|
HYPODERMOCLYSIS SET
|
Facility
|
OP
|
$14.53
|
|
| Hospital Charge Code |
40202430
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.26
|
| Rate for Payer: Aetna Government |
$7.26
|
| Rate for Payer: Brighton Health Commercial |
$10.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.88
|
| Rate for Payer: Group Health Inc Commercial |
$7.26
|
| Rate for Payer: Group Health Inc Medicare |
$5.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
|
|
HYPONEEDLE 25G
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
40200488
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.00
|
| Rate for Payer: Aetna Government |
$16.00
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.76
|
| Rate for Payer: Group Health Inc Commercial |
$16.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
|
|
HYPOTHERMIA MACHINE
|
Facility
|
OP
|
$45.36
|
|
| Hospital Charge Code |
40200830
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$36.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.68
|
| Rate for Payer: Aetna Government |
$22.68
|
| Rate for Payer: Brighton Health Commercial |
$34.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.84
|
| Rate for Payer: Group Health Inc Commercial |
$22.68
|
| Rate for Payer: Group Health Inc Medicare |
$15.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.68
|
|
|
HYPROCURE SIZE 05
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,147.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,172.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,370.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,975.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,271.25
|
| Rate for Payer: EmblemHealth Commercial |
$1,975.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,147.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,975.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,382.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,975.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,567.50
|
|
|
HYPROCURE SIZE 05
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.00 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,975.00
|
|
|
HYPROCURE SIZE 06
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.00 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,975.00
|
|
|
HYPROCURE SIZE 06
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,147.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,172.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,370.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,975.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,271.25
|
| Rate for Payer: EmblemHealth Commercial |
$1,975.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,147.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,975.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,382.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,975.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,567.50
|
|
|
HYPROCURE SIZE 07
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS S2117
|
| Hospital Charge Code |
64902351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.00 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,975.00
|
|
|
HYPROCURE SIZE 07
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS S2117
|
| Hospital Charge Code |
64902351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,382.50 |
| Max. Negotiated Rate |
$4,147.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,172.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,571.83
|
| Rate for Payer: Aetna Government |
$3,571.83
|
| Rate for Payer: Brighton Health Commercial |
$2,370.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,975.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,271.25
|
| Rate for Payer: EmblemHealth Commercial |
$1,975.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,147.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,975.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,382.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,975.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,567.50
|
|
|
HYPROMELLOSE 0.3 % OP GEL [91018]
|
Facility
|
OP
|
$0.86
|
|
|
Service Code
|
NDC 00065806401
|
| Hospital Charge Code |
00065806401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.43
|
| Rate for Payer: Aetna Government |
$0.43
|
| Rate for Payer: Brighton Health Commercial |
$0.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.43
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.56
|
|
|
HYPROMELLOSE 2.5 % OP SOLN [193146]
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 77790002215
|
| Hospital Charge Code |
77790002215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.23
|
| Rate for Payer: Aetna Government |
$1.23
|
| Rate for Payer: Brighton Health Commercial |
$1.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.60
|
|
|
HYSTEROSCOPC PROC KIT
|
Facility
|
OP
|
$880.00
|
|
| Hospital Charge Code |
64905904
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$704.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$484.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$440.00
|
| Rate for Payer: Aetna Government |
$440.00
|
| Rate for Payer: Brighton Health Commercial |
$660.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$704.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$598.40
|
| Rate for Payer: Group Health Inc Commercial |
$440.00
|
| Rate for Payer: Group Health Inc Medicare |
$308.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$440.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$440.00
|
|
|
HYSTEROSCOPIC PROC KIT
|
Facility
|
OP
|
$880.00
|
|
| Hospital Charge Code |
64905925
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$704.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$484.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$440.00
|
| Rate for Payer: Aetna Government |
$440.00
|
| Rate for Payer: Brighton Health Commercial |
$660.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$704.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$598.40
|
| Rate for Payer: Group Health Inc Commercial |
$440.00
|
| Rate for Payer: Group Health Inc Medicare |
$308.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$440.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$440.00
|
|
|
HYSTEROSCOPIC PROC KIT
|
Facility
|
OP
|
$880.00
|
|
| Hospital Charge Code |
64905900
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$704.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$484.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$440.00
|
| Rate for Payer: Aetna Government |
$440.00
|
| Rate for Payer: Brighton Health Commercial |
$660.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$704.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$598.40
|
| Rate for Payer: Group Health Inc Commercial |
$440.00
|
| Rate for Payer: Group Health Inc Medicare |
$308.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$440.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$440.00
|
|
|
HYSTEROSCOPIC ROTARY MORCEL
|
Facility
|
OP
|
$1,485.00
|
|
| Hospital Charge Code |
64905898
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$519.75 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$816.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$742.50
|
| Rate for Payer: Aetna Government |
$742.50
|
| Rate for Payer: Brighton Health Commercial |
$1,113.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,188.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,009.80
|
| Rate for Payer: Group Health Inc Commercial |
$742.50
|
| Rate for Payer: Group Health Inc Medicare |
$519.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$742.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$742.50
|
|
|
HYSTEROSCOPIC ROTARY MORCELLATOR
|
Facility
|
OP
|
$594.00
|
|
| Hospital Charge Code |
40205976
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$326.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$297.00
|
| Rate for Payer: Aetna Government |
$297.00
|
| Rate for Payer: Brighton Health Commercial |
$445.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$475.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$403.92
|
| Rate for Payer: Group Health Inc Commercial |
$297.00
|
| Rate for Payer: Group Health Inc Medicare |
$207.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$297.00
|
|
|
HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
40052190
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
40052190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$5,674.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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: Elderplan Medicare Advantage |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
Hysteroscopy, diagnostic (separate procedure)
|
Facility
|
OP
|
$3,687.70
|
|
|
Service Code
|
CPT 58555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$3,687.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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: Elderplan Medicare Advantage |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
HYSTEROSCOPY REMOVE FB
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58562
|
| Hospital Charge Code |
40059438
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,674.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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: Elderplan Medicare Advantage |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
HYSTEROSCOPY REMOVE FB
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58562
|
| Hospital Charge Code |
40059438
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
HYSTEROSCOPY REMOVE LEIOMYMATA
|
Facility
|
IP
|
$12,937.43
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
40054242
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,751.94
|
|
|
HYSTEROSCOPY REMOVE LEIOMYMATA
|
Facility
|
OP
|
$12,937.43
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
40054242
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$9,703.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,751.94
|
| Rate for Payer: Aetna Government |
$5,751.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,026.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,026.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,026.36
|
| Rate for Payer: Brighton Health Commercial |
$9,703.07
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,751.94
|
| 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: Elderplan Medicare Advantage |
$5,751.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,889.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,119.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,751.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,119.23
|
| Rate for Payer: Group Health Inc Commercial |
$5,751.94
|
| Rate for Payer: Group Health Inc Medicare |
$5,751.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,468.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,751.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,889.15
|
| Rate for Payer: Healthfirst QHP |
$5,751.94
|
| Rate for Payer: Humana Medicare |
$5,866.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,751.94
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,751.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,751.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,601.55
|
| Rate for Payer: Wellcare Medicare |
$5,464.34
|
|
|
Hysteroscopy, surgical; with division or resection of intrauterine septum (any method)
|
Facility
|
OP
|
$5,866.98
|
|
|
Service Code
|
CPT 58560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$5,866.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,751.94
|
| Rate for Payer: Aetna Government |
$5,751.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,026.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,026.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,026.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,751.94
|
| 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: Elderplan Medicare Advantage |
$5,751.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,889.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,119.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,751.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,119.23
|
| Rate for Payer: Group Health Inc Commercial |
$5,751.94
|
| Rate for Payer: Group Health Inc Medicare |
$5,751.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,751.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,889.15
|
| Rate for Payer: Healthfirst QHP |
$5,751.94
|
| Rate for Payer: Humana Medicare |
$5,866.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,751.94
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,751.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,751.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,601.55
|
| Rate for Payer: Wellcare Medicare |
$5,464.34
|
|
|
Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)
|
Facility
|
OP
|
$5,866.98
|
|
|
Service Code
|
CPT 58563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$5,866.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,751.94
|
| Rate for Payer: Aetna Government |
$5,751.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,026.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,026.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,026.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,751.94
|
| 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: Elderplan Medicare Advantage |
$5,751.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,889.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,119.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,751.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,119.23
|
| Rate for Payer: Group Health Inc Commercial |
$5,751.94
|
| Rate for Payer: Group Health Inc Medicare |
$5,751.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,751.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,889.15
|
| Rate for Payer: Healthfirst QHP |
$5,751.94
|
| Rate for Payer: Humana Medicare |
$5,866.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,751.94
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,751.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,751.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,601.55
|
| Rate for Payer: Wellcare Medicare |
$5,464.34
|
|
