|
PALATAL LIFT PROSTHESIS, INTERIM
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS D5958
|
| Hospital Charge Code |
42301350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$678.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,265.00
|
| Rate for Payer: Aetna Government |
$1,265.00
|
| Rate for Payer: Brighton Health Commercial |
$924.75
|
| 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: Group Health Inc Commercial |
$616.50
|
| Rate for Payer: Group Health Inc Medicare |
$431.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$616.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$616.50
|
|
|
PALATAL LIFT PROSTHESIS, MODIFICA
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS D5959
|
| Hospital Charge Code |
42301355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$678.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,115.31
|
| Rate for Payer: Aetna Government |
$1,115.31
|
| Rate for Payer: Brighton Health Commercial |
$924.75
|
| 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: Group Health Inc Commercial |
$616.50
|
| Rate for Payer: Group Health Inc Medicare |
$431.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$616.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$616.50
|
|
|
Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty)
|
Facility
|
OP
|
$6,907.65
|
|
|
Service Code
|
CPT 42145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,907.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Humana Medicare |
$6,907.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
PALIPERIDONE 117MG/0.75ML INJ
|
Facility
|
IP
|
$12.19
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41656600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$6.10 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.10
|
|
|
PALIPERIDONE 117MG/0.75ML INJ
|
Facility
|
OP
|
$12.19
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41646600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$7.31
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 117MG/0.75ML INJ
|
Facility
|
IP
|
$12.19
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41646600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$6.10 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.10
|
|
|
PALIPERIDONE 117MG/0.75ML INJ
|
Facility
|
OP
|
$12.19
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41656600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$7.31
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 156MG INJ (CLINIC)
|
Facility
|
OP
|
$11.97
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41652555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$7.18
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 156MG INJ (CLINIC)
|
Facility
|
OP
|
$11.97
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41642555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$7.18
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 156MG INJ (CLINIC)
|
Facility
|
IP
|
$11.97
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41642555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$5.98 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.98
|
|
|
PALIPERIDONE 156MG INJ (CLINIC)
|
Facility
|
IP
|
$11.97
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41652555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$5.98 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.98
|
|
|
PALIPERIDONE 156MG INJ (INPATIENT
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41642557
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 156MG INJ (INPATIENT
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41642557
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
PALIPERIDONE 156MG INJ (O/P)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41652557
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 156MG INJ (O/P)
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41652557
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
PALIPERIDONE 234MG INJ (CLINIC)
|
Facility
|
IP
|
$11.69
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41652556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.84
|
|
|
PALIPERIDONE 234MG INJ (CLINIC)
|
Facility
|
IP
|
$11.69
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41642556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.84
|
|
|
PALIPERIDONE 234MG INJ (CLINIC)
|
Facility
|
OP
|
$11.69
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41652556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$7.01
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 234MG INJ (CLINIC)
|
Facility
|
OP
|
$11.69
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41642556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$7.01
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 234MG INJ (INPATIENT
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41642559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
PALIPERIDONE 234MG INJ (INPATIENT
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41642559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 234MG INJ (O/P)
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41652559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
PALIPERIDONE 234MG INJ (O/P)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41652559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 39MG/0.25ML INJ
|
Facility
|
OP
|
$20.88
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41656598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$12.53
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
|
PALIPERIDONE 39MG/0.25ML INJ
|
Facility
|
OP
|
$20.88
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41646598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$12.53
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.17
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: SOMOS Essential |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
|
