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
|
|
|
CC EBUS ASPIRATION NEEDLE
|
Facility
OP
|
$887.50
|
|
| Hospital Charge Code |
66571553
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$310.62 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$488.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$443.75
|
| Rate for Payer: Aetna Government |
$443.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$710.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$603.50
|
| Rate for Payer: Group Health Inc Commercial |
$443.75
|
| Rate for Payer: Group Health Inc Medicare |
$310.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$443.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$443.75
|
|
|
CC ED LIFE 6 FR THERM CATH 110CM
|
Facility
OP
|
$242.00
|
|
| Hospital Charge Code |
66528399
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$193.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.00
|
| Rate for Payer: Aetna Government |
$121.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.56
|
| Rate for Payer: Group Health Inc Commercial |
$121.00
|
| Rate for Payer: Group Health Inc Medicare |
$84.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.00
|
|
|
CC EDWARDS CARDIAC OUTPUT KIT
|
Facility
OP
|
$50.94
|
|
| Hospital Charge Code |
66528229
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$40.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.47
|
| Rate for Payer: Aetna Government |
$25.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.64
|
| Rate for Payer: Group Health Inc Commercial |
$25.47
|
| Rate for Payer: Group Health Inc Medicare |
$17.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.47
|
|
|
CC EDWARDS PRESSURE TUBINGS
|
Facility
OP
|
$16.20
|
|
| Hospital Charge Code |
66528230
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.10
|
| Rate for Payer: Aetna Government |
$8.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.02
|
| Rate for Payer: Group Health Inc Commercial |
$8.10
|
| Rate for Payer: Group Health Inc Medicare |
$5.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.10
|
|
|
CC EKG, SIGNAL - AVERAGED
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 93278 26
|
| Hospital Charge Code |
66528672
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.30
|
| Rate for Payer: Aetna Government |
$83.30
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.46
|
| Rate for Payer: Group Health Inc Commercial |
$83.30
|
| Rate for Payer: Group Health Inc Medicare |
$58.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.84
|
|
|
CC EMBOLIC A.C. MED.EXPORT AP 6F
|
Facility
IP
|
$1,390.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
66522023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.00 |
| Max. Negotiated Rate |
$695.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$695.00
|
|
|
CC EMBOLIC A.C. MED.EXPORT AP 6F
|
Facility
OP
|
$1,390.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
66522023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$1,459.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$764.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.33
|
| Rate for Payer: Aetna Government |
$16.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$695.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$799.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,459.50
|
| Rate for Payer: Group Health Inc Commercial |
$695.00
|
| Rate for Payer: Group Health Inc Medicare |
$486.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$695.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$903.50
|
|
|
CC EMBOLIC A.C.VAS.SOL. GUIDELINE
|
Facility
IP
|
$790.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
66522017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$395.00 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.00
|
|
|
CC EMBOLIC A.C.VAS.SOL. GUIDELINE
|
Facility
OP
|
$790.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
66522017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$829.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$434.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.33
|
| Rate for Payer: Aetna Government |
$16.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$395.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$454.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.50
|
| Rate for Payer: Group Health Inc Commercial |
$395.00
|
| Rate for Payer: Group Health Inc Medicare |
$276.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$513.50
|
|
|
CC EMBOLIC A.C. V.S PRONTO LP
|
Facility
IP
|
$990.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
66522019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$495.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$495.00
|
|
