|
CC PREP KIT
|
Facility
OP
|
$19.40
|
|
| Hospital Charge Code |
66520252
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.70
|
| Rate for Payer: Aetna Government |
$9.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.19
|
| Rate for Payer: Group Health Inc Commercial |
$9.70
|
| Rate for Payer: Group Health Inc Medicare |
$6.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.70
|
|
|
CC PRO-PADZ RADIOLUCENT
|
Facility
OP
|
$90.33
|
|
| Hospital Charge Code |
66526866
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$72.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.16
|
| Rate for Payer: Aetna Government |
$45.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.42
|
| Rate for Payer: Group Health Inc Commercial |
$45.16
|
| Rate for Payer: Group Health Inc Medicare |
$31.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.16
|
|
|
CC PSA DISP CABLE S-101-97
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
66526879
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.00
|
| Rate for Payer: Aetna Government |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
| Rate for Payer: Group Health Inc Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Medicare |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
|
|
CC PSA DISPOSABLE CABLE
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
66526875
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.00
|
| Rate for Payer: Aetna Government |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
| Rate for Payer: Group Health Inc Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Medicare |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
|
|
CC PTCA INITIAL VESSEL
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
66522555
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$594.15 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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 |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$594.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$660.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
CC PULMONARY NONSELECTIVE ANGIO
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75746 26
|
| Hospital Charge Code |
66528676
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.28 |
| Max. Negotiated Rate |
$3,952.22 |
| 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 |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,952.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,359.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.28
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.42
|
|
|
CC RAD ACCESS KIT 5F TERUMO 100CM
|
Facility
OP
|
$792.50
|
|
| Hospital Charge Code |
66520300
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$277.38 |
| Max. Negotiated Rate |
$634.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$435.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$396.25
|
| Rate for Payer: Aetna Government |
$396.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$634.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$538.90
|
| Rate for Payer: Group Health Inc Commercial |
$396.25
|
| Rate for Payer: Group Health Inc Medicare |
$277.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.25
|
|
|
CC RAD ACCESS KIT 5F TERUMO160CM
|
Facility
OP
|
$490.00
|
|
| Hospital Charge Code |
66520246
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$269.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$245.00
|
| Rate for Payer: Aetna Government |
$245.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$392.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$333.20
|
| Rate for Payer: Group Health Inc Commercial |
$245.00
|
| Rate for Payer: Group Health Inc Medicare |
$171.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.00
|
|
|
CC RAD BOARD-REVRS RAD ARM BOARD
|
Facility
OP
|
$399.00
|
|
| Hospital Charge Code |
66526861
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$199.50
|
| Rate for Payer: Aetna Government |
$199.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$319.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.32
|
| Rate for Payer: Group Health Inc Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Medicare |
$139.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.50
|
|
|
CC RAD CATH 5F JACKY RADIALTERUMO
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$46.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| 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 |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.20
|
| Rate for Payer: Group Health Inc Commercial |
$22.00
|
| Rate for Payer: Group Health Inc Medicare |
$15.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.60
|
|
|
CC RAD CATH 5F JACKY RADIALTERUMO
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.00
|
|
|
CC RAD CATH 6F SARAH RADIALTERUMO
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.00
|
|
|
CC RAD CATH 6F SARAH RADIALTERUMO
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$46.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| 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 |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.20
|
| Rate for Payer: Group Health Inc Commercial |
$22.00
|
| Rate for Payer: Group Health Inc Medicare |
$15.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.60
|
|
|
CC RAD-REST DISP ADJ UPR EXT SUPP
|
Facility
OP
|
$59.00
|
|
| Hospital Charge Code |
66526862
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.50
|
| Rate for Payer: Aetna Government |
$29.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.12
|
| Rate for Payer: Group Health Inc Commercial |
$29.50
|
| Rate for Payer: Group Health Inc Medicare |
$20.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.50
|
|
|
CC RA FIX DUAL COILIS-1/DF-1 64CM
|
Facility
OP
|
$10,120.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
66528870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.11 |
| Max. Negotiated Rate |
$10,626.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,566.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,139.11
|
| Rate for Payer: Aetna Government |
$3,139.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,060.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,819.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,626.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,060.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,542.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,060.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,060.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,578.00
|
|
|
CC RA FIX DUAL COILIS-1/DF-1 64CM
|
Facility
IP
|
$10,120.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
66528870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,060.00 |
| Max. Negotiated Rate |
$5,060.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,060.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,060.00
|
|
|
CC RELIANCE COIL
|
Facility
IP
|
$5,060.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
66520059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,530.00 |
| Max. Negotiated Rate |
$2,530.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,530.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,530.00
|
|
|
CC RELIANCE COIL
|
Facility
OP
|
$5,060.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
66520059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.97 |
| Max. Negotiated Rate |
$5,313.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,783.00
|
| 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 |
$2,530.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,909.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,313.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,530.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,771.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,530.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,530.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,289.00
|
|
|
CC RELIANCE COIL IS-1/DF 1-64CM
|
Facility
OP
|
$5,060.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
66526883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.97 |
| Max. Negotiated Rate |
$5,313.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,783.00
|
| 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 |
$2,530.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,909.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,313.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,530.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,771.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,530.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,530.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,289.00
|
|
|
CC RELIANCE COIL IS-1/DF 1-64CM
|
Facility
IP
|
$5,060.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
66526883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,530.00 |
| Max. Negotiated Rate |
$2,530.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,530.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,530.00
|
|
|
CC RELIANCE DUAL IS-1/DF-1-59 CM
|
Facility
OP
|
$5,060.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
66526877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.97 |
| Max. Negotiated Rate |
$5,313.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,783.00
|
| 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 |
$2,530.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,909.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,313.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,530.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,771.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,530.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,530.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,289.00
|
|
|
CC RELIANCE DUAL IS-1/DF-1-59 CM
|
Facility
IP
|
$5,060.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
66526877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,530.00 |
| Max. Negotiated Rate |
$2,530.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,530.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,530.00
|
|
|
CC RELIANCE FIX COIL IS-1/DF-1 64
|
Facility
OP
|
$5,060.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
66526881
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$988.18 |
| Max. Negotiated Rate |
$5,313.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,783.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$988.18
|
| Rate for Payer: Aetna Government |
$988.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,530.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,909.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,313.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,530.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,771.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,530.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,530.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,289.00
|
|
|
CC REMOVE 1-PACER LEAD ONLY
|
Facility
OP
|
$9,037.83
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
66528641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$549.69 |
| Max. Negotiated Rate |
$4,541.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,541.28
|
| Rate for Payer: Aetna Government |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,541.28
|
| 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 |
$4,541.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$549.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,860.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,041.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,541.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,041.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,541.28
|
| Rate for Payer: Group Health Inc Medicare |
$4,541.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,518.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,541.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,860.09
|
| Rate for Payer: Healthfirst QHP |
$4,541.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,541.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,541.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,633.02
|
| Rate for Payer: Wellcare Medicare |
$4,314.22
|
|
|
CC REMOVE 2-PACER LEAD ONLY
|
Facility
OP
|
$9,037.83
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
66528642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$724.52 |
| Max. Negotiated Rate |
$4,541.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,541.28
|
| Rate for Payer: Aetna Government |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,541.28
|
| 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 |
$4,541.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$724.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,860.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,041.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,541.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,041.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,541.28
|
| Rate for Payer: Group Health Inc Medicare |
$4,541.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,518.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,541.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$805.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,860.09
|
| Rate for Payer: Healthfirst QHP |
$4,541.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,541.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,541.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,633.02
|
| Rate for Payer: Wellcare Medicare |
$4,314.22
|
|
