|
HPV VACC 9-VAL (VFC)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
41657927
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$23,021.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$258.54
|
| Rate for Payer: Aetna Government |
$258.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$517.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$517.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$230.21
|
| Rate for Payer: Amida Care Medicaid |
$230.21
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,021.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$230.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$241.72
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$230.21
|
| Rate for Payer: Healthfirst Essential Plan |
$517.97
|
| Rate for Payer: Healthfirst QHP |
$230.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$230.21
|
| Rate for Payer: SOMOS Essential |
$230.21
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$517.97
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$253.23
|
| Rate for Payer: United Healthcare Medicaid |
$230.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.21
|
|
|
HPV VACC 9-VAL (VFC)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
41647927
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$23,021.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$258.54
|
| Rate for Payer: Aetna Government |
$258.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$517.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$517.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$230.21
|
| Rate for Payer: Amida Care Medicaid |
$230.21
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,021.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$230.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$241.72
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$230.21
|
| Rate for Payer: Healthfirst Essential Plan |
$517.97
|
| Rate for Payer: Healthfirst QHP |
$230.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$230.21
|
| Rate for Payer: SOMOS Essential |
$230.21
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$517.97
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$253.23
|
| Rate for Payer: United Healthcare Medicaid |
$230.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.21
|
|
|
HPV VACCINE
|
Facility
|
OP
|
$132.50
|
|
|
Service Code
|
HCPCS 90650
|
| Hospital Charge Code |
30303095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.38 |
| Max. Negotiated Rate |
$141.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$141.25
|
| Rate for Payer: Aetna Government |
$141.25
|
| Rate for Payer: Brighton Health Commercial |
$99.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.10
|
| Rate for Payer: Group Health Inc Commercial |
$66.25
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.12
|
|
|
HPV VACCINE (3 DOSE SCHEDULE)
|
Facility
|
OP
|
$241.50
|
|
|
Service Code
|
HCPCS 90649
|
| Hospital Charge Code |
30303091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.52 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.24
|
| Rate for Payer: Aetna Government |
$163.24
|
| Rate for Payer: Brighton Health Commercial |
$181.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.22
|
| Rate for Payer: Group Health Inc Commercial |
$120.75
|
| Rate for Payer: Group Health Inc Medicare |
$84.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.98
|
|
|
HPV VACCINE 3 DOSE SCHEDULE
|
Facility
|
OP
|
$116.57
|
|
|
Service Code
|
HCPCS 90649 SL
|
| Hospital Charge Code |
30301407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$163.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.24
|
| Rate for Payer: Aetna Government |
$163.24
|
| Rate for Payer: Brighton Health Commercial |
$87.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$79.27
|
| Rate for Payer: Group Health Inc Commercial |
$58.28
|
| Rate for Payer: Group Health Inc Medicare |
$40.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.77
|
|
|
HPV (VFC) 0.5ML VIAL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90649
|
| Hospital Charge Code |
41659561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
HPV (VFC) 0.5ML VIAL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90649
|
| Hospital Charge Code |
41649561
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$163.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.24
|
| Rate for Payer: Aetna Government |
$163.24
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
HPV (VFC) 0.5ML VIAL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90649
|
| Hospital Charge Code |
41659561
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$163.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.24
|
| Rate for Payer: Aetna Government |
$163.24
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
H. PYLORI, IGG ABS
|
Facility
|
OP
|
$42.13
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
40729364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.85
|
| Rate for Payer: Aetna Government |
$16.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.80
|
| Rate for Payer: Brighton Health Commercial |
$31.60
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.85
|
| Rate for Payer: EmblemHealth Commercial |
$16.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.00
|
| Rate for Payer: Group Health Inc Commercial |
$16.85
|
| Rate for Payer: Group Health Inc Medicare |
$16.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.85
|
| Rate for Payer: Healthfirst QHP |
$16.85
|
| Rate for Payer: Humana Medicare |
$17.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.85
|
| Rate for Payer: United Healthcare Commercial |
$18.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.48
|
| Rate for Payer: Wellcare Medicare |
$15.16
|
|
|
H. PYLORI, IGG ABS
|
Facility
|
IP
|
$42.13
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
40729364
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.85
|
|
|
H. PYLORI STOOL AG, EIA
|
Facility
|
OP
|
$35.95
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
40619195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.38
|
| Rate for Payer: Aetna Government |
$14.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$26.96
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.38
|
| Rate for Payer: EmblemHealth Commercial |
$14.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.80
|
| Rate for Payer: Group Health Inc Commercial |
$14.38
|
| Rate for Payer: Group Health Inc Medicare |
$14.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.38
|
| Rate for Payer: Healthfirst QHP |
$14.38
|
| Rate for Payer: Humana Medicare |
$14.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.38
|
| Rate for Payer: United Healthcare Commercial |
$18.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.50
|
| Rate for Payer: Wellcare Medicare |
$12.94
|
|
|
H. PYLORI STOOL AG, EIA
|
Facility
|
IP
|
$35.95
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
40619195
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$14.38
|
|
|
HRIS ACET CUP CUT TIP
|
Facility
|
OP
|
$3,143.00
|
|
| Hospital Charge Code |
64907289
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,100.05 |
| Max. Negotiated Rate |
$2,514.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,728.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,571.50
|
| Rate for Payer: Aetna Government |
$1,571.50
|
| Rate for Payer: Brighton Health Commercial |
$2,357.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,514.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,137.24
|
| Rate for Payer: Group Health Inc Commercial |
$1,571.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,100.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,571.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,571.50
|
|
|
HRIS ACET CUP SCT GUIDE
|
Facility
|
OP
|
$731.50
|
|
| Hospital Charge Code |
64907290
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$256.02 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$402.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.75
|
| Rate for Payer: Aetna Government |
$365.75
|
| Rate for Payer: Brighton Health Commercial |
$548.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$585.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$497.42
|
| Rate for Payer: Group Health Inc Commercial |
$365.75
|
| Rate for Payer: Group Health Inc Medicare |
$256.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$365.75
|
|
|
HRIS CANN END
|
Facility
|
OP
|
$1,715.00
|
|
| Hospital Charge Code |
64907283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$600.25 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$943.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$857.50
|
| Rate for Payer: Aetna Government |
$857.50
|
| Rate for Payer: Brighton Health Commercial |
$1,286.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,372.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,166.20
|
| Rate for Payer: Group Health Inc Commercial |
$857.50
|
| Rate for Payer: Group Health Inc Medicare |
$600.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$857.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$857.50
|
|
|
HRIS END MILL GRIP
|
Facility
|
OP
|
$5,633.25
|
|
| Hospital Charge Code |
64907285
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,971.64 |
| Max. Negotiated Rate |
$4,506.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,098.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,816.62
|
| Rate for Payer: Aetna Government |
$2,816.62
|
| Rate for Payer: Brighton Health Commercial |
$4,224.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,506.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,830.61
|
| Rate for Payer: Group Health Inc Commercial |
$2,816.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,971.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,816.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,816.62
|
|
|
HRIS FLEXIBLE OSTEO
|
Facility
|
OP
|
$1,055.25
|
|
| Hospital Charge Code |
64907284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$369.34 |
| Max. Negotiated Rate |
$844.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$580.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$527.62
|
| Rate for Payer: Aetna Government |
$527.62
|
| Rate for Payer: Brighton Health Commercial |
$791.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$844.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$717.57
|
| Rate for Payer: Group Health Inc Commercial |
$527.62
|
| Rate for Payer: Group Health Inc Medicare |
$369.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$527.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$527.62
|
|
|
HRIS OSTEO CUR
|
Facility
|
OP
|
$770.00
|
|
| Hospital Charge Code |
64907286
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$423.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$385.00
|
| Rate for Payer: Aetna Government |
$385.00
|
| Rate for Payer: Brighton Health Commercial |
$577.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$616.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$523.60
|
| Rate for Payer: Group Health Inc Commercial |
$385.00
|
| Rate for Payer: Group Health Inc Medicare |
$269.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$385.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$385.00
|
|
|
HRIS OSTEO STR
|
Facility
|
OP
|
$682.50
|
|
| Hospital Charge Code |
64907287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$375.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$341.25
|
| Rate for Payer: Aetna Government |
$341.25
|
| Rate for Payer: Brighton Health Commercial |
$511.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$546.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$464.10
|
| Rate for Payer: Group Health Inc Commercial |
$341.25
|
| Rate for Payer: Group Health Inc Medicare |
$238.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.25
|
|
|
HRIS ROUND GOUGE
|
Facility
|
OP
|
$1,435.00
|
|
| Hospital Charge Code |
64907288
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$502.25 |
| Max. Negotiated Rate |
$1,148.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$789.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$717.50
|
| Rate for Payer: Aetna Government |
$717.50
|
| Rate for Payer: Brighton Health Commercial |
$1,076.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,148.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$975.80
|
| Rate for Payer: Group Health Inc Commercial |
$717.50
|
| Rate for Payer: Group Health Inc Medicare |
$502.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$717.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$717.50
|
|
|
HSC GEL BREAST IMPLANT
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
40005330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$715.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$715.00
|
|
|
HSC GEL BREAST IMPLANT
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
40005330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.32 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$786.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.32
|
| Rate for Payer: Aetna Government |
$402.32
|
| Rate for Payer: Brighton Health Commercial |
$858.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$715.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$822.25
|
| Rate for Payer: EmblemHealth Commercial |
$715.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,501.50
|
| Rate for Payer: Group Health Inc Commercial |
$715.00
|
| Rate for Payer: Group Health Inc Medicare |
$500.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$715.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$715.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$929.50
|
|
|
HSC+ GEL BREAST IMPLANT
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
40005335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.00 |
| Max. Negotiated Rate |
$895.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$895.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$895.00
|
|
|
HSC+ GEL BREAST IMPLANT
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
40005335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.32 |
| Max. Negotiated Rate |
$1,879.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$984.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.32
|
| Rate for Payer: Aetna Government |
$402.32
|
| Rate for Payer: Brighton Health Commercial |
$1,074.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$895.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,029.25
|
| Rate for Payer: EmblemHealth Commercial |
$895.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,879.50
|
| Rate for Payer: Group Health Inc Commercial |
$895.00
|
| Rate for Payer: Group Health Inc Medicare |
$626.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$895.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$895.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,163.50
|
|
|
HSC MOD PLUS GEL BREAST IMP
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
40004201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.32 |
| Max. Negotiated Rate |
$1,879.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$984.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.32
|
| Rate for Payer: Aetna Government |
$402.32
|
| Rate for Payer: Brighton Health Commercial |
$1,074.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$895.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,029.25
|
| Rate for Payer: EmblemHealth Commercial |
$895.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,879.50
|
| Rate for Payer: Group Health Inc Commercial |
$895.00
|
| Rate for Payer: Group Health Inc Medicare |
$626.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$895.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$895.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,163.50
|
|
