|
HC INSERTN IMPL DEFRIB PULSE GEN ONLY, EXSTG SING LEAD
|
Facility
|
OP
|
$68,791.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
3613324001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.27 |
| Max. Negotiated Rate |
$51,593.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,425.20
|
| Rate for Payer: Aetna Government |
$27,425.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19,197.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19,197.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,197.64
|
| Rate for Payer: Brighton Health Commercial |
$51,593.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,425.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,425.20
|
| Rate for Payer: EmblemHealth Commercial |
$27,425.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,682.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23,311.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24,408.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,425.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,408.43
|
| Rate for Payer: Group Health Inc Commercial |
$27,425.20
|
| Rate for Payer: Group Health Inc Medicare |
$27,425.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,425.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,593.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$419.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,311.42
|
| Rate for Payer: Healthfirst QHP |
$27,425.20
|
| Rate for Payer: Humana Medicare |
$27,973.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,425.20
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,425.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,425.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26,053.94
|
| Rate for Payer: Wellcare Medicare |
$26,053.94
|
|
|
HC INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$4,940.00
|
|
|
Service Code
|
CPT 36556 TC
|
| Hospital Charge Code |
3613655601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,470.00 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
|
|
HC INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$4,940.00
|
|
|
Service Code
|
CPT 36556 TC
|
| Hospital Charge Code |
3613655601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$3,705.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.00
|
| Rate for Payer: Aetna Government |
$129.00
|
| Rate for Payer: Brighton Health Commercial |
$3,705.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$2,470.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,470.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,588.69
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC INSERT NON-TUNNEL CV CATH < 5 Y/O
|
Facility
|
IP
|
$4,940.00
|
|
|
Service Code
|
CPT 36555 TC
|
| Hospital Charge Code |
3613655501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,470.00 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
|
|
HC INSERT NON-TUNNEL CV CATH < 5 Y/O
|
Facility
|
OP
|
$4,940.00
|
|
|
Service Code
|
CPT 36555 TC
|
| Hospital Charge Code |
3613655501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.09 |
| Max. Negotiated Rate |
$3,705.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$273.09
|
| Rate for Payer: Aetna Government |
$273.09
|
| Rate for Payer: Brighton Health Commercial |
$3,705.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$2,470.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,470.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,588.69
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC INSERTN SUBQ CAR RHYTHM MNTR
|
Facility
|
IP
|
$23,145.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
3613328501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,572.50 |
| Max. Negotiated Rate |
$11,572.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.50
|
|
|
HC INSERTN SUBQ CAR RHYTHM MNTR
|
Facility
|
OP
|
$23,145.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
3613328501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.51 |
| Max. Negotiated Rate |
$17,358.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10,111.76
|
| Rate for Payer: Aetna Government |
$10,111.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7,078.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7,078.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7,078.23
|
| Rate for Payer: Brighton Health Commercial |
$17,358.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10,111.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$10,111.76
|
| Rate for Payer: EmblemHealth Commercial |
$10,111.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9,100.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,595.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,999.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,111.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,999.47
|
| Rate for Payer: Group Health Inc Commercial |
$10,111.76
|
| Rate for Payer: Group Health Inc Medicare |
$10,111.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,111.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,027.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,595.00
|
| Rate for Payer: Healthfirst QHP |
$10,111.76
|
| Rate for Payer: Humana Medicare |
$10,314.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10,111.76
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,111.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10,111.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,606.17
|
| Rate for Payer: Wellcare Medicare |
$9,606.17
|
|
|
HC INSERT PACING ELEC LV W/INITIAL IMPLNT (ADDON)
|
Facility
|
OP
|
$1,317.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
3613322501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$523.37
|
| Rate for Payer: Aetna Government |
$523.37
|
| Rate for Payer: Brighton Health Commercial |
$987.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$658.50
|
| Rate for Payer: Group Health Inc Commercial |
$658.50
|
| Rate for Payer: Group Health Inc Medicare |
$460.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$658.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$658.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$533.43
|
| Rate for Payer: United Healthcare Commercial |
$3,047.00
|
|
|
HC INSERT PACING ELEC LV W/INITIAL IMPLNT (ADDON)
|
Facility
|
IP
|
$1,317.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
3613322501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$658.50 |
| Max. Negotiated Rate |
$658.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$658.50
|
|
|
HC INSERT PACING ELEC LV W/PRE IMPLNT
|
Facility
|
OP
|
$31,050.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
3613322401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$590.77 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,786.75
|
| Rate for Payer: Aetna Government |
$12,786.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,950.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,950.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,950.73
|
| Rate for Payer: Brighton Health Commercial |
$23,287.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,786.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,786.75
|
| Rate for Payer: EmblemHealth Commercial |
$12,786.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11,508.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,868.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,380.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,786.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,380.21
|
| Rate for Payer: Group Health Inc Commercial |
$12,786.75
|
| Rate for Payer: Group Health Inc Medicare |
$12,786.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,786.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,636.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$590.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,868.74
|
| Rate for Payer: Healthfirst QHP |
$12,786.75
|
| Rate for Payer: Humana Medicare |
$13,042.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,786.75
|
| Rate for Payer: United Healthcare Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,786.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,786.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,147.41
|
| Rate for Payer: Wellcare Medicare |
$12,147.41
|
|
|
HC INSERT PACING ELEC LV W/PRE IMPLNT
|
Facility
|
IP
|
$31,050.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
3613322401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,525.00 |
| Max. Negotiated Rate |
$15,525.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,525.00
|
|
|
HC INSERT PERM PACEMAKER W/ TRANSVENOUS ELECT, ATRIAL
|
Facility
|
IP
|
$31,050.00
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
4813320601
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$15,525.00 |
| Max. Negotiated Rate |
$15,525.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,525.00
|
|
|
HC INSERT PERM PACEMAKER W/ TRANSVENOUS ELECT, ATRIAL
|
Facility
|
OP
|
$31,050.00
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
4813320601
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$528.47 |
| Max. Negotiated Rate |
$16,751.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,786.75
|
| Rate for Payer: Aetna Government |
$12,786.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,950.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,950.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,950.73
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,786.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,786.75
|
| Rate for Payer: EmblemHealth Commercial |
$12,786.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11,508.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,868.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,380.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,786.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,380.21
|
| Rate for Payer: Group Health Inc Commercial |
$12,786.75
|
| Rate for Payer: Group Health Inc Medicare |
$12,786.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,786.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,408.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$528.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,868.74
|
| Rate for Payer: Healthfirst QHP |
$12,786.75
|
| Rate for Payer: Humana Medicare |
$13,042.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,786.75
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,786.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,786.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,147.41
|
| Rate for Payer: Wellcare Medicare |
$12,147.41
|
|
|
HC INSERT PERM PACEMAKER W/ TRANSVENOUS ELECT, ATRIAL & VENTRICULAR
|
Facility
|
OP
|
$30,076.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
4813320801
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$22,108.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,108.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,786.75
|
| Rate for Payer: Aetna Government |
$12,786.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,950.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,950.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,950.73
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,786.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,786.75
|
| Rate for Payer: EmblemHealth Commercial |
$12,786.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11,508.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,868.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,380.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,786.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,380.21
|
| Rate for Payer: Group Health Inc Commercial |
$12,786.75
|
| Rate for Payer: Group Health Inc Medicare |
$12,786.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,786.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,689.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$600.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,868.74
|
| Rate for Payer: Healthfirst QHP |
$12,786.75
|
| Rate for Payer: Humana Medicare |
$13,042.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,786.75
|
| Rate for Payer: United Healthcare Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,786.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,786.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,147.41
|
| Rate for Payer: Wellcare Medicare |
$12,147.41
|
|
|
HC INSERT PERM PACEMAKER W/ TRANSVENOUS ELECT, ATRIAL & VENTRICULAR
|
Facility
|
IP
|
$30,076.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
4813320801
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$15,038.00 |
| Max. Negotiated Rate |
$15,038.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,038.00
|
|
|
HC INSERT PERM PACEMAKER W/ TRANSVENOUS ELECT, VENTRICULAR
|
Facility
|
IP
|
$30,076.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
4813320701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$15,038.00 |
| Max. Negotiated Rate |
$15,038.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,038.00
|
|
|
HC INSERT PERM PACEMAKER W/ TRANSVENOUS ELECT, VENTRICULAR
|
Facility
|
OP
|
$30,076.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
4813320701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$556.67 |
| Max. Negotiated Rate |
$16,751.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,786.75
|
| Rate for Payer: Aetna Government |
$12,786.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,950.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,950.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,950.73
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,786.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,786.75
|
| Rate for Payer: EmblemHealth Commercial |
$12,786.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11,508.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,868.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,380.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,786.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,380.21
|
| Rate for Payer: Group Health Inc Commercial |
$12,786.75
|
| Rate for Payer: Group Health Inc Medicare |
$12,786.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,786.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,589.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$556.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,868.74
|
| Rate for Payer: Healthfirst QHP |
$12,786.75
|
| Rate for Payer: Humana Medicare |
$13,042.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,786.75
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,786.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,786.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,147.41
|
| Rate for Payer: Wellcare Medicare |
$12,147.41
|
|
|
HC INSERT/REPL PERM IMP DEFRIB SYS, SING OR DUAL
|
Facility
|
OP
|
$98,886.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
3613324901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,057.04 |
| Max. Negotiated Rate |
$74,164.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39,173.48
|
| Rate for Payer: Aetna Government |
$39,173.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27,421.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27,421.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27,421.44
|
| Rate for Payer: Brighton Health Commercial |
$74,164.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,173.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$39,173.48
|
| Rate for Payer: EmblemHealth Commercial |
$39,173.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35,256.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33,297.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34,864.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$39,173.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34,864.40
|
| Rate for Payer: Group Health Inc Commercial |
$39,173.48
|
| Rate for Payer: Group Health Inc Medicare |
$39,173.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39,173.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,924.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,057.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33,297.46
|
| Rate for Payer: Healthfirst QHP |
$39,173.48
|
| Rate for Payer: Humana Medicare |
$39,956.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39,173.48
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39,173.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39,173.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37,214.81
|
| Rate for Payer: Wellcare Medicare |
$37,214.81
|
|
|
HC INSERT/REPL PERM IMP DEFRIB SYS, SING OR DUAL
|
Facility
|
IP
|
$98,886.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
3613324901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49,443.00 |
| Max. Negotiated Rate |
$49,443.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49,443.00
|
|
|
HC INSERT TEMP INDWELLING BLADDER CATHETER, COMP
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
3615170301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC INSERT TEMP INDWELLING BLADDER CATHETER, COMP
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
3615170301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC INSERT TEMP INDWELLING BLADDER CATHETER, SIMPLE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
3615170201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC INSERT TEMP INDWELLING BLADDER CATHETER, SIMPLE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
3615170201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC INSERT TEMP NON-INDWELLING BLADDER CATHETER
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
3615170101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC INSERT TEMP NON-INDWELLING BLADDER CATHETER
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
3615170101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
