|
HUMERAL NAIL 7 X 200
|
Facility
|
OP
|
$2,900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,045.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,595.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,740.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,450.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,667.50
|
| Rate for Payer: EmblemHealth Commercial |
$1,450.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,045.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,450.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,015.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,450.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,450.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,885.00
|
|
|
HUM MRS BODY M/F TAPER
|
Facility
|
IP
|
$9,268.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,634.06 |
| Max. Negotiated Rate |
$4,634.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,634.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,634.06
|
|
|
HUM MRS BODY M/F TAPER
|
Facility
|
OP
|
$9,268.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$9,731.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,097.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$5,560.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,634.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,329.17
|
| Rate for Payer: EmblemHealth Commercial |
$4,634.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,731.53
|
| Rate for Payer: Group Health Inc Commercial |
$4,634.06
|
| Rate for Payer: Group Health Inc Medicare |
$3,243.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,634.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,634.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,024.28
|
|
|
HVA, 24HR URINE
|
Facility
|
OP
|
$34.24
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
40608255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$30.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.41
|
| Rate for Payer: Aetna Government |
$22.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.69
|
| Rate for Payer: Brighton Health Commercial |
$25.68
|
| Rate for Payer: Cash Price |
$22.41
|
| Rate for Payer: Cash Price |
$22.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.41
|
| Rate for Payer: EmblemHealth Commercial |
$22.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.94
|
| Rate for Payer: Group Health Inc Commercial |
$22.41
|
| Rate for Payer: Group Health Inc Medicare |
$22.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.41
|
| Rate for Payer: Healthfirst QHP |
$22.41
|
| Rate for Payer: Humana Medicare |
$22.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.41
|
| Rate for Payer: United Healthcare Commercial |
$24.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.93
|
| Rate for Payer: Wellcare Medicare |
$20.17
|
|
|
HVA, 24HR URINE
|
Facility
|
IP
|
$34.24
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
40608255
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$22.41
|
|
|
HYALOMATRIX PER SQ CM
|
Facility
|
IP
|
$42.44
|
|
|
Service Code
|
HCPCS Q4117
|
| Hospital Charge Code |
40001366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.22
|
|
|
HYALOMATRIX PER SQ CM
|
Facility
|
OP
|
$42.44
|
|
|
Service Code
|
HCPCS Q4117
|
| Hospital Charge Code |
40001366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$27.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.80
|
| Rate for Payer: Aetna Government |
$19.80
|
| Rate for Payer: Brighton Health Commercial |
$25.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.40
|
| Rate for Payer: Group Health Inc Commercial |
$21.22
|
| Rate for Payer: Group Health Inc Medicare |
$14.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.59
|
|
|
HYALOMATRIX, PER SQ CM
|
Facility
|
IP
|
$42.44
|
|
|
Service Code
|
HCPCS Q4117
|
| Hospital Charge Code |
40201963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.22
|
|
|
HYALOMATRIX, PER SQ CM
|
Facility
|
OP
|
$42.44
|
|
|
Service Code
|
HCPCS Q4117
|
| Hospital Charge Code |
40201963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$27.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.80
|
| Rate for Payer: Aetna Government |
$19.80
|
| Rate for Payer: Brighton Health Commercial |
$25.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.40
|
| Rate for Payer: Group Health Inc Commercial |
$21.22
|
| Rate for Payer: Group Health Inc Medicare |
$14.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.59
|
|
|
HYALURONAN 88 MG/4ML IX SOSY [125669]
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
59676082001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$754.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$714.37
|
| Rate for Payer: Aetna Government |
$714.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$500.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$500.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$500.06
|
| Rate for Payer: Brighton Health Commercial |
$337.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$714.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$714.37
|
| Rate for Payer: EmblemHealth Commercial |
$714.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$607.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$635.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$714.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$635.79
|
| Rate for Payer: Group Health Inc Commercial |
$714.37
|
| Rate for Payer: Group Health Inc Medicare |
$714.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$607.21
|
| Rate for Payer: Healthfirst QHP |
$714.37
|
| Rate for Payer: Humana Medicare |
$728.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$711.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$754.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$754.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$754.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$714.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$714.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$571.49
|
| Rate for Payer: Wellcare Medicare |
$678.65
|
|
|
HYALURONATE NF 48MG/6ML INTRA-ART
|
Facility
|
IP
|
$61.66
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
41646637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.83 |
| Max. Negotiated Rate |
$30.83 |
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.83
|
|
|
HYALURONATE NF 48MG/6ML INTRA-ART
|
Facility
|
IP
|
$61.66
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
41656637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.83 |
| Max. Negotiated Rate |
$30.83 |
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.83
|
|
|
HYALURONATE NF 48MG/6ML INTRA-ART
|
Facility
|
OP
|
$61.66
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
41656637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$40.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.12
|
| Rate for Payer: Aetna Government |
$9.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.39
|
| Rate for Payer: Brighton Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.12
|
| Rate for Payer: EmblemHealth Commercial |
$9.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.58
|
| Rate for Payer: Group Health Inc Commercial |
$9.12
|
| Rate for Payer: Group Health Inc Medicare |
$9.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.75
|
| Rate for Payer: Healthfirst QHP |
$9.12
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.41
|
| Rate for Payer: SOMOS Essential |
$9.41
|
| Rate for Payer: United Healthcare Commercial |
$9.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.30
|
| Rate for Payer: Wellcare Medicare |
$8.67
|
|
|
HYALURONATE NF 48MG/6ML INTRA-ART
|
Facility
|
OP
|
$61.66
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
41646637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$40.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.12
|
| Rate for Payer: Aetna Government |
$9.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.39
|
| Rate for Payer: Brighton Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.12
|
| Rate for Payer: EmblemHealth Commercial |
$9.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.58
|
| Rate for Payer: Group Health Inc Commercial |
$9.12
|
| Rate for Payer: Group Health Inc Medicare |
$9.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.75
|
| Rate for Payer: Healthfirst QHP |
$9.12
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.41
|
| Rate for Payer: SOMOS Essential |
$9.41
|
| Rate for Payer: United Healthcare Commercial |
$9.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.30
|
| Rate for Payer: Wellcare Medicare |
$8.67
|
|
|
HYALURONATE SODIUM
|
Facility
|
IP
|
$51.14
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
41640283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Cash Price |
$714.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.57
|
|
|
HYALURONATE SODIUM
|
Facility
|
OP
|
$51.14
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
41640283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$754.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$714.37
|
| Rate for Payer: Aetna Government |
$714.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$500.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$500.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$500.06
|
| Rate for Payer: Brighton Health Commercial |
$30.68
|
| Rate for Payer: Cash Price |
$714.37
|
| Rate for Payer: Cash Price |
$714.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$714.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$714.37
|
| Rate for Payer: EmblemHealth Commercial |
$714.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$714.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$714.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$750.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$714.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$750.09
|
| Rate for Payer: Group Health Inc Commercial |
$714.37
|
| Rate for Payer: Group Health Inc Medicare |
$714.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$607.21
|
| Rate for Payer: Healthfirst QHP |
$714.37
|
| Rate for Payer: Humana Medicare |
$728.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$714.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$754.24
|
| Rate for Payer: SOMOS Essential |
$754.24
|
| Rate for Payer: United Healthcare Commercial |
$712.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$714.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$571.49
|
| Rate for Payer: Wellcare Medicare |
$678.65
|
|
|
HYALURONATE SODIUM
|
Facility
|
OP
|
$51.14
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
41650283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$754.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$714.37
|
| Rate for Payer: Aetna Government |
$714.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$500.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$500.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$500.06
|
| Rate for Payer: Brighton Health Commercial |
$30.68
|
| Rate for Payer: Cash Price |
$714.37
|
| Rate for Payer: Cash Price |
$714.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$714.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$714.37
|
| Rate for Payer: EmblemHealth Commercial |
$714.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$714.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$714.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$750.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$714.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$750.09
|
| Rate for Payer: Group Health Inc Commercial |
$714.37
|
| Rate for Payer: Group Health Inc Medicare |
$714.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$607.21
|
| Rate for Payer: Healthfirst QHP |
$714.37
|
| Rate for Payer: Humana Medicare |
$728.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$714.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$754.24
|
| Rate for Payer: SOMOS Essential |
$754.24
|
| Rate for Payer: United Healthcare Commercial |
$712.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$714.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$571.49
|
| Rate for Payer: Wellcare Medicare |
$678.65
|
|
|
HYALURONATE SODIUM
|
Facility
|
IP
|
$51.14
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
41650283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Cash Price |
$714.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.57
|
|
|
HYALURONIDASE 200U/ML 1.2ML PER U
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
HCPCS J3471
|
| Hospital Charge Code |
41648008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.47
|
| Rate for Payer: Aetna Government |
$0.47
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
|
HYALURONIDASE 200U/ML 1.2ML PER U
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
HCPCS J3471
|
| Hospital Charge Code |
41658008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.47
|
| Rate for Payer: Aetna Government |
$0.47
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
|
HYALURONIDASE 200U/ML 1.2ML PER U
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
HCPCS J3471
|
| Hospital Charge Code |
41658008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
|
|
HYALURONIDASE 200U/ML 1.2ML PER U
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
HCPCS J3471
|
| Hospital Charge Code |
41648008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
|
|
HYALURONIDASE OVINE 200 UNIT/ML IJ SOLN [40449]
|
Facility
|
OP
|
$120.83
|
|
|
Service Code
|
HCPCS J3471
|
| Hospital Charge Code |
24208000202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$96.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.47
|
| Rate for Payer: Aetna Government |
$0.47
|
| Rate for Payer: Brighton Health Commercial |
$90.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.16
|
| Rate for Payer: Group Health Inc Commercial |
$60.41
|
| Rate for Payer: Group Health Inc Medicare |
$42.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.54
|
|
|
HYDEOCEPHALUS SHUNT
|
Facility
|
OP
|
$4,917.42
|
|
|
Service Code
|
HCPCS 62180
|
| Hospital Charge Code |
40000230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$3,688.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,704.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,022.13
|
| Rate for Payer: Aetna Government |
$2,022.13
|
| Rate for Payer: Brighton Health Commercial |
$3,688.06
|
| 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 |
$2,458.71
|
| Rate for Payer: Group Health Inc Medicare |
$1,721.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,458.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,458.71
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HYDRA JAGWIRE .035X260CM STR
|
Facility
|
OP
|
$798.00
|
|
| Hospital Charge Code |
40200572
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$638.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$438.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$399.00
|
| Rate for Payer: Aetna Government |
$399.00
|
| Rate for Payer: Brighton Health Commercial |
$598.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$638.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$542.64
|
| Rate for Payer: Group Health Inc Commercial |
$399.00
|
| Rate for Payer: Group Health Inc Medicare |
$279.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$399.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$399.00
|
|
