|
HC INSERT TUNNELED CV CATH WITH PORT
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
3613656101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$377.82 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,845.68
|
| Rate for Payer: Aetna Government |
$3,845.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,691.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,691.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,691.98
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,845.68
|
| 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 |
$3,845.68
|
| Rate for Payer: EmblemHealth Commercial |
$3,845.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,461.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,268.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,422.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,845.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,422.66
|
| Rate for Payer: Group Health Inc Commercial |
$3,845.68
|
| Rate for Payer: Group Health Inc Medicare |
$3,845.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,845.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,588.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$377.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,268.83
|
| Rate for Payer: Healthfirst QHP |
$3,845.68
|
| Rate for Payer: Humana Medicare |
$3,922.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,845.68
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,845.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,845.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,653.40
|
| Rate for Payer: Wellcare Medicare |
$3,653.40
|
|
|
HC INSERT TUNNELED CV CATH WITH PORT
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
3613656101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC INSERT TUNNELED CV CATH W/O PORT OR PUMP
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 36558 TC
|
| Hospital Charge Code |
3613655801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$843.93 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$843.93
|
| Rate for Payer: Aetna Government |
$843.93
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| 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 |
$4,196.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,588.69
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC INSERT TUNNELED CV CATH W/O PORT OR PUMP
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 36558 TC
|
| Hospital Charge Code |
3613655801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC INSERT TUNNELED CV CATH W/O PORT OR PUMP < 5 Y/O
|
Facility
|
IP
|
$13,920.00
|
|
|
Service Code
|
CPT 36557 TC
|
| Hospital Charge Code |
3613655701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,960.00 |
| Max. Negotiated Rate |
$6,960.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.00
|
|
|
HC INSERT TUNNELED CV CATH W/O PORT OR PUMP < 5 Y/O
|
Facility
|
OP
|
$13,920.00
|
|
|
Service Code
|
CPT 36557 TC
|
| Hospital Charge Code |
3613655701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$10,440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$367.50
|
| Rate for Payer: Aetna Government |
$367.50
|
| Rate for Payer: Brighton Health Commercial |
$10,440.00
|
| 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 |
$6,960.00
|
| Rate for Payer: Group Health Inc Commercial |
$6,960.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,872.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,009.55
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
|
|
HC IN SITU HYBRIDIZATION PER SPECIMEN; EACH ADDL SINGLE PROBE STAIN
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
3128836401
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$403.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.98
|
| Rate for Payer: Aetna Government |
$84.98
|
| Rate for Payer: Brighton Health Commercial |
$58.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.04
|
| Rate for Payer: EmblemHealth Commercial |
$147.62
|
| Rate for Payer: Group Health Inc Commercial |
$39.00
|
| Rate for Payer: Group Health Inc Medicare |
$27.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.38
|
| Rate for Payer: Healthfirst Essential Plan |
$403.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$179.38
|
|
|
HC IN SITU HYBRIDIZATION PER SPECIMEN; EACH ADDL SINGLE PROBE STAIN
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
3128836401
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
|
|
HC IN SITU HYBRIDIZATION PER SPECIMEN; INITIAL SINGLE PROBE STAIN
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
3128836501
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$86.35 |
| Max. Negotiated Rate |
$403.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.37
|
| Rate for Payer: Aetna Government |
$209.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$146.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$146.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$146.56
|
| Rate for Payer: Brighton Health Commercial |
$209.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$209.37
|
| Rate for Payer: EmblemHealth Commercial |
$199.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.34
|
| Rate for Payer: Group Health Inc Commercial |
$209.37
|
| Rate for Payer: Group Health Inc Medicare |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.38
|
| Rate for Payer: Healthfirst Essential Plan |
$403.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.37
|
| Rate for Payer: Healthfirst QHP |
$209.37
|
| Rate for Payer: Humana Medicare |
$213.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$179.38
|
| Rate for Payer: Wellcare Medicare |
$188.43
|
|
|
HC IN SITU HYBRIDIZATION PER SPECIMEN; INITIAL SINGLE PROBE STAIN
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
3128836501
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$78.50 |
| Max. Negotiated Rate |
$78.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.50
|
|
|
HC INS PACEMAKER P-GEN ONLY W/EXISTING DUAL LEADS
|
Facility
|
OP
|
$31,050.00
|
|
|
Service Code
|
CPT 33213
|
| Hospital Charge Code |
3613321301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$392.63 |
| Max. Negotiated Rate |
$23,287.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| 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 |
$7,545.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$392.63
|
| 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 INS PACEMAKER P-GEN ONLY W/EXISTING DUAL LEADS
|
Facility
|
IP
|
$31,050.00
|
|
|
Service Code
|
CPT 33213
|
| Hospital Charge Code |
3613321301
|
|
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 INS PACEMAKER P-GEN ONLY W/EXISTING SING LEAD
|
Facility
|
IP
|
$23,145.00
|
|
|
Service Code
|
CPT 33212
|
| Hospital Charge Code |
3613321201
|
|
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 INS PACEMAKER P-GEN ONLY W/EXISTING SING LEAD
|
Facility
|
OP
|
$23,145.00
|
|
|
Service Code
|
CPT 33212
|
| Hospital Charge Code |
3613321201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$377.98 |
| Max. Negotiated Rate |
$17,358.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| 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 |
$6,519.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$377.98
|
| 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 INS PERM SUBQ DEFIB SYSTEM
|
Facility
|
OP
|
$97,776.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
3613327001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$650.20 |
| Max. Negotiated Rate |
$73,332.00 |
| 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 |
$73,332.00
|
| 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 |
$25,448.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$650.20
|
| 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 INS PERM SUBQ DEFIB SYSTEM
|
Facility
|
IP
|
$97,776.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
3613327001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48,888.00 |
| Max. Negotiated Rate |
$48,888.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48,888.00
|
|
|
HC INS/REPL TEMP TRANSVEN DUAL CHAMB CARD ELECTRODE OR PACEMAKER CATH
|
Facility
|
OP
|
$23,145.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
3613321101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.21 |
| Max. Negotiated Rate |
$17,358.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| 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 |
$7,418.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.21
|
| 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 |
$2,546.00
|
| 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 INS/REPL TEMP TRANSVEN DUAL CHAMB CARD ELECTRODE OR PACEMAKER CATH
|
Facility
|
IP
|
$23,145.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
3613321101
|
|
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 INS/REPL TEMP TRANSVEN SING CHAMB CARD ELECTRODE OR PACEMAKER CATH
|
Facility
|
OP
|
$23,145.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
3613321001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.16 |
| Max. Negotiated Rate |
$17,358.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| 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 |
$4,366.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.16
|
| 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 |
$2,546.00
|
| 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 INS/REPL TEMP TRANSVEN SING CHAMB CARD ELECTRODE OR PACEMAKER CATH
|
Facility
|
IP
|
$23,145.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
3613321001
|
|
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 INSRTN SING TRANSVENOUS ELECTRODE, PERM PACEMKR OR IMPLBLE DEFRIB
|
Facility
|
OP
|
$23,145.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
3613321601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.19 |
| Max. Negotiated Rate |
$17,358.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| 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 |
$5,902.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$432.19
|
| 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 |
$2,546.00
|
| 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 INSRTN SING TRANSVENOUS ELECTRODE, PERM PACEMKR OR IMPLBLE DEFRIB
|
Facility
|
IP
|
$23,145.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
3613321601
|
|
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 INSRTN TWO TRANSVENOUS ELECTRODE, PERM PACEMKR OR IMPLBLE DEFRIB
|
Facility
|
OP
|
$23,145.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
3613321701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$430.22 |
| Max. Negotiated Rate |
$17,358.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| 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 |
$6,178.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$430.22
|
| 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 |
$2,546.00
|
| 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 INSRTN TWO TRANSVENOUS ELECTRODE, PERM PACEMKR OR IMPLBLE DEFRIB
|
Facility
|
IP
|
$23,145.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
3613321701
|
|
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 INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, 1ST DAY
|
Facility
|
OP
|
$1,909.00
|
|
|
Service Code
|
CPT 32561 TC
|
| Hospital Charge Code |
3613256101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.53
|
| Rate for Payer: Aetna Government |
$96.53
|
| Rate for Payer: Brighton Health Commercial |
$1,431.75
|
| 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 |
$954.50
|
| Rate for Payer: Group Health Inc Commercial |
$954.50
|
| Rate for Payer: Group Health Inc Medicare |
$668.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$954.50
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
