|
CC TOTAL HEMOGLOBIN (THB) MEASURE
|
Facility
|
OP
|
$5.93
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
66526895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.37
|
| Rate for Payer: Aetna Government |
$2.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.66
|
| Rate for Payer: Brighton Health Commercial |
$4.45
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.37
|
| Rate for Payer: EmblemHealth Commercial |
$2.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.11
|
| Rate for Payer: Group Health Inc Commercial |
$2.37
|
| Rate for Payer: Group Health Inc Medicare |
$2.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.37
|
| Rate for Payer: Healthfirst QHP |
$2.37
|
| Rate for Payer: Humana Medicare |
$2.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.37
|
| Rate for Payer: United Healthcare Commercial |
$3.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.90
|
| Rate for Payer: Wellcare Medicare |
$2.13
|
|
|
CC TRANSVENOUS DUAL CHMBR PMKR TE
|
Facility
|
IP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33211
|
| Hospital Charge Code |
66528394
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$9,824.59
|
|
|
CC TRANSVENOUS DUAL CHMBR PMKR TE
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33211
|
| Hospital Charge Code |
66528394
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$11,572.62 |
| 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 |
$6,937.00
|
| 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 |
$9,824.59
|
| 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 TRANSVENOUS SING CHMBR
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
66528395
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$11,572.62 |
| 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 |
$6,937.00
|
| 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 |
$9,824.59
|
| 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 TRANSVENOUS SING CHMBR
|
Facility
|
IP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
66528395
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$9,824.59
|
|
|
CC TREK/NC (ALL LENGTHS)
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66526894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$159.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Brighton Health Commercial |
$174.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$145.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.75
|
| Rate for Payer: EmblemHealth Commercial |
$145.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$304.50
|
| Rate for Payer: Group Health Inc Commercial |
$145.00
|
| Rate for Payer: Group Health Inc Medicare |
$101.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$188.50
|
|
|
CC TREK/NC (ALL LENGTHS)
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66526894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.00
|
|
|
CC ULTRASONIC ENDO BALLOON
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
66571551
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.00
|
| Rate for Payer: Aetna Government |
$35.00
|
| Rate for Payer: Brighton Health Commercial |
$52.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.60
|
| Rate for Payer: Group Health Inc Commercial |
$35.00
|
| Rate for Payer: Group Health Inc Medicare |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
|
|
CC UPGRADE IMPL PACEMKR, SC TO DC
|
Facility
|
IP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33214
|
| Hospital Charge Code |
66528634
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
CC UPGRADE IMPL PACEMKR, SC TO DC
|
Facility
|
OP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33214
|
| Hospital Charge Code |
66528634
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$23,287.94 |
| 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 |
$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 VASCULAR PERCLOSE PROGLIDE 6F
|
Facility
|
OP
|
$470.00
|
|
| Hospital Charge Code |
66528406
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$235.00
|
| Rate for Payer: Aetna Government |
$235.00
|
| Rate for Payer: Brighton Health Commercial |
$352.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$376.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$319.60
|
| Rate for Payer: Group Health Inc Commercial |
$235.00
|
| Rate for Payer: Group Health Inc Medicare |
$164.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
|
|
CC VENOGRAM, EXTREMITY,UNILATERAL
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75820 26
|
| Hospital Charge Code |
66528668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$954.82 |
| Max. Negotiated Rate |
$1,889.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,050.31
|
| 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 |
$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 |
$1,438.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,217.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,852.05
|
| Rate for Payer: EmblemHealth Commercial |
$1,296.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,574.24
|
| 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 |
$1,666.84
|
| Rate for Payer: Group Health Inc Medicare |
$1,666.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,666.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,852.05
|
| 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 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 VENOGRAM, EXTREMITY,UNILATERAL
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75820 26
|
| Hospital Charge Code |
66528668
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
CC VISIPAQUE 250 ML
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
66526100
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.62
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.81
|
|
|
CC VISIPAQUE 320MG/ML 100ML
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
66526101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.77
|
| Rate for Payer: Group Health Inc Commercial |
$0.67
|
| Rate for Payer: Group Health Inc Medicare |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.15
|
| Rate for Payer: SOMOS Essential |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.87
|
|
|
CC VISIPAQUE 320MG/ML 100ML
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
66526101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
|
|
CC VISIPAQUE 320MG/ML 150ML
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
66526105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.90
|
|
|
CC VISIPAQUE 320MG/ML 150ML
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
66526105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$1.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Medicare |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.15
|
| Rate for Payer: SOMOS Essential |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.17
|
|
|
CC VISIPAQUE 320MG/ML 50ML
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
66526106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
|
|
CC VISIPAQUE 320MG/ML 50ML
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
66526106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.77
|
| Rate for Payer: Group Health Inc Commercial |
$0.67
|
| Rate for Payer: Group Health Inc Medicare |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.15
|
| Rate for Payer: SOMOS Essential |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.87
|
|
|
CC VOLCANO P WIRE P 0.014X185CM
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$715.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Brighton Health Commercial |
$780.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$650.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$747.50
|
| Rate for Payer: EmblemHealth Commercial |
$650.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,365.00
|
| Rate for Payer: Group Health Inc Commercial |
$650.00
|
| Rate for Payer: Group Health Inc Medicare |
$455.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$650.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$650.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$845.00
|
|
|
CC VOLCANO P WIRE P 0.014X185CM
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66522003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$650.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$650.00
|
|
|
CC WI PACER INSERTION
|
Facility
|
OP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
66528626
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$22,557.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| 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 |
$3,190.00
|
| 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 WI PACER INSERTION
|
Facility
|
IP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
66528626
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
CC WIRES STANDARD J-TIP .025 150C
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.12
|
| Rate for Payer: EmblemHealth Commercial |
$17.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.75
|
| Rate for Payer: Group Health Inc Commercial |
$17.50
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.75
|
|
