|
Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older
|
Facility
|
OP
|
$3,759.80
|
|
|
Service Code
|
CPT 36558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$3,759.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
Insertion of tunneled intraperitoneal catheter for dialysis, open
|
Facility
|
OP
|
$4,080.85
|
|
|
Service Code
|
CPT 49421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$4,080.85 |
| 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: 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 |
$4,000.83
|
| 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 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
|
|
|
INSERTION ON CANNULA EXTERNAL
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36810
|
| Hospital Charge Code |
40039833
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
INSERTION ON CANNULA EXTERNAL
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36810
|
| Hospital Charge Code |
40039833
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
Insertion or replacement of breast implant on separate day from mastectomy
|
Facility
|
OP
|
$11,119.19
|
|
|
Service Code
|
CPT 19342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$11,119.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10,901.17
|
| Rate for Payer: Aetna Government |
$10,901.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7,630.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7,630.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7,630.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10,901.17
|
| 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 |
$10,901.17
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9,265.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9,702.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,901.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9,702.04
|
| Rate for Payer: Group Health Inc Commercial |
$10,901.17
|
| Rate for Payer: Group Health Inc Medicare |
$10,901.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,901.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,265.99
|
| Rate for Payer: Healthfirst QHP |
$10,901.17
|
| Rate for Payer: Humana Medicare |
$11,119.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10,901.17
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,901.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10,901.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8,720.94
|
| Rate for Payer: Wellcare Medicare |
$10,356.11
|
|
|
Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber
|
Facility
|
OP
|
$44,507.00
|
|
|
Service Code
|
CPT 33249
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,045.24
|
| Rate for Payer: Aetna Government |
$38,045.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26,631.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26,631.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,631.67
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38,045.24
|
| 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 |
$38,045.24
|
| Rate for Payer: EmblemHealth Commercial |
$38,045.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32,338.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33,860.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,045.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33,860.26
|
| Rate for Payer: Group Health Inc Commercial |
$38,045.24
|
| Rate for Payer: Group Health Inc Medicare |
$38,045.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,045.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32,338.45
|
| Rate for Payer: Healthfirst QHP |
$38,045.24
|
| Rate for Payer: Humana Medicare |
$38,806.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,045.24
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,045.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,045.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,436.19
|
| Rate for Payer: Wellcare Medicare |
$36,142.98
|
|
|
Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber
|
Facility
|
OP
|
$44,507.00
|
|
|
Service Code
|
CPT 33249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,045.24
|
| Rate for Payer: Aetna Government |
$38,045.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26,631.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26,631.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,631.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38,045.24
|
| 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 |
$38,045.24
|
| Rate for Payer: EmblemHealth Commercial |
$38,045.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32,338.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33,860.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,045.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33,860.26
|
| Rate for Payer: Group Health Inc Commercial |
$38,045.24
|
| Rate for Payer: Group Health Inc Medicare |
$38,045.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,045.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32,338.45
|
| Rate for Payer: Healthfirst QHP |
$38,045.24
|
| Rate for Payer: Humana Medicare |
$38,806.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,045.24
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,045.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,045.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,436.19
|
| Rate for Payer: Wellcare Medicare |
$36,142.98
|
|
|
INSERTION PENILE PROSTHESIS
|
Facility
|
OP
|
$53,227.13
|
|
|
Service Code
|
HCPCS 54400
|
| Hospital Charge Code |
40123015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$39,920.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14,844.80
|
| Rate for Payer: Aetna Government |
$14,844.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10,391.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10,391.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10,391.36
|
| Rate for Payer: Brighton Health Commercial |
$39,920.35
|
| Rate for Payer: Cash Price |
$14,844.80
|
| Rate for Payer: Cash Price |
$14,844.80
|
| Rate for Payer: Cash Price |
$14,844.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14,844.80
|
| 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 |
$14,844.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12,618.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13,211.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,844.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13,211.87
|
| Rate for Payer: Group Health Inc Commercial |
$14,844.80
|
| Rate for Payer: Group Health Inc Medicare |
$14,844.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26,613.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14,844.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,618.08
|
| Rate for Payer: Healthfirst QHP |
$14,844.80
|
| Rate for Payer: Humana Medicare |
$15,141.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14,844.80
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,844.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,844.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11,875.84
|
| Rate for Payer: Wellcare Medicare |
$14,102.56
|
|
|
INSERTION PENILE PROSTHESIS
|
Facility
|
IP
|
$53,227.13
|
|
|
Service Code
|
HCPCS 54400
|
| Hospital Charge Code |
40123015
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$14,844.80
|
|
|
INSERTION - STEINMAN PIN,HIP
|
Facility
|
OP
|
$3,719.57
|
|
|
Service Code
|
HCPCS 27187
|
| Hospital Charge Code |
40021530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,023.13 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,045.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,023.13
|
| Rate for Payer: Aetna Government |
$1,023.13
|
| Rate for Payer: Brighton Health Commercial |
$2,789.68
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,859.78
|
| Rate for Payer: Group Health Inc Medicare |
$1,301.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,859.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,859.78
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
|
|
Insertion, subcutaneous cardiac rhythm monitor, including programming
|
Facility
|
OP
|
$16,751.00
|
|
|
Service Code
|
CPT 33285
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$16,751.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| 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: 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 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 |
$3,190.00
|
| 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
|
|
|
INSERTION TENCHKOFF CATHETER
|
Facility
|
OP
|
$3,663.33
|
|
|
Service Code
|
HCPCS 49060
|
| Hospital Charge Code |
30103232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,301.14
|
| Rate for Payer: Aetna Government |
$1,301.14
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| 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: EmblemHealth Commercial |
$525.00
|
| 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 |
$1,831.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,831.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
INSERT LEVEEN SHUNT
|
Facility
|
OP
|
$2,425.06
|
|
|
Service Code
|
HCPCS 49425
|
| Hospital Charge Code |
40010960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$848.77 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,333.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$860.90
|
| Rate for Payer: Aetna Government |
$860.90
|
| Rate for Payer: Brighton Health Commercial |
$1,818.80
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,212.53
|
| Rate for Payer: Group Health Inc Medicare |
$848.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,212.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,212.53
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
|
|
INSERT MESH/PELVIC FLR DEFECT REP
|
Facility
|
OP
|
$656.35
|
|
|
Service Code
|
HCPCS 57267
|
| Hospital Charge Code |
40059467
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$229.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$315.75
|
| Rate for Payer: Aetna Government |
$315.75
|
| Rate for Payer: Brighton Health Commercial |
$492.26
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$328.18
|
| Rate for Payer: Group Health Inc Medicare |
$229.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.18
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
INSERT ORTHOPEDIC 14MM X 8.5MM
|
Facility
|
IP
|
$118.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64901813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.38 |
| Max. Negotiated Rate |
$59.38 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.38
|
|
|
INSERT ORTHOPEDIC 14MM X 8.5MM
|
Facility
|
OP
|
$118.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64901813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$71.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.28
|
| Rate for Payer: EmblemHealth Commercial |
$59.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.69
|
| Rate for Payer: Group Health Inc Commercial |
$59.38
|
| Rate for Payer: Group Health Inc Medicare |
$41.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.19
|
|
|
INSERT PERC KIT
|
Facility
|
OP
|
$487.50
|
|
| Hospital Charge Code |
64907138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$170.62 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$268.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$243.75
|
| Rate for Payer: Aetna Government |
$243.75
|
| Rate for Payer: Brighton Health Commercial |
$365.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$390.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$331.50
|
| Rate for Payer: Group Health Inc Commercial |
$243.75
|
| Rate for Payer: Group Health Inc Medicare |
$170.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.75
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$502.93
|
|
|
Service Code
|
HCPCS 57160
|
| Hospital Charge Code |
30301146
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$230.44
|
|
|
INSERT PESSARY/OTHER DEVICE
|
Facility
|
OP
|
$502.93
|
|
|
Service Code
|
HCPCS 57160
|
| Hospital Charge Code |
30301146
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.31 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.44
|
| Rate for Payer: Aetna Government |
$230.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$161.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$161.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$161.31
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.44
|
| 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 |
$230.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.09
|
| 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 |
$251.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.87
|
| Rate for Payer: Healthfirst QHP |
$230.44
|
| Rate for Payer: Humana Medicare |
$235.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.44
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$184.35
|
| Rate for Payer: Wellcare Medicare |
$218.92
|
|
|
INSERT PICC CATH 5+ YEARS OF AGE
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
30105351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,852.05
|
| Rate for Payer: Aetna Government |
$1,852.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,296.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,296.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,296.44
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,852.05
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,852.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,852.05
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,852.05
|
| Rate for Payer: Humana Medicare |
$1,889.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,852.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,852.05
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,852.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,481.64
|
| Rate for Payer: Wellcare Medicare |
$1,759.45
|
|
|
INSERT PICC CATH 5+ YEARS OF AGE
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
30105351
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
INSERT PS 11MM SIZE 3-4
|
Facility
|
IP
|
$2,736.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64904493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,368.06 |
| Max. Negotiated Rate |
$1,368.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,368.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,368.06
|
|
|
INSERT PS 11MM SIZE 3-4
|
Facility
|
OP
|
$2,736.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64904493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,872.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,504.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,641.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,368.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,573.27
|
| Rate for Payer: EmblemHealth Commercial |
$1,368.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,872.94
|
| Rate for Payer: Group Health Inc Commercial |
$1,368.06
|
| Rate for Payer: Group Health Inc Medicare |
$957.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,368.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,368.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,778.48
|
|
|
INSERT PULSE GEN W DUAL LEADS
|
Facility
|
OP
|
$68,791.68
|
|
|
Service Code
|
HCPCS 33230
|
| Hospital Charge Code |
66520282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$51,593.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,258.51
|
| Rate for Payer: Aetna Government |
$27,258.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19,080.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19,080.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,080.96
|
| Rate for Payer: Brighton Health Commercial |
$51,593.76
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,258.51
|
| 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 |
$27,258.51
|
| Rate for Payer: EmblemHealth Commercial |
$27,258.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23,169.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24,260.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,258.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,260.07
|
| Rate for Payer: Group Health Inc Commercial |
$27,258.51
|
| Rate for Payer: Group Health Inc Medicare |
$27,258.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34,395.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,258.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,169.73
|
| Rate for Payer: Healthfirst QHP |
$27,258.51
|
| Rate for Payer: Humana Medicare |
$27,803.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,258.51
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,258.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,258.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,806.81
|
| Rate for Payer: Wellcare Medicare |
$25,895.58
|
|
|
INSERT PULSE GEN W DUAL LEADS
|
Facility
|
IP
|
$68,791.68
|
|
|
Service Code
|
HCPCS 33230
|
| Hospital Charge Code |
66520282
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$27,258.51
|
|
