|
CC EMBOLIC A.C. V.S PRONTO LP
|
Facility
OP
|
$990.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
66522019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$1,039.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$544.50
|
| 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 |
$495.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$569.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,039.50
|
| Rate for Payer: Group Health Inc Commercial |
$495.00
|
| Rate for Payer: Group Health Inc Medicare |
$346.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$495.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$495.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$643.50
|
|
|
CC ENDOMYOCARDIAL BIOPSY
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 93505 TC
|
| Hospital Charge Code |
66528201
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$471.22 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| 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 |
$471.22
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$523.58
|
|
|
CC EP EVAL CD, W GENERATOR TEST
|
Facility
OP
|
$947.20
|
|
|
Service Code
|
HCPCS 93641 26
|
| Hospital Charge Code |
66528664
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$331.52 |
| Max. Negotiated Rate |
$757.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$520.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$473.60
|
| Rate for Payer: Aetna Government |
$473.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$757.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$644.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.94
|
| Rate for Payer: Group Health Inc Commercial |
$473.60
|
| Rate for Payer: Group Health Inc Medicare |
$331.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$473.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$473.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$381.05
|
|
|
CC EP EVAL CD, W PACING
|
Facility
OP
|
$2,991.08
|
|
|
Service Code
|
HCPCS 93642 26
|
| Hospital Charge Code |
66528665
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$279.15 |
| Max. Negotiated Rate |
$2,392.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,645.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,495.54
|
| Rate for Payer: Aetna Government |
$1,495.54
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,392.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,033.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.15
|
| Rate for Payer: Group Health Inc Commercial |
$1,495.54
|
| Rate for Payer: Group Health Inc Medicare |
$1,046.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,495.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,495.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$310.17
|
|
|
CC ESOPH ATRIAL ELECTROGRAM
|
Facility
OP
|
$2,991.08
|
|
|
Service Code
|
HCPCS 93615 26
|
| Hospital Charge Code |
66528674
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.07 |
| Max. Negotiated Rate |
$2,392.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,645.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,495.54
|
| Rate for Payer: Aetna Government |
$1,495.54
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,392.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,033.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.07
|
| Rate for Payer: Group Health Inc Commercial |
$1,495.54
|
| Rate for Payer: Group Health Inc Medicare |
$1,046.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,495.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,495.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.19
|
|
|
CC ESOPH ATRIAL ELECTROGR, W PACI
|
Facility
OP
|
$2,991.08
|
|
|
Service Code
|
HCPCS 93616 26
|
| Hospital Charge Code |
66528675
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$2,392.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,645.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,495.54
|
| Rate for Payer: Aetna Government |
$1,495.54
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,392.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,033.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.64
|
| Rate for Payer: Group Health Inc Commercial |
$1,495.54
|
| Rate for Payer: Group Health Inc Medicare |
$1,046.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,495.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,495.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.16
|
|
|
CC EXERCISE W/HEMODYNAMIC MEAS
|
Facility
OP
|
$772.35
|
|
|
Service Code
|
HCPCS 93464 TC
|
| Hospital Charge Code |
66528902
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$146.71 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$424.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$386.18
|
| Rate for Payer: Aetna Government |
$386.18
|
| 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 |
$146.71
|
| Rate for Payer: Group Health Inc Commercial |
$386.18
|
| Rate for Payer: Group Health Inc Medicare |
$270.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$386.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.01
|
|
|
CC EXOSEAL VASC CLOSE DEVICE 5F
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
66526867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
|
|
CC EXOSEAL VASC CLOSE DEVICE 5F
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
66526867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.50
|
| Rate for Payer: Aetna Government |
$73.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.25
|
| Rate for Payer: Group Health Inc Commercial |
$112.50
|
| Rate for Payer: Group Health Inc Medicare |
$78.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.25
|
|
|
CC EXOSEAL VASC CLOSE DEVICE 6F
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
66526868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
|
|
CC EXOSEAL VASC CLOSE DEVICE 6F
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
66526868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.50
|
| Rate for Payer: Aetna Government |
$73.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.25
|
| Rate for Payer: Group Health Inc Commercial |
$112.50
|
| Rate for Payer: Group Health Inc Medicare |
$78.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.25
|
|
|
CC EXOSEAL VASC CLOSE DEVICE 7F
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
66526869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
|
|
CC EXOSEAL VASC CLOSE DEVICE 7F
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
66526869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.50
|
| Rate for Payer: Aetna Government |
$73.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.25
|
| Rate for Payer: Group Health Inc Commercial |
$112.50
|
| Rate for Payer: Group Health Inc Medicare |
$78.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.25
|
|
|
CC EXTREM VENOGRAM INJ
|
Facility
OP
|
$1,032.38
|
|
|
Service Code
|
HCPCS 36005
|
| Hospital Charge Code |
66528655
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.98
|
| Rate for Payer: Aetna Government |
$52.98
|
| 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 |
$53.28
|
| Rate for Payer: Group Health Inc Commercial |
$516.19
|
| Rate for Payer: Group Health Inc Medicare |
$361.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$516.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$516.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.20
|
|
|
CC FIBEROPTIC BRONCH SWIVEL ADAPT
|
Facility
OP
|
$500.00
|
|
| Hospital Charge Code |
66571552
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$250.00
|
| Rate for Payer: Aetna Government |
$250.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
|
CC FLUOROSCOPE EXAM EXTENSIVE 1+
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Hospital Charge Code |
66520312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.38
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.87
|
|
|
CC FLUOROSCOPE EXAMINATION =< 1 H
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Hospital Charge Code |
66520311
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.38
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.87
|
|
|
CC G/C AR I 7F MEDTRONIC LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66528999
|
|
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/C AR I 7F MEDTRONIC LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66528999
|
|
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 ALI 7F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66528997
|
|
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 ALI 7F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66528997
|
|
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 AR II6F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66529000
|
|
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 AR II6F MED LAUNCHER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66529000
|
|
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 EBU 3.0 6F MED LAUNCHER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66529118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$81.60 |
| 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 |
$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 G/CATH EBU 3.0 6F MED LAUNCHER
|
Facility
IP
|
$574.09
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66529108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.04 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$287.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.04
|
|
