ABBOTT STENT 2.50MM X 33MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523364
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ABBOTT STENT 2.50MM X 33MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523364
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
ABBOTT STENT 2.50MM X 38MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523365
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ABBOTT STENT 2.50MM X 38MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523365
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
ABBOTT STENT 2.75MM X 08MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523366
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
ABBOTT STENT 2.75MM X 08MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523366
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ABBOTT STENT 2.75MM X 12MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523367
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ABBOTT STENT 2.75MM X 12MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523367
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
ABBOTT STENT 2.75MM X 15MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523368
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ABBOTT STENT 2.75MM X 15MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523368
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
ABBOTT STENT 2.75MM X 18MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523369
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
ABBOTT STENT 2.75MM X 18MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523369
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ABBOTT STENT 2.75MM X 23MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523370
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
ABBOTT STENT 2.75MM X 23MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523370
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ABBOTT STENT 2.75MM X 28MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523371
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ABBOTT STENT 2.75MM X 28MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523371
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
ABBOTT STENT 2.75MM X 33MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523372
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
ABBOTT STENT 2.75MM X 33MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523372
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ABBOTT STENT 2.75MM X 38MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523373
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
ABBOTT STENT 2.75MM X 38MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523373
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,310.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
Rate for Payer: Group Health Inc Medicare |
$770.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
ABBOTT STENT 2.8MM X 19MM
|
Facility
OP
|
$4,790.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523431
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$5,029.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,634.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,395.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,754.25
|
Rate for Payer: Fidelis Medicare Advantage |
$5,029.50
|
Rate for Payer: Group Health Inc Commercial |
$2,395.00
|
Rate for Payer: Group Health Inc Medicare |
$1,676.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,395.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,395.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,113.50
|
|
ABBOTT STENT 2.8MM X 19MM
|
Facility
IP
|
$4,790.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523431
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,395.00 |
Max. Negotiated Rate |
$2,395.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,395.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,395.00
|
|
ABBOTT STENT 2.8MM X 26MM
|
Facility
OP
|
$4,790.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523432
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$5,029.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,634.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,395.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,754.25
|
Rate for Payer: Fidelis Medicare Advantage |
$5,029.50
|
Rate for Payer: Group Health Inc Commercial |
$2,395.00
|
Rate for Payer: Group Health Inc Medicare |
$1,676.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,395.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,395.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,113.50
|
|
ABBOTT STENT 2.8MM X 26MM
|
Facility
IP
|
$4,790.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523432
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,395.00 |
Max. Negotiated Rate |
$2,395.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,395.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,395.00
|
|
ABBOTT STENT 3.00MM X 08MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523374
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,100.00 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|