|
HUMAN FEMUR SHAFT TISSUE 24.0CM
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
64906217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.70 |
| Max. Negotiated Rate |
$1,879.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$595.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,879.82
|
| Rate for Payer: Aetna Government |
$1,879.82
|
| Rate for Payer: Brighton Health Commercial |
$649.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$541.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$622.15
|
| Rate for Payer: EmblemHealth Commercial |
$541.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,136.10
|
| Rate for Payer: Group Health Inc Commercial |
$541.00
|
| Rate for Payer: Group Health Inc Medicare |
$378.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$541.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$541.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$703.30
|
|
|
HUMAN FEMUR SHAFT TISSUE 24.0CM
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
40002336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$541.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$541.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$541.00
|
|
|
HUMAN FEMUR SHAFT TISSUE 24.0CM
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
64906217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$541.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$541.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$541.00
|
|
|
HUMAN FEMUR SHAFT TISSUE 24.0CM
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
40002336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.70 |
| Max. Negotiated Rate |
$1,879.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$595.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,879.82
|
| Rate for Payer: Aetna Government |
$1,879.82
|
| Rate for Payer: Brighton Health Commercial |
$649.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$541.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$622.15
|
| Rate for Payer: EmblemHealth Commercial |
$541.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,136.10
|
| Rate for Payer: Group Health Inc Commercial |
$541.00
|
| Rate for Payer: Group Health Inc Medicare |
$378.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$541.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$541.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$703.30
|
|
|
HUMAN GRANULOCYTIC EHRLICH-HGE
|
Facility
|
IP
|
$25.45
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
40729362
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$10.18
|
|
|
HUMAN GRANULOCYTIC EHRLICH-HGE
|
Facility
|
OP
|
$25.45
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
40729362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.18
|
| Rate for Payer: Aetna Government |
$10.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.13
|
| Rate for Payer: Brighton Health Commercial |
$19.09
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.18
|
| Rate for Payer: EmblemHealth Commercial |
$10.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.18
|
| Rate for Payer: Healthfirst QHP |
$10.18
|
| Rate for Payer: Humana Medicare |
$10.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare Commercial |
$12.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.14
|
| Rate for Payer: Wellcare Medicare |
$9.16
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE INJ 0.5 ML
|
Facility
|
OP
|
$242.00
|
|
| Hospital Charge Code |
41644545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.00
|
| Rate for Payer: Aetna Government |
$121.00
|
| Rate for Payer: Brighton Health Commercial |
$145.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$121.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$139.15
|
| Rate for Payer: Group Health Inc Commercial |
$121.00
|
| Rate for Payer: Group Health Inc Medicare |
$84.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.30
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE INJ 0.5 ML
|
Facility
|
IP
|
$242.00
|
|
| Hospital Charge Code |
41654545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.00
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE INJ 0.5 ML
|
Facility
|
OP
|
$242.00
|
|
| Hospital Charge Code |
41654545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.00
|
| Rate for Payer: Aetna Government |
$121.00
|
| Rate for Payer: Brighton Health Commercial |
$145.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$121.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$139.15
|
| Rate for Payer: Group Health Inc Commercial |
$121.00
|
| Rate for Payer: Group Health Inc Medicare |
$84.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.30
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE INJ 0.5 ML
|
Facility
|
IP
|
$242.00
|
|
| Hospital Charge Code |
41644545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.00
|
|
|
HUMAN PAP VIRUS VACC 9-VAL SYR
|
Facility
|
OP
|
$389.39
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
41647929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$23,021.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.16
|
| 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 |
$292.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$311.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$264.79
|
| 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 |
$194.70
|
| Rate for Payer: Group Health Inc Medicare |
$136.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.70
|
| 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 |
$253.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.21
|
|
|
HUMAN PAP VIRUS VACC 9-VAL SYR
|
Facility
|
IP
|
$389.39
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
41657929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.70 |
| Max. Negotiated Rate |
$194.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.70
|
|
|
HUMAN PAP VIRUS VACC 9-VAL SYR
|
Facility
|
OP
|
$389.39
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
41657929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$23,021.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.16
|
| 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 |
$233.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$194.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$223.90
|
| 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 |
$194.70
|
| Rate for Payer: Group Health Inc Medicare |
$136.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.70
|
| 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 |
$253.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.21
|
|
|
HUMAN PAP VIRUS VACC 9-VAL VIAL
|
Facility
|
OP
|
$389.39
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
41647931
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$23,021.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.16
|
| 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 |
$292.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$311.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$264.79
|
| 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 |
$194.70
|
| Rate for Payer: Group Health Inc Medicare |
$136.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.70
|
| 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 |
$253.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.21
|
|
|
HUMAN PAP VIRUS VACC 9-VAL VIAL
|
Facility
|
OP
|
$389.39
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
41657931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$23,021.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.16
|
| 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 |
$233.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$194.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$223.90
|
| 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 |
$194.70
|
| Rate for Payer: Group Health Inc Medicare |
$136.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.70
|
| 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 |
$253.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.21
|
|
|
HUMAN PAP VIRUS VACC 9-VAL VIAL
|
Facility
|
IP
|
$389.39
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
41657931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.70 |
| Max. Negotiated Rate |
$194.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.70
|
|
|
HUMATE -P 1,200RCF FACTOR VIII
|
Facility
|
OP
|
$5.88
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
41640212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.35
|
| Rate for Payer: Aetna Government |
$1.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.94
|
| Rate for Payer: Brighton Health Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.35
|
| Rate for Payer: EmblemHealth Commercial |
$1.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.42
|
| Rate for Payer: Group Health Inc Commercial |
$1.35
|
| Rate for Payer: Group Health Inc Medicare |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.15
|
| Rate for Payer: Healthfirst QHP |
$1.35
|
| Rate for Payer: Humana Medicare |
$1.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.48
|
| Rate for Payer: SOMOS Essential |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.08
|
| Rate for Payer: Wellcare Medicare |
$1.28
|
|
|
HUMATE -P 1,200RCF FACTOR VIII
|
Facility
|
IP
|
$5.88
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
41640212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
|
|
HUMATE -P 1,200RCF FACTOR VIII
|
Facility
|
OP
|
$5.88
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
41650212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.35
|
| Rate for Payer: Aetna Government |
$1.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.94
|
| Rate for Payer: Brighton Health Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.35
|
| Rate for Payer: EmblemHealth Commercial |
$1.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.42
|
| Rate for Payer: Group Health Inc Commercial |
$1.35
|
| Rate for Payer: Group Health Inc Medicare |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.15
|
| Rate for Payer: Healthfirst QHP |
$1.35
|
| Rate for Payer: Humana Medicare |
$1.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.48
|
| Rate for Payer: SOMOS Essential |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.08
|
| Rate for Payer: Wellcare Medicare |
$1.28
|
|
|
HUMATE -P 1,200RCF FACTOR VIII
|
Facility
|
IP
|
$5.88
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
41650212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
|
|
HUMATE -P 2,400RCF FACTOR VIII
|
Facility
|
OP
|
$5.88
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
41650214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.35
|
| Rate for Payer: Aetna Government |
$1.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.94
|
| Rate for Payer: Brighton Health Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.35
|
| Rate for Payer: EmblemHealth Commercial |
$1.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.42
|
| Rate for Payer: Group Health Inc Commercial |
$1.35
|
| Rate for Payer: Group Health Inc Medicare |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.15
|
| Rate for Payer: Healthfirst QHP |
$1.35
|
| Rate for Payer: Humana Medicare |
$1.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.48
|
| Rate for Payer: SOMOS Essential |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.08
|
| Rate for Payer: Wellcare Medicare |
$1.28
|
|
|
HUMATE -P 2,400RCF FACTOR VIII
|
Facility
|
IP
|
$5.88
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
41640214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
|
|
HUMATE -P 2,400RCF FACTOR VIII
|
Facility
|
OP
|
$5.88
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
41640214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.35
|
| Rate for Payer: Aetna Government |
$1.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.94
|
| Rate for Payer: Brighton Health Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.35
|
| Rate for Payer: EmblemHealth Commercial |
$1.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.42
|
| Rate for Payer: Group Health Inc Commercial |
$1.35
|
| Rate for Payer: Group Health Inc Medicare |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.15
|
| Rate for Payer: Healthfirst QHP |
$1.35
|
| Rate for Payer: Humana Medicare |
$1.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.48
|
| Rate for Payer: SOMOS Essential |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.08
|
| Rate for Payer: Wellcare Medicare |
$1.28
|
|
|
HUMATE -P 2,400RCF FACTOR VIII
|
Facility
|
IP
|
$5.88
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
41650214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
|
|
HUMERAL NAIL 7 X 200
|
Facility
|
IP
|
$2,900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,450.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,450.00
|
|
