|
CC MEDTRONIC STEERABLE .014
|
Facility
OP
|
$710.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66522013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$745.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$390.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$355.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$745.50
|
| Rate for Payer: Group Health Inc Commercial |
$355.00
|
| Rate for Payer: Group Health Inc Medicare |
$248.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.50
|
|
|
CC MEDTRONIC V LEAD 6947-65CM
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528991
|
|
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 MEDTRONIC V LEAD 6947-65CM
|
Facility
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| 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 |
$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 MEDTRON PROFLO 6FR NTR 100CM
|
Facility
OP
|
$43.50
|
|
| Hospital Charge Code |
66528424
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$34.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.75
|
| Rate for Payer: Aetna Government |
$21.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.58
|
| Rate for Payer: Group Health Inc Commercial |
$21.75
|
| Rate for Payer: Group Health Inc Medicare |
$15.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.75
|
|
|
CC MEDTRON PROFLO XT 6FR NTR 100C
|
Facility
OP
|
$43.50
|
|
| Hospital Charge Code |
66528425
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$34.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.75
|
| Rate for Payer: Aetna Government |
$21.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.58
|
| Rate for Payer: Group Health Inc Commercial |
$21.75
|
| Rate for Payer: Group Health Inc Medicare |
$15.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.75
|
|
|
CC MEDTRON SITESEER 5FR NTR 100CM
|
Facility
OP
|
$43.50
|
|
| Hospital Charge Code |
66528426
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$34.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.75
|
| Rate for Payer: Aetna Government |
$21.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.58
|
| Rate for Payer: Group Health Inc Commercial |
$21.75
|
| Rate for Payer: Group Health Inc Medicare |
$15.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.75
|
|
|
CC MERIT ANGIOPLASTY PACK
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
66520309
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
|
|
CC MERIT THREE WAY- STOPCOCK
|
Facility
OP
|
$3.30
|
|
| Hospital Charge Code |
66520310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.65
|
| Rate for Payer: Aetna Government |
$1.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.24
|
| Rate for Payer: Group Health Inc Commercial |
$1.65
|
| Rate for Payer: Group Health Inc Medicare |
$1.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.65
|
|
|
CC MICROVOLT T-WAVE ASSESS
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93025 26
|
| Hospital Charge Code |
66528666
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.52
|
| Rate for Payer: Aetna Government |
$209.52
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.02
|
| Rate for Payer: Group Health Inc Commercial |
$209.52
|
| Rate for Payer: Group Health Inc Medicare |
$146.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.13
|
|
|
CC MP A-1 (100CM) 5F
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
66528792
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
|
CC MULTI PT DISPOSABLE SET
|
Facility
OP
|
$74.80
|
|
| Hospital Charge Code |
66520251
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$59.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.40
|
| Rate for Payer: Aetna Government |
$37.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.86
|
| Rate for Payer: Group Health Inc Commercial |
$37.40
|
| Rate for Payer: Group Health Inc Medicare |
$26.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.40
|
|
|
CC NONSELECT CATH RT HEART/MAIN P
|
Facility
OP
|
$2,450.50
|
|
|
Service Code
|
HCPCS 36013
|
| Hospital Charge Code |
66528656
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.28 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.79
|
| Rate for Payer: Aetna Government |
$135.79
|
| 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 |
$134.28
|
| Rate for Payer: Group Health Inc Commercial |
$1,225.25
|
| Rate for Payer: Group Health Inc Medicare |
$857.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,225.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,225.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.20
|
|
|
CC NS CATH - EXTREMITY ARTERY
|
Facility
OP
|
$1,475.15
|
|
|
Service Code
|
HCPCS 36140
|
| Hospital Charge Code |
66528671
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.72
|
| Rate for Payer: Aetna Government |
$114.72
|
| 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 |
$99.42
|
| Rate for Payer: Group Health Inc Commercial |
$737.58
|
| Rate for Payer: Group Health Inc Medicare |
$516.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$737.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$737.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.47
|
|
|
CC OMNIPAQUE 250ML
|
Facility
OP
|
$1.96
|
|
| Hospital Charge Code |
66526102
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.98
|
| Rate for Payer: Aetna Government |
$0.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.98
|
| Rate for Payer: Group Health Inc Medicare |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.27
|
|
|
CC OMNIPAQUE 350MG/ML 100ML
|
Facility
IP
|
$1.96
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
66526104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
|
|
CC OMNIPAQUE 350MG/ML 100ML
|
Facility
OP
|
$1.96
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
66526104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.98
|
| Rate for Payer: Group Health Inc Medicare |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.15
|
| Rate for Payer: SOMOS Essential |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.27
|
|
|
CC OMNIPAQUE 350MG/ML 50ML
|
Facility
OP
|
$1.96
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
66526103
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.98
|
| Rate for Payer: Group Health Inc Medicare |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.27
|
|
|
CC OXYHEMOGLOBIN (Q2HB) MEASURED
|
Facility
OP
|
$24.43
|
|
|
Service Code
|
HCPCS 82810
|
| Hospital Charge Code |
66526896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.77
|
| Rate for Payer: Aetna Government |
$9.77
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.77
|
| Rate for Payer: EmblemHealth Commercial |
$9.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.70
|
| Rate for Payer: Group Health Inc Commercial |
$9.77
|
| Rate for Payer: Group Health Inc Medicare |
$9.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.77
|
| Rate for Payer: Healthfirst QHP |
$9.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.82
|
| Rate for Payer: Wellcare Medicare |
$8.79
|
|
|
CC PACEMAKER CATHETER
|
Facility
OP
|
$226.00
|
|
| Hospital Charge Code |
66529922
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$180.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.00
|
| Rate for Payer: Aetna Government |
$113.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$180.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$153.68
|
| Rate for Payer: Group Health Inc Commercial |
$113.00
|
| Rate for Payer: Group Health Inc Medicare |
$79.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.00
|
|
|
CC PACER POCKET REVISION
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 33222
|
| Hospital Charge Code |
66528639
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$389.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$432.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
CCP ANTIBODIES IGG/IGA
|
Facility
OP
|
$32.38
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
40729328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.95
|
| Rate for Payer: Aetna Government |
$12.95
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.95
|
| Rate for Payer: EmblemHealth Commercial |
$12.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.53
|
| Rate for Payer: Group Health Inc Commercial |
$12.95
|
| Rate for Payer: Group Health Inc Medicare |
$12.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.95
|
| Rate for Payer: Healthfirst QHP |
$12.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.36
|
| Rate for Payer: Wellcare Medicare |
$11.66
|
|
|
CCPD/COMPOSITE
|
Facility
OP
|
$383.08
|
|
| Hospital Charge Code |
42901851
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$134.08 |
| Max. Negotiated Rate |
$306.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.54
|
| Rate for Payer: Aetna Government |
$191.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.49
|
| Rate for Payer: Group Health Inc Commercial |
$191.54
|
| Rate for Payer: Group Health Inc Medicare |
$134.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.54
|
|
|
CC PERC CARD ANGIO/ATHREC ADDL AR
|
Facility
OP
|
$7,671.18
|
|
|
Service Code
|
HCPCS 92925
|
| Hospital Charge Code |
66523405
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,219.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.00
|
| Rate for Payer: Aetna Government |
$300.00
|
| 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: Group Health Inc Commercial |
$3,835.59
|
| Rate for Payer: Group Health Inc Medicare |
$2,684.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,835.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,835.59
|
|
|
CC PERC CARD ANGIOPLASTY ADDL ART
|
Facility
OP
|
$4,023.05
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
66523400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$329.07 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$329.07
|
| Rate for Payer: Aetna Government |
$329.07
|
| 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: Group Health Inc Commercial |
$2,011.52
|
| Rate for Payer: Group Health Inc Medicare |
$1,408.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,011.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,011.52
|
|
|
CC PERC CARD REVASC CHRONIC 1 VSL
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
66523409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$745.24 |
| Max. Negotiated Rate |
$16,751.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,721.98
|
| 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 |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$12,721.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$745.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,813.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,322.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,322.56
|
| Rate for Payer: Group Health Inc Commercial |
$12,721.98
|
| Rate for Payer: Group Health Inc Medicare |
$12,721.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$828.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,813.68
|
| Rate for Payer: Healthfirst QHP |
$12,721.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,721.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10,177.58
|
| Rate for Payer: Wellcare Medicare |
$12,085.88
|
|
