|
HYDROXYZINE PAMOATE 50 MG PO CAPS [3778]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 14539067501
|
| Hospital Charge Code |
14539067501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.31
|
| Rate for Payer: Aetna Government |
$0.31
|
| Rate for Payer: Brighton Health Commercial |
$0.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.42
|
| Rate for Payer: Group Health Inc Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.40
|
|
|
HYDROXYZINE PAMOATE 50 MG PO CAPS [3778]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 50268039911
|
| Hospital Charge Code |
50268039911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Brighton Health Commercial |
$0.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.39
|
| Rate for Payer: Group Health Inc Commercial |
$0.29
|
| Rate for Payer: Group Health Inc Medicare |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.37
|
|
|
HYDROXYZINE PAMOATE 50 MG PO CAPS [3778]
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
NDC 00555030202
|
| Hospital Charge Code |
00555030202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.31
|
| Rate for Payer: Aetna Government |
$0.31
|
| Rate for Payer: Brighton Health Commercial |
$0.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.42
|
| Rate for Payer: Group Health Inc Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.40
|
|
|
HYDROXYZINE PAMOATE 50 MG PO CAPS [3778]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 50268039950
|
| Hospital Charge Code |
50268039950
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Brighton Health Commercial |
$0.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.39
|
| Rate for Payer: Group Health Inc Commercial |
$0.29
|
| Rate for Payer: Group Health Inc Medicare |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.37
|
|
|
HYLAN G-F 20 16 MG/2ML IX SOSY [124667]
|
Facility
|
OP
|
$273.92
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
58468009001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$219.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$150.66
|
| 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 |
$205.44
|
| 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 |
$219.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$186.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.12
|
| Rate for Payer: EmblemHealth Commercial |
$9.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.12
|
| 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 |
$136.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.12
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.30
|
| Rate for Payer: Wellcare Medicare |
$8.67
|
|
|
HYLAN G-F 20 48 MG/6ML IX SOSY [124668]
|
Facility
|
OP
|
$273.92
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
58468009003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$219.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$150.66
|
| 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 |
$205.44
|
| 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 |
$219.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$186.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.12
|
| Rate for Payer: EmblemHealth Commercial |
$9.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.12
|
| 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 |
$136.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.12
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.30
|
| Rate for Payer: Wellcare Medicare |
$8.67
|
|
|
HYPERBARIC OXYGEN THERAPY 30 MIN
|
Facility
|
OP
|
$348.50
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
42500100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$112.33 |
| Max. Negotiated Rate |
$3,163.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$160.47
|
| Rate for Payer: Aetna Government |
$160.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$112.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$112.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$112.33
|
| Rate for Payer: Brighton Health Commercial |
$261.38
|
| Rate for Payer: Cash Price |
$160.47
|
| Rate for Payer: Cash Price |
$160.47
|
| Rate for Payer: Cash Price |
$160.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$160.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$174.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$198.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$160.47
|
| Rate for Payer: EmblemHealth Commercial |
$160.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.82
|
| Rate for Payer: Group Health Inc Commercial |
$160.47
|
| Rate for Payer: Group Health Inc Medicare |
$160.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.40
|
| Rate for Payer: Healthfirst QHP |
$160.47
|
| Rate for Payer: Humana Medicare |
$163.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.47
|
| Rate for Payer: United Healthcare Commercial |
$3,163.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$128.38
|
| Rate for Payer: Wellcare Medicare |
$152.45
|
|
|
HYPERBARIC OXYGEN THERAPY 30 MIN
|
Facility
|
IP
|
$348.50
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
42500100
|
|
Hospital Revenue Code
|
413
|
| Rate for Payer: Cash Price |
$160.47
|
|
|
HYPERRAB IG IM/SC 1500U/10ML INJ
|
Facility
|
OP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41658448
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$562.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$475.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$289.98
|
| Rate for Payer: Aetna Government |
$289.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$202.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$202.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$202.99
|
| Rate for Payer: Brighton Health Commercial |
$518.78
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$497.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$289.98
|
| Rate for Payer: EmblemHealth Commercial |
$289.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.48
|
| Rate for Payer: Group Health Inc Commercial |
$289.98
|
| Rate for Payer: Group Health Inc Medicare |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.48
|
| Rate for Payer: Healthfirst QHP |
$289.98
|
| Rate for Payer: Humana Medicare |
$295.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.79
|
| Rate for Payer: SOMOS Essential |
$302.79
|
| Rate for Payer: United Healthcare Commercial |
$278.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$562.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$231.98
|
| Rate for Payer: Wellcare Medicare |
$275.48
|
|
|
HYPERRAB IG IM/SC 1500U/10ML INJ
|
Facility
|
IP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41658448
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.32 |
| Max. Negotiated Rate |
$432.32 |
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
|
|
HYPERRAB IG IM/SC 1500U/10ML INJ
|
Facility
|
IP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41648448
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.32 |
| Max. Negotiated Rate |
$432.32 |
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
|
|
HYPERRAB IG IM/SC 1500U/10ML INJ
|
Facility
|
OP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41648448
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$562.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$475.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$289.98
|
| Rate for Payer: Aetna Government |
$289.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$202.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$202.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$202.99
|
| Rate for Payer: Brighton Health Commercial |
$518.78
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$497.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$289.98
|
| Rate for Payer: EmblemHealth Commercial |
$289.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.48
|
| Rate for Payer: Group Health Inc Commercial |
$289.98
|
| Rate for Payer: Group Health Inc Medicare |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.48
|
| Rate for Payer: Healthfirst QHP |
$289.98
|
| Rate for Payer: Humana Medicare |
$295.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.79
|
| Rate for Payer: SOMOS Essential |
$302.79
|
| Rate for Payer: United Healthcare Commercial |
$278.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$562.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$231.98
|
| Rate for Payer: Wellcare Medicare |
$275.48
|
|
|
HYPERRAB IG IM/SC 300U/2ML INJ
|
Facility
|
IP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41648447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.32 |
| Max. Negotiated Rate |
$432.32 |
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
|
|
HYPERRAB IG IM/SC 300U/2ML INJ
|
Facility
|
OP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41648447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$562.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$475.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$289.98
|
| Rate for Payer: Aetna Government |
$289.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$202.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$202.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$202.99
|
| Rate for Payer: Brighton Health Commercial |
$518.78
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$497.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$289.98
|
| Rate for Payer: EmblemHealth Commercial |
$289.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.48
|
| Rate for Payer: Group Health Inc Commercial |
$289.98
|
| Rate for Payer: Group Health Inc Medicare |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.48
|
| Rate for Payer: Healthfirst QHP |
$289.98
|
| Rate for Payer: Humana Medicare |
$295.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.79
|
| Rate for Payer: SOMOS Essential |
$302.79
|
| Rate for Payer: United Healthcare Commercial |
$278.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$562.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$231.98
|
| Rate for Payer: Wellcare Medicare |
$275.48
|
|
|
HYPERRAB IG IM/SC 300U/2ML INJ
|
Facility
|
IP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41658447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.32 |
| Max. Negotiated Rate |
$432.32 |
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
|
|
HYPERRAB IG IM/SC 300U/2ML INJ
|
Facility
|
OP
|
$864.63
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
41658447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$562.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$475.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$289.98
|
| Rate for Payer: Aetna Government |
$289.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$202.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$202.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$202.99
|
| Rate for Payer: Brighton Health Commercial |
$518.78
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Cash Price |
$289.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$497.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$289.98
|
| Rate for Payer: EmblemHealth Commercial |
$289.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.48
|
| Rate for Payer: Group Health Inc Commercial |
$289.98
|
| Rate for Payer: Group Health Inc Medicare |
$289.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.48
|
| Rate for Payer: Healthfirst QHP |
$289.98
|
| Rate for Payer: Humana Medicare |
$295.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.79
|
| Rate for Payer: SOMOS Essential |
$302.79
|
| Rate for Payer: United Healthcare Commercial |
$278.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$562.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$231.98
|
| Rate for Payer: Wellcare Medicare |
$275.48
|
|
|
HYPERTENSION WITH MCC
|
Facility
|
IP
|
$31,984.54
|
|
|
Service Code
|
MSDRG 304
|
| Min. Negotiated Rate |
$9,852.68 |
| Max. Negotiated Rate |
$31,984.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,942.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,261.48
|
| Rate for Payer: Aetna Government |
$23,261.48
|
| Rate for Payer: Brighton Health Commercial |
$16,660.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,726.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,842.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,374.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,098.41
|
| Rate for Payer: EmblemHealth Commercial |
$9,852.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,261.48
|
| Rate for Payer: Group Health Inc Commercial |
$23,261.48
|
| Rate for Payer: Group Health Inc Medicare |
$23,261.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,261.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,816.59
|
| Rate for Payer: Humana Medicare |
$31,984.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,261.48
|
| Rate for Payer: United Healthcare Commercial |
$22,850.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,261.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,261.48
|
| Rate for Payer: Wellcare Medicare |
$22,098.41
|
|
|
HYPERTENSION WITHOUT MCC
|
Facility
|
IP
|
$24,443.24
|
|
|
Service Code
|
MSDRG 305
|
| Min. Negotiated Rate |
$6,461.26 |
| Max. Negotiated Rate |
$24,443.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,110.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,776.90
|
| Rate for Payer: Aetna Government |
$17,776.90
|
| Rate for Payer: Brighton Health Commercial |
$10,925.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,132.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,012.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,738.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,888.06
|
| Rate for Payer: EmblemHealth Commercial |
$6,461.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,776.90
|
| Rate for Payer: Group Health Inc Commercial |
$17,776.90
|
| Rate for Payer: Group Health Inc Medicare |
$17,776.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,776.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,266.26
|
| Rate for Payer: Humana Medicare |
$24,443.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,776.90
|
| Rate for Payer: United Healthcare Commercial |
$14,984.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,776.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,776.90
|
| Rate for Payer: Wellcare Medicare |
$16,888.06
|
|
|
HYPERTENSIVE ENCEPHALOPATHY WITH CC
|
Facility
|
IP
|
$29,465.69
|
|
|
Service Code
|
MSDRG 078
|
| Min. Negotiated Rate |
$8,719.92 |
| Max. Negotiated Rate |
$29,465.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,994.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,429.59
|
| Rate for Payer: Aetna Government |
$21,429.59
|
| Rate for Payer: Brighton Health Commercial |
$14,745.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,858.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,560.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,491.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,358.11
|
| Rate for Payer: EmblemHealth Commercial |
$8,719.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,429.59
|
| Rate for Payer: Group Health Inc Commercial |
$21,429.59
|
| Rate for Payer: Group Health Inc Medicare |
$21,429.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,429.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,964.76
|
| Rate for Payer: Humana Medicare |
$29,465.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,429.59
|
| Rate for Payer: United Healthcare Commercial |
$20,223.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,429.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,429.59
|
| Rate for Payer: Wellcare Medicare |
$20,358.11
|
|
|
HYPERTENSIVE ENCEPHALOPATHY WITH MCC
|
Facility
|
IP
|
$38,885.11
|
|
|
Service Code
|
MSDRG 077
|
| Min. Negotiated Rate |
$12,956.00 |
| Max. Negotiated Rate |
$38,885.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,278.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,280.08
|
| Rate for Payer: Aetna Government |
$28,280.08
|
| Rate for Payer: Brighton Health Commercial |
$21,908.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,845.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,091.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,532.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,866.08
|
| Rate for Payer: EmblemHealth Commercial |
$12,956.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,280.08
|
| Rate for Payer: Group Health Inc Commercial |
$28,280.08
|
| Rate for Payer: Group Health Inc Medicare |
$28,280.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,280.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,150.24
|
| Rate for Payer: Humana Medicare |
$38,885.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,280.08
|
| Rate for Payer: United Healthcare Commercial |
$30,047.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,280.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,280.08
|
| Rate for Payer: Wellcare Medicare |
$26,866.08
|
|
|
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC
|
Facility
|
IP
|
$24,201.11
|
|
|
Service Code
|
MSDRG 079
|
| Min. Negotiated Rate |
$6,352.36 |
| Max. Negotiated Rate |
$24,201.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,923.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,600.81
|
| Rate for Payer: Aetna Government |
$17,600.81
|
| Rate for Payer: Brighton Health Commercial |
$10,741.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,952.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,792.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,557.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,720.77
|
| Rate for Payer: EmblemHealth Commercial |
$6,352.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,600.81
|
| Rate for Payer: Group Health Inc Commercial |
$17,600.81
|
| Rate for Payer: Group Health Inc Medicare |
$17,600.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,600.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,184.38
|
| Rate for Payer: Humana Medicare |
$24,201.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,600.81
|
| Rate for Payer: United Healthcare Commercial |
$14,732.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,600.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,600.81
|
| Rate for Payer: Wellcare Medicare |
$16,720.77
|
|
|
HYPO-CURE TARSI IMPLANT
|
Facility
|
IP
|
$2,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.00 |
| Max. Negotiated Rate |
$1,295.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,295.00
|
|
|
HYPO-CURE TARSI IMPLANT
|
Facility
|
OP
|
$2,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,719.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,424.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,554.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,295.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,489.25
|
| Rate for Payer: EmblemHealth Commercial |
$1,295.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,719.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,295.00
|
| Rate for Payer: Group Health Inc Medicare |
$906.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,295.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,683.50
|
|
|
HYPO-CURE TARSI IMPLANT 6MM
|
Facility
|
OP
|
$2,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,097.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,622.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,770.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,475.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,696.25
|
| Rate for Payer: EmblemHealth Commercial |
$1,475.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,097.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,475.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,032.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,475.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,475.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,917.50
|
|
|
HYPO-CURE TARSI IMPLANT 6MM
|
Facility
|
IP
|
$2,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.00 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,475.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,475.00
|
|
