|
CC ICD VIRTUOSO 11 VR D274VRC
|
Facility
|
IP
|
$43,500.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
66528883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,750.00 |
| Max. Negotiated Rate |
$21,750.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,750.00
|
|
|
CC ICD VIRTUOSO 11 VR D274VRC
|
Facility
|
OP
|
$43,500.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
66528883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,962.88 |
| Max. Negotiated Rate |
$45,675.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,925.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,962.88
|
| Rate for Payer: Aetna Government |
$5,962.88
|
| Rate for Payer: Brighton Health Commercial |
$26,100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,750.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,012.50
|
| Rate for Payer: EmblemHealth Commercial |
$21,750.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$45,675.00
|
| Rate for Payer: Group Health Inc Commercial |
$21,750.00
|
| Rate for Payer: Group Health Inc Medicare |
$15,225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,750.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,275.00
|
|
|
CC INJECT CONGENITAL CARD CATH
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 93563
|
| Hospital Charge Code |
66528863
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$53.93 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.93
|
| Rate for Payer: Aetna Government |
$53.93
|
| 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 |
$85.00
|
| Rate for Payer: Group Health Inc Medicare |
$59.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
CC INJECT CONGENITAL CARD CATH
|
Facility
|
OP
|
$158.10
|
|
|
Service Code
|
HCPCS 93563
|
| Hospital Charge Code |
66528885
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$53.93 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.93
|
| Rate for Payer: Aetna Government |
$53.93
|
| 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 |
$79.05
|
| Rate for Payer: Group Health Inc Medicare |
$55.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.05
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
CC INJECT HRT CONGNTL ART/GRFT
|
Facility
|
OP
|
$161.25
|
|
|
Service Code
|
HCPCS 93564
|
| Hospital Charge Code |
66528866
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.22
|
| Rate for Payer: Aetna Government |
$57.22
|
| 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 |
$80.62
|
| Rate for Payer: Group Health Inc Medicare |
$56.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.62
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
CC INJECTION FOR HEART XRAY LEFT
|
Facility
|
OP
|
$249.43
|
|
|
Service Code
|
HCPCS 93565
|
| Hospital Charge Code |
66528221
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.31
|
| Rate for Payer: Aetna Government |
$42.31
|
| 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 |
$124.72
|
| Rate for Payer: Group Health Inc Medicare |
$87.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
CC INJECT L VENTR/ATRIAL ANGIO
|
Facility
|
OP
|
$249.43
|
|
|
Service Code
|
HCPCS 93565
|
| Hospital Charge Code |
66528890
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.31
|
| Rate for Payer: Aetna Government |
$42.31
|
| 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 |
$124.72
|
| Rate for Payer: Group Health Inc Medicare |
$87.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
CC INJECT PULM ART HRT CATH
|
Facility
|
OP
|
$471.85
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
66528886
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.85
|
| Rate for Payer: Aetna Government |
$43.85
|
| 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 |
$235.92
|
| Rate for Payer: Group Health Inc Medicare |
$165.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.92
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
CC INJECT PULM ART HRT CATH
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
66528876
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.85
|
| Rate for Payer: Aetna Government |
$43.85
|
| 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 |
$255.00
|
| Rate for Payer: Group Health Inc Medicare |
$178.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.00
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
CC INJECT R VENTR/ATRIAL ANGIO
|
Facility
|
OP
|
$524.33
|
|
|
Service Code
|
HCPCS 93566
|
| Hospital Charge Code |
66528891
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$154.83 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$154.83
|
| Rate for Payer: Aetna Government |
$154.83
|
| 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 |
$262.16
|
| Rate for Payer: Group Health Inc Medicare |
$183.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.16
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
CC INJECT SUPRVLV AORTOGRAPHY
|
Facility
|
OP
|
$427.75
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
66528867
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.82
|
| Rate for Payer: Aetna Government |
$48.82
|
| 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 |
$213.88
|
| Rate for Payer: Group Health Inc Medicare |
$149.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.88
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
CC INS CATH REN ART 1ST BILAT
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
66528251
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
CC INS CATH REN ART 1ST BILAT
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36252
|
| Hospital Charge Code |
66528251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
CC INSERTION KIT
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
66528272
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.00
|
| Rate for Payer: Aetna Government |
$125.00
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
CC INSERT LEAD PACE-DEFIB, DUAL
|
Facility
|
IP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33217
|
| Hospital Charge Code |
66528636
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,824.59
|
|
|
CC INSERT LEAD PACE-DEFIB, DUAL
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33217
|
| Hospital Charge Code |
66528636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$17,358.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,824.59
|
| Rate for Payer: Aetna Government |
$9,824.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,877.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,877.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,877.21
|
| Rate for Payer: Brighton Health Commercial |
$17,358.94
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,824.59
|
| 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 |
$9,824.59
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,350.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,743.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,824.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,743.89
|
| Rate for Payer: Group Health Inc Commercial |
$9,824.59
|
| Rate for Payer: Group Health Inc Medicare |
$9,824.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,824.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,350.90
|
| Rate for Payer: Healthfirst QHP |
$9,824.59
|
| Rate for Payer: Humana Medicare |
$10,021.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,824.59
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,824.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,824.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7,859.67
|
| Rate for Payer: Wellcare Medicare |
$9,333.36
|
|
|
CC INSERT PACING LEAD & CONNECT
|
Facility
|
IP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
66528651
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
CC INSERT PACING LEAD & CONNECT
|
Facility
|
OP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
66528651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| Rate for Payer: Aetna Government |
$12,348.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,644.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,644.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,644.01
|
| Rate for Payer: Brighton Health Commercial |
$23,287.94
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,348.58
|
| 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 |
$12,348.58
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,496.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,990.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,348.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,990.24
|
| Rate for Payer: Group Health Inc Commercial |
$12,348.58
|
| Rate for Payer: Group Health Inc Medicare |
$12,348.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,525.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,496.29
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Humana Medicare |
$12,595.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: United Healthcare Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,348.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,348.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,878.86
|
| Rate for Payer: Wellcare Medicare |
$11,731.15
|
|
|
CC INS/REP ELECTRODE LEADS W INS
|
Facility
|
IP
|
$98,886.00
|
|
|
Service Code
|
HCPCS 33249
|
| Hospital Charge Code |
66528643
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$38,045.24
|
|
|
CC INS/REP ELECTRODE LEADS W INS
|
Facility
|
OP
|
$98,886.00
|
|
|
Service Code
|
HCPCS 33249
|
| Hospital Charge Code |
66528643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$74,164.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,045.24
|
| Rate for Payer: Aetna Government |
$38,045.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26,631.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26,631.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,631.67
|
| Rate for Payer: Brighton Health Commercial |
$74,164.50
|
| Rate for Payer: Cash Price |
$38,045.24
|
| Rate for Payer: Cash Price |
$38,045.24
|
| Rate for Payer: Cash Price |
$38,045.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38,045.24
|
| 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 |
$38,045.24
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32,338.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33,860.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,045.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33,860.26
|
| Rate for Payer: Group Health Inc Commercial |
$38,045.24
|
| Rate for Payer: Group Health Inc Medicare |
$38,045.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49,443.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,045.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32,338.45
|
| Rate for Payer: Healthfirst QHP |
$38,045.24
|
| Rate for Payer: Humana Medicare |
$38,806.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,045.24
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,045.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,045.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,436.19
|
| Rate for Payer: Wellcare Medicare |
$36,142.98
|
|
|
CC INS/REPL PERM PACEMAKER, AV
|
Facility
|
OP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
66528625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$22,557.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,108.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| Rate for Payer: Aetna Government |
$12,348.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,644.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,644.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,644.01
|
| Rate for Payer: Brighton Health Commercial |
$22,557.00
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,348.58
|
| 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 |
$12,348.58
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,496.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,990.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,348.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,990.24
|
| Rate for Payer: Group Health Inc Commercial |
$12,348.58
|
| Rate for Payer: Group Health Inc Medicare |
$12,348.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,038.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,496.29
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Humana Medicare |
$12,595.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: United Healthcare Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,348.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,348.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,878.86
|
| Rate for Payer: Wellcare Medicare |
$11,731.15
|
|
|
CC INS/REPL PERM PACEMAKER, AV
|
Facility
|
IP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
66528625
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
CC INS/REPL PG ONLY, DUAL CHAMBER
|
Facility
|
IP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
66528628
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
CC INS/REPL PG ONLY, DUAL CHAMBER
|
Facility
|
OP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
66528628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$23,287.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| Rate for Payer: Aetna Government |
$12,348.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,644.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,644.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,644.01
|
| Rate for Payer: Brighton Health Commercial |
$23,287.94
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,348.58
|
| 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 |
$12,348.58
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,496.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,990.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,348.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,990.24
|
| Rate for Payer: Group Health Inc Commercial |
$12,348.58
|
| Rate for Payer: Group Health Inc Medicare |
$12,348.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,525.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,496.29
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Humana Medicare |
$12,595.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,348.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,348.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,878.86
|
| Rate for Payer: Wellcare Medicare |
$11,731.15
|
|
|
CC INS/REPL PG ONLY, SGL CHAMBER
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
66528629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$17,358.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,824.59
|
| Rate for Payer: Aetna Government |
$9,824.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,877.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,877.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,877.21
|
| Rate for Payer: Brighton Health Commercial |
$17,358.94
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,824.59
|
| 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 |
$9,824.59
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,350.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,743.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,824.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,743.89
|
| Rate for Payer: Group Health Inc Commercial |
$9,824.59
|
| Rate for Payer: Group Health Inc Medicare |
$9,824.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,824.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,350.90
|
| Rate for Payer: Healthfirst QHP |
$9,824.59
|
| Rate for Payer: Humana Medicare |
$10,021.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,824.59
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,824.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,824.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7,859.67
|
| Rate for Payer: Wellcare Medicare |
$9,333.36
|
|
