|
CC AB MINI VISION 2.25MMX15MM
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
66528915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.00
|
|
|
CC AB VISION ML RX3.0MMX18MM
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
66528929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.00
|
|
|
CC AB VISION ML RX3.0MMX18MM
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
66528929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,072.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$398.18
|
| Rate for Payer: Aetna Government |
$398.18
|
| Rate for Payer: Brighton Health Commercial |
$1,170.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$975.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,121.25
|
| Rate for Payer: EmblemHealth Commercial |
$975.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,047.50
|
| Rate for Payer: Group Health Inc Commercial |
$975.00
|
| Rate for Payer: Group Health Inc Medicare |
$682.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,267.50
|
|
|
CC AB VISION ML RX4.0MMX15MM
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
66528939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,072.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$398.18
|
| Rate for Payer: Aetna Government |
$398.18
|
| Rate for Payer: Brighton Health Commercial |
$1,170.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$975.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,121.25
|
| Rate for Payer: EmblemHealth Commercial |
$975.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,047.50
|
| Rate for Payer: Group Health Inc Commercial |
$975.00
|
| Rate for Payer: Group Health Inc Medicare |
$682.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,267.50
|
|
|
CC AB VISION ML RX4.0MMX15MM
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
66528939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.00
|
|
|
CC AB V ML RX 4.0MMX12MM
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
66528940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.00
|
|
|
CC AB V ML RX 4.0MMX12MM
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
66528940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,072.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$398.18
|
| Rate for Payer: Aetna Government |
$398.18
|
| Rate for Payer: Brighton Health Commercial |
$1,170.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$975.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,121.25
|
| Rate for Payer: EmblemHealth Commercial |
$975.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,047.50
|
| Rate for Payer: Group Health Inc Commercial |
$975.00
|
| Rate for Payer: Group Health Inc Medicare |
$682.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,267.50
|
|
|
CC ACCESS 6177 10BX SHERILE RF HE
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
66526890
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.00
|
| Rate for Payer: Aetna Government |
$135.00
|
| Rate for Payer: Brighton Health Commercial |
$202.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$216.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$183.60
|
| Rate for Payer: Group Health Inc Commercial |
$135.00
|
| Rate for Payer: Group Health Inc Medicare |
$94.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
|
|
CC ACCESS KIT 5F VAS/SOL
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
66520236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$6,937.00 |
| 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: 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 |
$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 ACID ICD PREP KIT
|
Facility
|
OP
|
$140.78
|
|
| Hospital Charge Code |
66520270
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.39
|
| Rate for Payer: Aetna Government |
$70.39
|
| Rate for Payer: Brighton Health Commercial |
$105.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.73
|
| Rate for Payer: Group Health Inc Commercial |
$70.39
|
| Rate for Payer: Group Health Inc Medicare |
$49.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.39
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
CC ACID PACK
|
Facility
|
OP
|
$113.50
|
|
| Hospital Charge Code |
66520254
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.72 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.75
|
| Rate for Payer: Aetna Government |
$56.75
|
| Rate for Payer: Brighton Health Commercial |
$85.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.18
|
| Rate for Payer: Group Health Inc Commercial |
$56.75
|
| Rate for Payer: Group Health Inc Medicare |
$39.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.75
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
CC ACTIVATED CLOTTING TIME
|
Facility
|
OP
|
$10.70
|
|
|
Service Code
|
HCPCS 85347
|
| Hospital Charge Code |
66521925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.28
|
| Rate for Payer: Aetna Government |
$4.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$8.02
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.28
|
| Rate for Payer: EmblemHealth Commercial |
$4.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.81
|
| Rate for Payer: Group Health Inc Commercial |
$4.28
|
| Rate for Payer: Group Health Inc Medicare |
$4.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.28
|
| Rate for Payer: Healthfirst QHP |
$4.28
|
| Rate for Payer: Humana Medicare |
$4.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.28
|
| Rate for Payer: United Healthcare Commercial |
$5.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.42
|
| Rate for Payer: Wellcare Medicare |
$3.85
|
|
|
CC ACTIVATED CLOTTING TIME
|
Facility
|
IP
|
$10.70
|
|
|
Service Code
|
HCPCS 85347
|
| Hospital Charge Code |
66521925
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$4.28
|
|
|
CC ADVANTIO DR IS-1
|
Facility
|
OP
|
$11,100.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
66526899
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$11,655.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,105.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
| Rate for Payer: Aetna Government |
$275.42
|
| Rate for Payer: Brighton Health Commercial |
$6,660.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,550.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,382.50
|
| Rate for Payer: EmblemHealth Commercial |
$5,550.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,655.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,550.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,885.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,550.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,550.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,215.00
|
|
|
CC ADVANTIO SR IS-1
|
Facility
|
OP
|
$10,100.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
66526898
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,116.69 |
| Max. Negotiated Rate |
$10,605.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,555.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,116.69
|
| Rate for Payer: Aetna Government |
$1,116.69
|
| Rate for Payer: Brighton Health Commercial |
$6,060.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,050.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,807.50
|
| Rate for Payer: EmblemHealth Commercial |
$5,050.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,605.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,050.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,535.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,050.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,050.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,565.00
|
|
|
CC AL 11 7F MED LAUNCHER
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66528998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna Government |
$3.21
|
| Rate for Payer: Brighton Health Commercial |
$61.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: EmblemHealth Commercial |
$51.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.10
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
CC AL 11 7F MED LAUNCHER
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66528998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
CC AL I (100CM)5F
|
Facility
|
OP
|
$44.80
|
|
| Hospital Charge Code |
66528783
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.40
|
| Rate for Payer: Aetna Government |
$22.40
|
| Rate for Payer: Brighton Health Commercial |
$33.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.46
|
| Rate for Payer: Group Health Inc Commercial |
$22.40
|
| Rate for Payer: Group Health Inc Medicare |
$15.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
CC ALTRUA 60 DDDR IS-1 (EL)
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
66526871
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$5,775.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,025.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
| Rate for Payer: Aetna Government |
$275.42
|
| Rate for Payer: Brighton Health Commercial |
$3,300.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,750.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,162.50
|
| Rate for Payer: EmblemHealth Commercial |
$2,750.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,775.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,750.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,925.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,750.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,575.00
|
|
|
CC AMPLATZ SUPER STIFF .035X180CM
|
Facility
|
OP
|
$83.07
|
|
| Hospital Charge Code |
66528317
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.54
|
| Rate for Payer: Aetna Government |
$41.54
|
| Rate for Payer: Brighton Health Commercial |
$62.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.49
|
| Rate for Payer: Group Health Inc Commercial |
$41.54
|
| Rate for Payer: Group Health Inc Medicare |
$29.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.54
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
CC AMPLATZ SUPERSTIFF 0.38/180CM
|
Facility
|
OP
|
$59.38
|
|
| Hospital Charge Code |
66528407
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.78 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.69
|
| Rate for Payer: Aetna Government |
$29.69
|
| Rate for Payer: Brighton Health Commercial |
$44.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.38
|
| Rate for Payer: Group Health Inc Commercial |
$29.69
|
| Rate for Payer: Group Health Inc Medicare |
$20.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.69
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
CC AMP. SUPERSTIFF .035/260CM JTP
|
Facility
|
OP
|
$83.07
|
|
| Hospital Charge Code |
66528318
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.54
|
| Rate for Payer: Aetna Government |
$41.54
|
| Rate for Payer: Brighton Health Commercial |
$62.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.49
|
| Rate for Payer: Group Health Inc Commercial |
$41.54
|
| Rate for Payer: Group Health Inc Medicare |
$29.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.54
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
CC ANGIOGRAPHIC CONTROL SYRINGE
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
66528404
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
|
|
CC ANGIO KIT LEFT HEART KIT BOSTO
|
Facility
|
OP
|
$59.04
|
|
| Hospital Charge Code |
66528410
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.66 |
| Max. Negotiated Rate |
$47.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.52
|
| Rate for Payer: Aetna Government |
$29.52
|
| Rate for Payer: Brighton Health Commercial |
$44.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.15
|
| Rate for Payer: Group Health Inc Commercial |
$29.52
|
| Rate for Payer: Group Health Inc Medicare |
$20.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.52
|
|
|
CC ANGIO-SEAL STS PLUS 6F ST. JUD
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
66528403
|
|
Hospital Revenue Code
|
270
|
| 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: Brighton Health Commercial |
$367.50
|
| 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
|
|
