|
CC PERC REVASC BYPASS GRFT 1 VSL
|
Facility
|
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
66523402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$16,751.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,905.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,905.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,905.39
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,721.98
|
| 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 |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$12,721.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,813.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,322.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,322.56
|
| Rate for Payer: Group Health Inc Commercial |
$12,721.98
|
| Rate for Payer: Group Health Inc Medicare |
$12,721.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,813.68
|
| Rate for Payer: Healthfirst QHP |
$12,721.98
|
| Rate for Payer: Humana Medicare |
$12,976.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,721.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,721.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10,177.58
|
| Rate for Payer: Wellcare Medicare |
$12,085.88
|
|
|
CC PERC REVASC BYPSS GRFT ADD VSL
|
Facility
|
OP
|
$6,110.44
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
66523403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$255.83 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$255.83
|
| Rate for Payer: Aetna Government |
$255.83
|
| 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 |
$3,055.22
|
| Rate for Payer: Group Health Inc Medicare |
$2,138.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,055.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,055.22
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
|
|
CC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 33016 TC
|
| Hospital Charge Code |
66576536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,188.00 |
| Max. Negotiated Rate |
$3,705.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,852.05
|
| Rate for Payer: Aetna Government |
$1,852.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,296.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,296.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,296.44
|
| Rate for Payer: Brighton Health Commercial |
$3,705.21
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,852.05
|
| 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 |
$1,852.05
|
| Rate for Payer: EmblemHealth Commercial |
$1,852.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,574.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,648.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,852.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,648.32
|
| Rate for Payer: Group Health Inc Commercial |
$1,852.05
|
| Rate for Payer: Group Health Inc Medicare |
$1,852.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,574.24
|
| Rate for Payer: Healthfirst QHP |
$1,852.05
|
| Rate for Payer: Humana Medicare |
$1,889.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,852.05
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,852.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,481.64
|
| Rate for Payer: Wellcare Medicare |
$1,759.45
|
|
|
CC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 33016 TC
|
| Hospital Charge Code |
66576536
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
CC PERIC DRG 0-5YR OR W/ANOMLY
|
Facility
|
OP
|
$819.96
|
|
|
Service Code
|
HCPCS 33018 TC
|
| Hospital Charge Code |
66576538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$286.99 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$450.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Government |
$311.25
|
| Rate for Payer: Brighton Health Commercial |
$614.97
|
| 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: Group Health Inc Commercial |
$409.98
|
| Rate for Payer: Group Health Inc Medicare |
$286.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$409.98
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
CC PERIC DRG 6YR+ W/O CGENITA CAR
|
Facility
|
OP
|
$745.42
|
|
|
Service Code
|
HCPCS 33017 TC
|
| Hospital Charge Code |
66576537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$260.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$409.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.62
|
| Rate for Payer: Aetna Government |
$275.62
|
| Rate for Payer: Brighton Health Commercial |
$559.06
|
| 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: Group Health Inc Commercial |
$372.71
|
| Rate for Payer: Group Health Inc Medicare |
$260.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$372.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$372.71
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
CC PERIC DRG INSJ CATH CT
|
Facility
|
OP
|
$901.95
|
|
|
Service Code
|
HCPCS 33019 TC
|
| Hospital Charge Code |
66576539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$496.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$254.50
|
| Rate for Payer: Aetna Government |
$254.50
|
| Rate for Payer: Brighton Health Commercial |
$676.46
|
| 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: Group Health Inc Commercial |
$450.98
|
| Rate for Payer: Group Health Inc Medicare |
$315.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.98
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
CC PERIVAC PERICARDIOCENTESIS W/8
|
Facility
|
OP
|
$262.09
|
|
| Hospital Charge Code |
66528281
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$131.04
|
| Rate for Payer: Aetna Government |
$131.04
|
| Rate for Payer: Brighton Health Commercial |
$196.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$209.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.22
|
| Rate for Payer: Group Health Inc Commercial |
$131.04
|
| Rate for Payer: Group Health Inc Medicare |
$91.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.04
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
CCP IGG
|
Facility
|
OP
|
$32.38
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
40728450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.95
|
| Rate for Payer: Aetna Government |
$12.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.06
|
| Rate for Payer: Brighton Health Commercial |
$24.28
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.95
|
| Rate for Payer: EmblemHealth Commercial |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.53
|
| Rate for Payer: Group Health Inc Commercial |
$12.95
|
| Rate for Payer: Group Health Inc Medicare |
$12.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.95
|
| Rate for Payer: Healthfirst QHP |
$12.95
|
| Rate for Payer: Humana Medicare |
$13.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.95
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.36
|
| Rate for Payer: Wellcare Medicare |
$11.66
|
|
|
CCP IGG
|
Facility
|
IP
|
$32.38
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
30303356
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.95
|
|
|
CCP IGG
|
Facility
|
OP
|
$32.38
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
30303356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.95
|
| Rate for Payer: Aetna Government |
$12.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.06
|
| Rate for Payer: Brighton Health Commercial |
$24.28
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.95
|
| Rate for Payer: EmblemHealth Commercial |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.53
|
| Rate for Payer: Group Health Inc Commercial |
$12.95
|
| Rate for Payer: Group Health Inc Medicare |
$12.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.95
|
| Rate for Payer: Healthfirst QHP |
$12.95
|
| Rate for Payer: Humana Medicare |
$13.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.95
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.36
|
| Rate for Payer: Wellcare Medicare |
$11.66
|
|
|
CCP IGG
|
Facility
|
IP
|
$32.38
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
40728450
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.95
|
|
|
CC PLACEMENT OF OCCLUSIVE DEVICE
|
Facility
|
OP
|
$682.27
|
|
|
Service Code
|
HCPCS G0269
|
| Hospital Charge Code |
66528390
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$375.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.12
|
| Rate for Payer: Aetna Government |
$14.12
|
| 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 |
$341.14
|
| Rate for Payer: Group Health Inc Medicare |
$238.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.14
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
CC PPM LEAD ST JUDE AV PLUS DX 58
|
Facility
|
OP
|
$1,200.00
|
|
| Hospital Charge Code |
66525391
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$600.00
|
| Rate for Payer: Aetna Government |
$600.00
|
| Rate for Payer: Brighton Health Commercial |
$900.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$960.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$816.00
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
|
|
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: Brighton Health Commercial |
$14.55
|
| 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: Brighton Health Commercial |
$67.75
|
| 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: Brighton Health Commercial |
$22.50
|
| 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: Brighton Health Commercial |
$22.50
|
| 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
|
IP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
66522555
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$6,609.72
|
|
|
CC PTCA INITIAL VESSEL
|
Facility
|
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
66522555
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,546.00 |
| 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: Affinity Essential Plan 1&2 |
$4,626.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,626.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,626.80
|
| 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 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 Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Humana Medicare |
$6,741.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare 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 |
$1,217.14 |
| Max. Negotiated Rate |
$3,759.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.15
|
| 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 |
$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 |
$1,438.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,217.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$2,580.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,133.17
|
| 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 |
$3,317.47
|
| Rate for Payer: Group Health Inc Medicare |
$3,317.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,317.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,686.08
|
| 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 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 PULMONARY NONSELECTIVE ANGIO
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75746 26
|
| Hospital Charge Code |
66528676
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
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: Brighton Health Commercial |
$594.38
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
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: 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
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
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: Brighton Health Commercial |
$299.25
|
| 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
|
|
