|
INSERT ABDOM DRASIN PERM
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 49421
|
| Hospital Charge Code |
40034104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$7,063.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,000.83
|
| Rate for Payer: Aetna Government |
$4,000.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,800.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,800.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,800.58
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,000.83
|
| 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 |
$4,000.83
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,400.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,560.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,000.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,560.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,000.83
|
| Rate for Payer: Group Health Inc Medicare |
$4,000.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,000.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,400.71
|
| Rate for Payer: Healthfirst QHP |
$4,000.83
|
| Rate for Payer: Humana Medicare |
$4,080.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,000.83
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,000.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,000.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,200.66
|
| Rate for Payer: Wellcare Medicare |
$3,800.79
|
|
|
INSERT ABDOM DRASIN PERM
|
Facility
|
IP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 49421
|
| Hospital Charge Code |
40034104
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,000.83
|
|
|
INSERT ARTICULAR 9MM GEN IIPS
|
Facility
|
OP
|
$2,948.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64902706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,095.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,621.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,768.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,474.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,695.17
|
| Rate for Payer: EmblemHealth Commercial |
$1,474.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,095.54
|
| Rate for Payer: Group Health Inc Commercial |
$1,474.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,031.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,474.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,474.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,916.28
|
|
|
INSERT ARTICULAR 9MM GEN IIPS
|
Facility
|
IP
|
$2,948.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64902706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.06 |
| Max. Negotiated Rate |
$1,474.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,474.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,474.06
|
|
|
INSERT ARTICULAR GENII PS
|
Facility
|
OP
|
$2,948.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64902710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,095.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,621.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,768.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,474.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,695.17
|
| Rate for Payer: EmblemHealth Commercial |
$1,474.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,095.54
|
| Rate for Payer: Group Health Inc Commercial |
$1,474.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,031.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,474.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,474.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,916.28
|
|
|
INSERT ARTICULAR GENII PS
|
Facility
|
IP
|
$2,948.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64902710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.06 |
| Max. Negotiated Rate |
$1,474.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,474.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,474.06
|
|
|
INSERT BLADDER CATH COMP/BALLOON
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
30107832
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
INSERT BLADDER CATH COMP/BALLOON
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
30107832
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$180.64
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| 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 |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
INSERT BUMPER
|
Facility
|
OP
|
$2,079.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,183.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,143.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,247.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,039.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,195.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,039.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,183.35
|
| Rate for Payer: Group Health Inc Commercial |
$1,039.69
|
| Rate for Payer: Group Health Inc Medicare |
$727.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,039.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,039.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,351.60
|
|
|
INSERT BUMPER
|
Facility
|
IP
|
$2,079.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.69 |
| Max. Negotiated Rate |
$1,039.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,039.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,039.69
|
|
|
INSERT CX DILATOR (SEP PROC)
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
30301258
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$370.99
|
| Rate for Payer: Aetna Government |
$370.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$259.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$259.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$259.69
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.99
|
| 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 |
$370.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.18
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.34
|
| Rate for Payer: Healthfirst QHP |
$370.99
|
| Rate for Payer: Humana Medicare |
$378.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$370.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.99
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$370.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$296.79
|
| Rate for Payer: Wellcare Medicare |
$352.44
|
|
|
INSERT CX DILATOR (SEP PROC)
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
30301258
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$370.99
|
|
|
INSERT DIT FEM SZ B REV
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$510.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$267.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$291.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$243.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$279.45
|
| Rate for Payer: EmblemHealth Commercial |
$243.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$510.30
|
| Rate for Payer: Group Health Inc Commercial |
$243.00
|
| Rate for Payer: Group Health Inc Medicare |
$170.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$315.90
|
|
|
INSERT DIT FEM SZ B REV
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.00
|
|
|
INSERT DRUG IMPLANT DEVICE
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 11981
|
| Hospital Charge Code |
30306500
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
INSERT DRUG IMPLANT DEVICE
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 11981
|
| Hospital Charge Code |
30306500
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
INSERT HEART PM VENTRICULAR
|
Facility
|
IP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
30107550
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
INSERT HEART PM VENTRICULAR
|
Facility
|
OP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
30107550
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$16,751.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$12,348.58
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$12,348.58
|
| 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 |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,038.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Humana Medicare |
$12,595.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12,348.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| 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
|
|
|
INSERT HEW HEART PACE ATRIAL/VENT
|
Facility
|
IP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
30106637
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
INSERT HEW HEART PACE ATRIAL/VENT
|
Facility
|
OP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
30106637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$22,108.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,108.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$12,348.58
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$12,348.58
|
| 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 |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,038.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Humana Medicare |
$12,595.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12,348.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| 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
|
|
|
Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 11981
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
INSERTION JIB BOLT
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
|
|
INSERTION JIB BOLT
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$240.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.00
|
| Rate for Payer: EmblemHealth Commercial |
$200.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$420.00
|
| Rate for Payer: Group Health Inc Commercial |
$200.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.00
|
|
|
INSERTION JIG 125 DEGREE
|
Facility
|
OP
|
$11,104.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$11,659.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,107.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$6,662.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,552.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,384.80
|
| Rate for Payer: EmblemHealth Commercial |
$5,552.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,659.20
|
| Rate for Payer: Group Health Inc Commercial |
$5,552.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,886.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,552.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,552.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,217.60
|
|
|
INSERTION JIG 125 DEGREE
|
Facility
|
IP
|
$11,104.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,552.00 |
| Max. Negotiated Rate |
$5,552.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,552.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,552.00
|
|
