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
|
|
ABBOTT STENT 3.00MM X 12MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523375
|
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 3.00MM X 12MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523375
|
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 3.00MM X 15MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523376
|
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 3.00MM X 15MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523376
|
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 3.00MM X 18MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523377
|
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 3.00MM X 18MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523377
|
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 3.00MM X 23MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523378
|
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 3.00MM X 23MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523378
|
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 3.00MM X 28MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523379
|
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 3.00MM X 28MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523379
|
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 3.00MM X 33MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523380
|
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 3.00MM X 33MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523380
|
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 3.00MM X 38MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523381
|
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 3.00MM X 38MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523381
|
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 3.25MM X 08MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523382
|
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 3.25MM X 08MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523382
|
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 3.25MM X 12MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523383
|
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 3.25MM X 12MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523383
|
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 3.25MM X 15MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523384
|
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 3.25MM X 15MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523384
|
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 3.25MM X 18MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523385
|
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 3.25MM X 18MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523385
|
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 3.25MM X 23MM
|
Facility
OP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523386
|
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 3.25MM X 23MM
|
Facility
IP
|
$2,200.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66523386
|
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
|
|