|
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$141,120.14
|
|
|
Service Code
|
MSDRG 969
|
| Min. Negotiated Rate |
$47,724.27 |
| Max. Negotiated Rate |
$141,120.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101,336.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102,632.83
|
| Rate for Payer: Aetna Government |
$102,632.83
|
| Rate for Payer: Brighton Health Commercial |
$99,652.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104,685.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$118,682.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$97,942.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$97,501.19
|
| Rate for Payer: EmblemHealth Commercial |
$58,932.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$102,632.83
|
| Rate for Payer: Group Health Inc Commercial |
$102,632.83
|
| Rate for Payer: Group Health Inc Medicare |
$102,632.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102,632.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47,724.27
|
| Rate for Payer: Humana Medicare |
$141,120.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102,632.83
|
| Rate for Payer: United Healthcare Commercial |
$136,675.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102,632.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102,632.83
|
| Rate for Payer: Wellcare Medicare |
$97,501.19
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$63,076.23
|
|
|
Service Code
|
MSDRG 970
|
| Min. Negotiated Rate |
$20,617.70 |
| Max. Negotiated Rate |
$63,076.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35,452.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45,873.62
|
| Rate for Payer: Aetna Government |
$45,873.62
|
| Rate for Payer: Brighton Health Commercial |
$34,863.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46,791.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48,000.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39,612.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$43,579.94
|
| Rate for Payer: EmblemHealth Commercial |
$20,617.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$45,873.62
|
| Rate for Payer: Group Health Inc Commercial |
$45,873.62
|
| Rate for Payer: Group Health Inc Medicare |
$45,873.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45,873.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21,331.23
|
| Rate for Payer: Humana Medicare |
$63,076.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45,873.62
|
| Rate for Payer: United Healthcare Commercial |
$55,277.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45,873.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45,873.62
|
| Rate for Payer: Wellcare Medicare |
$43,579.94
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
|
IP
|
$36,070.73
|
|
|
Service Code
|
MSDRG 975
|
| Min. Negotiated Rate |
$11,690.30 |
| Max. Negotiated Rate |
$36,070.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,101.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,233.26
|
| Rate for Payer: Aetna Government |
$26,233.26
|
| Rate for Payer: Brighton Health Commercial |
$19,767.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,757.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23,542.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,428.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,921.60
|
| Rate for Payer: EmblemHealth Commercial |
$11,690.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,233.26
|
| Rate for Payer: Group Health Inc Commercial |
$26,233.26
|
| Rate for Payer: Group Health Inc Medicare |
$26,233.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,233.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,198.47
|
| Rate for Payer: Humana Medicare |
$36,070.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,233.26
|
| Rate for Payer: United Healthcare Commercial |
$27,111.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,233.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,233.26
|
| Rate for Payer: Wellcare Medicare |
$24,921.60
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
|
IP
|
$65,686.61
|
|
|
Service Code
|
MSDRG 974
|
| Min. Negotiated Rate |
$22,214.02 |
| Max. Negotiated Rate |
$65,686.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43,003.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47,772.08
|
| Rate for Payer: Aetna Government |
$47,772.08
|
| Rate for Payer: Brighton Health Commercial |
$42,289.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48,727.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50,365.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41,563.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$45,383.48
|
| Rate for Payer: EmblemHealth Commercial |
$25,009.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$47,772.08
|
| Rate for Payer: Group Health Inc Commercial |
$47,772.08
|
| Rate for Payer: Group Health Inc Medicare |
$47,772.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47,772.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22,214.02
|
| Rate for Payer: Humana Medicare |
$65,686.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47,772.08
|
| Rate for Payer: United Healthcare Commercial |
$58,000.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47,772.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47,772.08
|
| Rate for Payer: Wellcare Medicare |
$45,383.48
|
|
|
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
|
IP
|
$26,193.67
|
|
|
Service Code
|
MSDRG 976
|
| Min. Negotiated Rate |
$7,248.45 |
| Max. Negotiated Rate |
$26,193.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,463.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,049.94
|
| Rate for Payer: Aetna Government |
$19,049.94
|
| Rate for Payer: Brighton Health Commercial |
$12,256.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,430.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,597.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,046.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,097.44
|
| Rate for Payer: EmblemHealth Commercial |
$7,248.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,049.94
|
| Rate for Payer: Group Health Inc Commercial |
$19,049.94
|
| Rate for Payer: Group Health Inc Medicare |
$19,049.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,049.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,858.22
|
| Rate for Payer: Humana Medicare |
$26,193.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,049.94
|
| Rate for Payer: United Healthcare Commercial |
$16,810.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,049.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,049.94
|
| Rate for Payer: Wellcare Medicare |
$18,097.44
|
|
|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$37,077.48
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$12,143.10 |
| Max. Negotiated Rate |
$37,077.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,880.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,965.44
|
| Rate for Payer: Aetna Government |
$26,965.44
|
| Rate for Payer: Brighton Health Commercial |
$20,533.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,504.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,454.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,181.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,617.17
|
| Rate for Payer: EmblemHealth Commercial |
$12,143.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,965.44
|
| Rate for Payer: Group Health Inc Commercial |
$26,965.44
|
| Rate for Payer: Group Health Inc Medicare |
$26,965.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,965.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,538.93
|
| Rate for Payer: Humana Medicare |
$37,077.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,965.44
|
| Rate for Payer: United Healthcare Commercial |
$28,161.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,965.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,965.44
|
| Rate for Payer: Wellcare Medicare |
$25,617.17
|
|
|
HLA B 27 DISEASE ASSOCIATION
|
Facility
|
IP
|
$185.83
|
|
|
Service Code
|
HCPCS 81374
|
| Hospital Charge Code |
40729231
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$74.33
|
|
|
HLA B 27 DISEASE ASSOCIATION
|
Facility
|
OP
|
$185.83
|
|
|
Service Code
|
HCPCS 81374
|
| Hospital Charge Code |
40729231
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.03 |
| Max. Negotiated Rate |
$148.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.33
|
| Rate for Payer: Aetna Government |
$74.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$52.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$52.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$52.03
|
| Rate for Payer: Brighton Health Commercial |
$74.33
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$148.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$74.33
|
| Rate for Payer: EmblemHealth Commercial |
$74.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.15
|
| Rate for Payer: Group Health Inc Commercial |
$74.33
|
| Rate for Payer: Group Health Inc Medicare |
$74.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.33
|
| Rate for Payer: Healthfirst QHP |
$74.33
|
| Rate for Payer: Humana Medicare |
$75.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$59.46
|
| Rate for Payer: Wellcare Medicare |
$66.90
|
|
|
HLA B5701 TEST
|
Facility
|
IP
|
$424.75
|
|
|
Service Code
|
HCPCS 81381
|
| Hospital Charge Code |
40729232
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$169.90
|
|
|
HLA B5701 TEST
|
Facility
|
OP
|
$424.75
|
|
|
Service Code
|
HCPCS 81381
|
| Hospital Charge Code |
40729232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$118.93 |
| Max. Negotiated Rate |
$339.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.90
|
| Rate for Payer: Aetna Government |
$169.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$118.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$118.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$118.93
|
| Rate for Payer: Brighton Health Commercial |
$169.90
|
| Rate for Payer: Cash Price |
$169.90
|
| Rate for Payer: Cash Price |
$169.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$339.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$169.90
|
| Rate for Payer: EmblemHealth Commercial |
$169.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$151.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.21
|
| Rate for Payer: Group Health Inc Commercial |
$169.90
|
| Rate for Payer: Group Health Inc Medicare |
$169.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$169.90
|
| Rate for Payer: Healthfirst QHP |
$169.90
|
| Rate for Payer: Humana Medicare |
$173.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$135.92
|
| Rate for Payer: Wellcare Medicare |
$152.91
|
|
|
HLA-B5701 TYPING
|
Facility
|
OP
|
$424.75
|
|
|
Service Code
|
HCPCS 81381
|
| Hospital Charge Code |
40728370
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$118.93 |
| Max. Negotiated Rate |
$339.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.90
|
| Rate for Payer: Aetna Government |
$169.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$118.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$118.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$118.93
|
| Rate for Payer: Brighton Health Commercial |
$169.90
|
| Rate for Payer: Cash Price |
$169.90
|
| Rate for Payer: Cash Price |
$169.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$339.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$169.90
|
| Rate for Payer: EmblemHealth Commercial |
$169.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$151.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.21
|
| Rate for Payer: Group Health Inc Commercial |
$169.90
|
| Rate for Payer: Group Health Inc Medicare |
$169.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$169.90
|
| Rate for Payer: Healthfirst QHP |
$169.90
|
| Rate for Payer: Humana Medicare |
$173.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$135.92
|
| Rate for Payer: Wellcare Medicare |
$152.91
|
|
|
HLA-B5701 TYPING
|
Facility
|
IP
|
$424.75
|
|
|
Service Code
|
HCPCS 81381
|
| Hospital Charge Code |
40728370
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$169.90
|
|
|
HLA DRB1,DRB345 (IR)
|
Facility
|
IP
|
$305.55
|
|
|
Service Code
|
HCPCS 81376
|
| Hospital Charge Code |
40609850
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$122.22
|
|
|
HLA DRB1,DRB345 (IR)
|
Facility
|
OP
|
$305.55
|
|
|
Service Code
|
HCPCS 81376
|
| Hospital Charge Code |
40609850
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.55 |
| Max. Negotiated Rate |
$244.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$168.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.22
|
| Rate for Payer: Aetna Government |
$122.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$85.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$85.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$85.55
|
| Rate for Payer: Brighton Health Commercial |
$122.22
|
| Rate for Payer: Cash Price |
$122.22
|
| Rate for Payer: Cash Price |
$122.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$244.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$207.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$122.22
|
| Rate for Payer: EmblemHealth Commercial |
$122.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.78
|
| Rate for Payer: Group Health Inc Commercial |
$122.22
|
| Rate for Payer: Group Health Inc Medicare |
$122.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.22
|
| Rate for Payer: Healthfirst QHP |
$122.22
|
| Rate for Payer: Humana Medicare |
$124.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$97.78
|
| Rate for Payer: Wellcare Medicare |
$110.00
|
|
|
HLB VACCINE PRT-T, IM
|
Facility
|
OP
|
$25.63
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
30301193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$16.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.42
|
| Rate for Payer: Aetna Government |
$12.42
|
| Rate for Payer: Brighton Health Commercial |
$15.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.74
|
| Rate for Payer: Group Health Inc Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Medicare |
$8.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.66
|
|
|
HLB VACCINE PRT-T, IM
|
Facility
|
IP
|
$25.63
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
30301193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
|
|
HMP LIFEPORT ACCESS VASCULAR
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
40209366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$322.77
|
| Rate for Payer: Aetna Government |
$322.77
|
| Rate for Payer: Brighton Health Commercial |
$234.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: EmblemHealth Commercial |
$195.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
HMP LIFEPORT ACCESS VASCULAR
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
40209366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
HNBR5.0-38-65-P 65CM KMP SLIPCA
|
Facility
|
OP
|
$37.15
|
|
| Hospital Charge Code |
64905032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$29.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.58
|
| Rate for Payer: Aetna Government |
$18.58
|
| Rate for Payer: Brighton Health Commercial |
$27.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.26
|
| Rate for Payer: Group Health Inc Commercial |
$18.58
|
| Rate for Payer: Group Health Inc Medicare |
$13.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.58
|
|
|
HOFFMANII MRI PINS 150MM
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$627.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$684.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$570.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$655.50
|
| Rate for Payer: EmblemHealth Commercial |
$570.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,197.00
|
| Rate for Payer: Group Health Inc Commercial |
$570.00
|
| Rate for Payer: Group Health Inc Medicare |
$399.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$570.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$570.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$741.00
|
|
|
HOFFMANII MRI PINS 150MM
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.00 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$570.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$570.00
|
|
|
HOFFMAN ROD 5X250MM
|
Facility
|
OP
|
$1,594.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,673.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$876.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$956.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$797.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$916.55
|
| Rate for Payer: EmblemHealth Commercial |
$797.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,673.70
|
| Rate for Payer: Group Health Inc Commercial |
$797.00
|
| Rate for Payer: Group Health Inc Medicare |
$557.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$797.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$797.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,036.10
|
|
|
HOFFMAN ROD 5X250MM
|
Facility
|
IP
|
$1,594.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$797.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$797.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$797.00
|
|
|
HOLDER DISP LIMB WRIST
|
Facility
|
OP
|
$10.38
|
|
| Hospital Charge Code |
64901894
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.19
|
| Rate for Payer: Aetna Government |
$5.19
|
| Rate for Payer: Brighton Health Commercial |
$7.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.06
|
| Rate for Payer: Group Health Inc Commercial |
$5.19
|
| Rate for Payer: Group Health Inc Medicare |
$3.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.19
|
|
|
HOLDER,ENDOTRACH,MINI,PURPLE
|
Facility
|
OP
|
$27.47
|
|
| Hospital Charge Code |
64903258
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.74
|
| Rate for Payer: Aetna Government |
$13.74
|
| Rate for Payer: Brighton Health Commercial |
$20.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.68
|
| Rate for Payer: Group Health Inc Commercial |
$13.74
|
| Rate for Payer: Group Health Inc Medicare |
$9.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.74
|
|
