|
CC IVUS/FFR VOLCANO REV CATH
|
Facility
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66521093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$715.00
|
| 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 |
$650.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$747.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,365.00
|
| Rate for Payer: Group Health Inc Commercial |
$650.00
|
| Rate for Payer: Group Health Inc Medicare |
$455.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$650.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$650.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$845.00
|
|
|
CC IVUS VOLACNO EAGLE EYE P/CATH
|
Facility
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66521091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$725.00 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$725.00
|
|
|
CC IVUS VOLACNO EAGLE EYE P/CATH
|
Facility
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66521091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$797.50
|
| 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 |
$725.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$833.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,522.50
|
| Rate for Payer: Group Health Inc Commercial |
$725.00
|
| Rate for Payer: Group Health Inc Medicare |
$507.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$725.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$942.50
|
|
|
CC LEAD 5076-52 CAP NOVUS US EN
|
Facility
OP
|
$1,634.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66526886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$1,715.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$898.70
|
| 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 |
$817.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$939.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,715.70
|
| Rate for Payer: Group Health Inc Commercial |
$817.00
|
| Rate for Payer: Group Health Inc Medicare |
$571.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$817.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$817.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,062.10
|
|
|
CC LEAD 5076-52 CAP NOVUS US EN
|
Facility
IP
|
$1,634.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66526886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$817.00 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$817.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$817.00
|
|
|
CC LEAD 5076-58 CAP NOVUS US EN
|
Facility
IP
|
$1,634.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66526887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$817.00 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$817.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$817.00
|
|
|
CC LEAD 5076-58 CAP NOVUS US EN
|
Facility
OP
|
$1,634.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66526887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$1,715.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$898.70
|
| 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 |
$817.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$939.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,715.70
|
| Rate for Payer: Group Health Inc Commercial |
$817.00
|
| Rate for Payer: Group Health Inc Medicare |
$571.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$817.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$817.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,062.10
|
|
|
CC LEFT ARTERY/VENTRICLE ANGIO
|
Facility
OP
|
$3.90
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
66528878
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,768.27
|
| Rate for Payer: Aetna Government |
$3,768.27
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,768.27
|
| 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 |
$3,768.27
|
| Rate for Payer: EmblemHealth Commercial |
$3,768.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,160.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,203.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,353.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,768.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,353.76
|
| Rate for Payer: Group Health Inc Commercial |
$3,768.27
|
| Rate for Payer: Group Health Inc Medicare |
$3,768.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,768.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,289.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,203.03
|
| Rate for Payer: Healthfirst QHP |
$3,768.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,768.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,768.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,014.62
|
| Rate for Payer: Wellcare Medicare |
$3,579.86
|
|
|
CC LEFT ARTERY/VENTRICLE ANGIO
|
Facility
OP
|
$8,631.78
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
66528888
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,160.52 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,768.27
|
| Rate for Payer: Aetna Government |
$3,768.27
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,768.27
|
| 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 |
$3,768.27
|
| Rate for Payer: EmblemHealth Commercial |
$3,768.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,160.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,203.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,353.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,768.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,353.76
|
| Rate for Payer: Group Health Inc Commercial |
$3,768.27
|
| Rate for Payer: Group Health Inc Medicare |
$3,768.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,315.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,768.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,289.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,203.03
|
| Rate for Payer: Healthfirst QHP |
$3,768.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,768.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,768.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,014.62
|
| Rate for Payer: Wellcare Medicare |
$3,579.86
|
|
|
CC LEFT HRT CATH W/VENTRCLGRPHY
|
Facility
OP
|
$278.12
|
|
|
Service Code
|
HCPCS 93452
|
| Hospital Charge Code |
66528877
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$139.06 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,768.27
|
| Rate for Payer: Aetna Government |
$3,768.27
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,768.27
|
| 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 |
$3,768.27
|
| Rate for Payer: EmblemHealth Commercial |
$3,768.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,004.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,203.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,353.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,768.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,353.76
|
| Rate for Payer: Group Health Inc Commercial |
$3,768.27
|
| Rate for Payer: Group Health Inc Medicare |
$3,768.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,768.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,116.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,203.03
|
| Rate for Payer: Healthfirst QHP |
$3,768.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,768.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,768.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,014.62
|
| Rate for Payer: Wellcare Medicare |
$3,579.86
|
|
|
CC LEFT HRT CATH W/VENTRCLGRPHY
|
Facility
OP
|
$8,631.78
|
|
|
Service Code
|
HCPCS 93452 TC
|
| Hospital Charge Code |
66528887
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$745.79 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,747.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,315.89
|
| Rate for Payer: Aetna Government |
$4,315.89
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| 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 |
$745.79
|
| Rate for Payer: Group Health Inc Commercial |
$4,315.89
|
| Rate for Payer: Group Health Inc Medicare |
$3,021.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,315.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,315.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$828.66
|
|
|
CC L HRT ART/GRFT ANGIO
|
Facility
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 93459
|
| Hospital Charge Code |
66528879
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,248.87 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,768.27
|
| Rate for Payer: Aetna Government |
$3,768.27
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,768.27
|
| 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 |
$3,768.27
|
| Rate for Payer: EmblemHealth Commercial |
$3,768.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,248.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,203.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,353.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,768.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,353.76
|
| Rate for Payer: Group Health Inc Commercial |
$3,768.27
|
| Rate for Payer: Group Health Inc Medicare |
$3,768.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,768.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,387.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,203.03
|
| Rate for Payer: Healthfirst QHP |
$3,768.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,768.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,768.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,014.62
|
| Rate for Payer: Wellcare Medicare |
$3,579.86
|
|
|
CC L HRT CATH TRNSPTL PUNCTURE
|
Facility
OP
|
$4,463.00
|
|
|
Service Code
|
HCPCS 93462
|
| Hospital Charge Code |
66528900
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$195.09
|
| Rate for Payer: Aetna Government |
$195.09
|
| 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 |
$235.48
|
| Rate for Payer: Group Health Inc Commercial |
$2,231.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,562.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,231.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,231.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.65
|
|
|
CC LUNG/AIRWAY BIOPSY MANY SITES
|
Facility
OP
|
$4,535.55
|
|
|
Service Code
|
HCPCS 31625
|
| Hospital Charge Code |
66521560
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.70 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$162.70
|
| 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 |
$180.78
|
| 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 LUNG OR AIRWAY BIOPSY 1 LOBE
|
Facility
OP
|
$9,390.10
|
|
|
Service Code
|
HCPCS 31628
|
| Hospital Charge Code |
66521562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$4,695.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,330.61
|
| Rate for Payer: Aetna Government |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,330.61
|
| 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 |
$4,330.61
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,681.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,854.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,330.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,854.24
|
| Rate for Payer: Group Health Inc Commercial |
$4,330.61
|
| Rate for Payer: Group Health Inc Medicare |
$4,330.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,695.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,330.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,681.02
|
| Rate for Payer: Healthfirst QHP |
$4,330.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,330.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,330.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,464.49
|
| Rate for Payer: Wellcare Medicare |
$4,114.08
|
|
|
CC LV PACING LEAD ADD ON
|
Facility
OP
|
$1,317.18
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
66528652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$523.37
|
| Rate for Payer: Aetna Government |
$523.37
|
| 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 |
$527.42
|
| Rate for Payer: Group Health Inc Commercial |
$658.59
|
| Rate for Payer: Group Health Inc Medicare |
$461.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$658.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$658.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$586.02
|
|
|
CC MALLINCKROD .035 WHOLEY 260CM
|
Facility
OP
|
$195.60
|
|
| Hospital Charge Code |
66528260
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.46 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$97.80
|
| Rate for Payer: Aetna Government |
$97.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$156.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$133.01
|
| Rate for Payer: Group Health Inc Commercial |
$97.80
|
| Rate for Payer: Group Health Inc Medicare |
$68.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.80
|
|
|
CC MALLINCKRODT .035 WHOLEY 145CM
|
Facility
OP
|
$133.90
|
|
| Hospital Charge Code |
66528375
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.95
|
| Rate for Payer: Aetna Government |
$66.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$107.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.05
|
| Rate for Payer: Group Health Inc Commercial |
$66.95
|
| Rate for Payer: Group Health Inc Medicare |
$46.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.95
|
|
|
CC MED 9FR LEAD HL51009M/529603
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
66528882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
|
|
CC MED 9FR LEAD HL51009M/529603
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
66528882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$1,297.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,297.97
|
| Rate for Payer: Aetna Government |
$1,297.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.50
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.50
|
|
|
CC MED DES ENDEAVOR 2.5-8-30MM
|
Facility
IP
|
$3,450.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66528985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,725.00
|
|
|
CC MED DES ENDEAVOR 2.5-8-30MM
|
Facility
OP
|
$3,450.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66528985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$3,622.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,897.50
|
| 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 |
$1,725.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,983.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,622.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,725.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,207.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,725.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,242.50
|
|
|
CC MED DES ENDEAVR 2.5MM X 24MM
|
Facility
IP
|
$3,450.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66528987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,725.00
|
|
|
CC MED DES ENDEAVR 2.5MM X 24MM
|
Facility
OP
|
$3,450.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66528987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$3,622.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,897.50
|
| 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 |
$1,725.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,983.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,622.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,725.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,207.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,725.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,242.50
|
|
|
CC MED DES ENDEAVR 2.5MMX8MM
|
Facility
IP
|
$3,450.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,725.00
|
|
