|
CC PERC CARD REVASC CHRONIC ADD
|
Facility
OP
|
$6,110.44
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
66523410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$402.11 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.11
|
| Rate for Payer: Aetna Government |
$402.11
|
| 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 |
$3,055.22
|
| Rate for Payer: Group Health Inc Medicare |
$2,138.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,055.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,055.22
|
|
|
CC PERC CARD REVASC MI 1 VSL
|
Facility
OP
|
$30,948.00
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
66523408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$635.26 |
| Max. Negotiated Rate |
$17,021.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,021.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$635.26
|
| Rate for Payer: Aetna Government |
$635.26
|
| 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 |
$743.50
|
| Rate for Payer: Group Health Inc Commercial |
$15,474.00
|
| Rate for Payer: Group Health Inc Medicare |
$10,831.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,474.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,474.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$826.11
|
|
|
CC PERC CARD STENT/ANGIO 1 VSL
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
66523401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$663.64 |
| 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 |
$663.64
|
| 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 |
$737.38
|
| 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
|
|
|
CC PERC CARD STENT/ANGIO 1 VSL
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
30306669
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$663.64 |
| 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 |
$663.64
|
| 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 |
$737.38
|
| 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
|
|
|
CC PERC CARD STENT/ATH/ANG 1 VSL
|
Facility
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
66523406
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$743.52 |
| Max. Negotiated Rate |
$24,139.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| 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: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$20,278.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$743.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$826.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
CC PERC CARD STENT W/ANGIO ADDL
|
Facility
OP
|
$28,363.20
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
66523404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$384.04 |
| Max. Negotiated Rate |
$14,181.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$384.04
|
| Rate for Payer: Aetna Government |
$384.04
|
| 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 |
$14,181.60
|
| Rate for Payer: Group Health Inc Medicare |
$9,927.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14,181.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14,181.60
|
|
|
CC PERC CARD STNT/ATH/ANG ADD VSL
|
Facility
OP
|
$6,110.44
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
66523407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$324.86 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.86
|
| Rate for Payer: Aetna Government |
$324.86
|
| 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 |
$3,055.22
|
| Rate for Payer: Group Health Inc Medicare |
$2,138.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,055.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,055.22
|
|
|
CC PERC CORON THROMBECTOMY
|
Facility
OP
|
$31,452.50
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
66528907
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$17,298.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,298.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.49
|
| Rate for Payer: Aetna Government |
$165.49
|
| 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 |
$197.69
|
| Rate for Payer: Group Health Inc Commercial |
$15,726.25
|
| Rate for Payer: Group Health Inc Medicare |
$11,008.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,726.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,726.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$219.66
|
|
|
CC PERC D-E COR REVASC T CABG B
|
Facility
OP
|
$28,363.20
|
|
|
Service Code
|
HCPCS C9605
|
| Hospital Charge Code |
66526859
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$22,690.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14,181.60
|
| Rate for Payer: Aetna Government |
$14,181.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,690.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,286.98
|
| Rate for Payer: Group Health Inc Commercial |
$14,181.60
|
| Rate for Payer: Group Health Inc Medicare |
$9,927.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14,181.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14,181.60
|
|
|
CC PERC D-E COR REVASC T CABG S
|
Facility
OP
|
$15,526.36
|
|
|
Service Code
|
HCPCS C9604
|
| Hospital Charge Code |
66526858
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$7,763.18 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Brighton Health Commercial |
$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 |
$12,421.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,557.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$8,905.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10,813.68
|
| 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 |
$11,449.78
|
| Rate for Payer: Group Health Inc Medicare |
$11,449.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,763.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| 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
|
|
|
CC PERC D-E COR REVASC W AMI S
|
Facility
OP
|
$47,391.00
|
|
|
Service Code
|
HCPCS C9606
|
| Hospital Charge Code |
66526860
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$688.00 |
| Max. Negotiated Rate |
$37,912.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,065.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$688.00
|
| Rate for Payer: Aetna Government |
$688.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37,912.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,225.88
|
| Rate for Payer: Group Health Inc Commercial |
$23,695.50
|
| Rate for Payer: Group Health Inc Medicare |
$16,586.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,695.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,695.50
|
|
|
CC PERC DRUG-EL COR STENT BRAN
|
Facility
OP
|
$15,526.36
|
|
|
Service Code
|
HCPCS C9601
|
| Hospital Charge Code |
66526857
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$12,421.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,403.31
|
| Rate for Payer: Aetna Government |
$1,403.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,421.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,557.92
|
| Rate for Payer: Group Health Inc Commercial |
$7,763.18
|
| Rate for Payer: Group Health Inc Medicare |
$5,434.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,763.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,763.18
|
|
|
CC PERC DRUG-EL COR STENT SING
|
Facility
OP
|
$30,948.00
|
|
|
Service Code
|
HCPCS C9600
|
| Hospital Charge Code |
66526856
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$8,905.39 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Brighton Health Commercial |
$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 |
$24,758.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,044.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$8,905.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10,813.68
|
| 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 |
$11,449.78
|
| Rate for Payer: Group Health Inc Medicare |
$11,449.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,474.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| 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
|
|
|
CC PERC INTRA AORTIC BALLOON PUMP
|
Facility
OP
|
$3,604.03
|
|
|
Service Code
|
HCPCS 33967
|
| Hospital Charge Code |
66528398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$290.71 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,982.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$290.96
|
| Rate for Payer: Aetna Government |
$290.96
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| 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 |
$290.71
|
| Rate for Payer: Group Health Inc Commercial |
$1,802.02
|
| Rate for Payer: Group Health Inc Medicare |
$1,261.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,802.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,802.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$323.01
|
|
|
CC PERC REVASC BYPASS GRFT 1 VSL
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
66523402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$662.96 |
| 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 |
$662.96
|
| 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 |
$736.62
|
| 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
|
|
|
CC PERC REVASC BYPSS GRFT ADD VSL
|
Facility
OP
|
$6,110.44
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
66523403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$255.83 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$255.83
|
| Rate for Payer: Aetna Government |
$255.83
|
| 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 |
$3,055.22
|
| Rate for Payer: Group Health Inc Medicare |
$2,138.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,055.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,055.22
|
|
|
CC PERICARDIOCENTESIS W/IMAGING
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 33016 TC
|
| Hospital Charge Code |
66576536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,729.10 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,470.14
|
| Rate for Payer: Aetna Government |
$2,470.14
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| 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: Group Health Inc Commercial |
$2,470.14
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.14
|
|
|
CC PERIC DRG 0-5YR OR W/ANOMLY
|
Facility
OP
|
$819.96
|
|
|
Service Code
|
HCPCS 33018 TC
|
| Hospital Charge Code |
66576538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$286.99 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$450.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$409.98
|
| Rate for Payer: Aetna Government |
$409.98
|
| 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: Group Health Inc Commercial |
$409.98
|
| Rate for Payer: Group Health Inc Medicare |
$286.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$409.98
|
|
|
CC PERIC DRG 6YR+ W/O CGENITA CAR
|
Facility
OP
|
$745.42
|
|
|
Service Code
|
HCPCS 33017 TC
|
| Hospital Charge Code |
66576537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$260.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$409.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$372.71
|
| Rate for Payer: Aetna Government |
$372.71
|
| 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: Group Health Inc Commercial |
$372.71
|
| Rate for Payer: Group Health Inc Medicare |
$260.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$372.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$372.71
|
|
|
CC PERIC DRG INSJ CATH CT
|
Facility
OP
|
$901.95
|
|
|
Service Code
|
HCPCS 33019 TC
|
| Hospital Charge Code |
66576539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.68 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$496.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$450.98
|
| Rate for Payer: Aetna Government |
$450.98
|
| 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: Group Health Inc Commercial |
$450.98
|
| Rate for Payer: Group Health Inc Medicare |
$315.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.98
|
|
|
CC PERIVAC PERICARDIOCENTESIS W/8
|
Facility
OP
|
$262.09
|
|
| Hospital Charge Code |
66528281
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$209.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$131.04
|
| Rate for Payer: Aetna Government |
$131.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$209.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.22
|
| Rate for Payer: Group Health Inc Commercial |
$131.04
|
| Rate for Payer: Group Health Inc Medicare |
$91.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.04
|
|
|
CCP IGG
|
Facility
OP
|
$32.38
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
40728450
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
CCP IGG
|
Facility
OP
|
$32.38
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
30303356
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
CC PLACEMENT OF OCCLUSIVE DEVICE
|
Facility
OP
|
$682.27
|
|
|
Service Code
|
HCPCS G0269
|
| Hospital Charge Code |
66528390
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$375.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.12
|
| Rate for Payer: Aetna Government |
$14.12
|
| 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 |
$341.14
|
| Rate for Payer: Group Health Inc Medicare |
$238.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.14
|
|
|
CC PPM LEAD ST JUDE AV PLUS DX 58
|
Facility
OP
|
$1,200.00
|
|
| Hospital Charge Code |
66525391
|
|
Hospital Revenue Code
|
279
|
| 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
|
|
