|
PALIPERIDONE 39MG/0.25ML INJ
|
Facility
|
IP
|
$20.88
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41646598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.44
|
|
|
PALIPERIDONE 39MG/0.25ML INJ
|
Facility
|
IP
|
$20.88
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41656598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.44
|
|
|
PALIPERIDONE 78MG/0.5ML INJ
|
Facility
|
IP
|
$20.88
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41656599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.44
|
|
|
PALIPERIDONE 78MG/0.5ML INJ
|
Facility
|
OP
|
$20.88
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41656599
|
|
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 78MG/0.5ML INJ
|
Facility
|
IP
|
$20.88
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41646599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.44
|
|
|
PALIPERIDONE 78MG/0.5ML INJ
|
Facility
|
OP
|
$20.88
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
41646599
|
|
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 PALMITATE ER 117 MG/0.75ML IM SUSY [166236]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
50458056201
|
|
Hospital Revenue Code
|
250
|
| 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: 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 Essential Plan Aliesa |
$12.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.74
|
| 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 |
$14.32
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| 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 PALMITATE ER 156 MG/ML IM SUSY [166237]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
50458056301
|
|
Hospital Revenue Code
|
250
|
| 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: 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 Essential Plan Aliesa |
$12.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.74
|
| 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 |
$14.32
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| 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 PALMITATE ER 234 MG/1.5ML IM SUSY [166238]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
50458056401
|
|
Hospital Revenue Code
|
250
|
| 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: 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 Essential Plan Aliesa |
$12.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.74
|
| 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 |
$14.32
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| 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 PALMITATE ER 273 MG/0.88ML IM SUSY [182755]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS j3490
|
| Hospital Charge Code |
50458060601
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
PALIPERIDONE PALMITATE ER 39 MG/0.25ML IM SUSY [166234]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
50458056001
|
|
Hospital Revenue Code
|
250
|
| 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: 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 Essential Plan Aliesa |
$12.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.74
|
| 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 |
$14.32
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| 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 PALMITATE ER 546 MG/1.75ML IM SUSY [166241]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
50458060801
|
|
Hospital Revenue Code
|
250
|
| 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: 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 Essential Plan Aliesa |
$12.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.74
|
| 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 |
$14.32
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| 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 PALMITATE ER 78 MG/0.5ML IM SUSY [166235]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
50458056101
|
|
Hospital Revenue Code
|
250
|
| 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: 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 Essential Plan Aliesa |
$12.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.74
|
| 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 |
$14.32
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| 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
|
|
|
PALIVIZUMAB 100 MG/ML IM SOLN [41675]
|
Facility
|
OP
|
$4,125.50
|
|
|
Service Code
|
NDC 66658023101
|
| Hospital Charge Code |
66658023101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,443.92 |
| Max. Negotiated Rate |
$3,300.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,269.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,062.75
|
| Rate for Payer: Aetna Government |
$2,062.75
|
| Rate for Payer: Brighton Health Commercial |
$3,094.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,300.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,805.34
|
| Rate for Payer: Group Health Inc Commercial |
$2,062.75
|
| Rate for Payer: Group Health Inc Medicare |
$1,443.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,062.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,062.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,681.58
|
|
|
PALIVIZUMAB 100 MG/ML INJ
|
Facility
|
OP
|
$3,728.53
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41654604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.78 |
| Max. Negotiated Rate |
$2,423.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,050.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.68
|
| Rate for Payer: Aetna Government |
$339.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$237.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$237.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$237.78
|
| Rate for Payer: Brighton Health Commercial |
$2,237.12
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$339.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,864.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,143.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$339.68
|
| Rate for Payer: EmblemHealth Commercial |
$339.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$339.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.66
|
| Rate for Payer: Group Health Inc Commercial |
$339.68
|
| Rate for Payer: Group Health Inc Medicare |
$339.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,864.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,864.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$288.73
|
| Rate for Payer: Healthfirst QHP |
$339.68
|
| Rate for Payer: Humana Medicare |
$346.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$339.68
|
| Rate for Payer: United Healthcare Commercial |
$339.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,423.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$271.74
|
| Rate for Payer: Wellcare Medicare |
$322.70
|
|
|
PALIVIZUMAB 100 MG/ML INJ
|
Facility
|
IP
|
$3,728.53
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41654604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,864.26 |
| Max. Negotiated Rate |
$1,864.26 |
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,864.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,864.26
|
|
|
PALIVIZUMAB 100 MG/ML INJ
|
Facility
|
OP
|
$3,728.53
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41644604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.78 |
| Max. Negotiated Rate |
$2,423.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,050.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.68
|
| Rate for Payer: Aetna Government |
$339.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$237.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$237.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$237.78
|
| Rate for Payer: Brighton Health Commercial |
$2,237.12
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$339.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,864.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,143.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$339.68
|
| Rate for Payer: EmblemHealth Commercial |
$339.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$339.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.66
|
| Rate for Payer: Group Health Inc Commercial |
$339.68
|
| Rate for Payer: Group Health Inc Medicare |
$339.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,864.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,864.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$288.73
|
| Rate for Payer: Healthfirst QHP |
$339.68
|
| Rate for Payer: Humana Medicare |
$346.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$339.68
|
| Rate for Payer: United Healthcare Commercial |
$339.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,423.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$271.74
|
| Rate for Payer: Wellcare Medicare |
$322.70
|
|
|
PALIVIZUMAB 100 MG/ML INJ
|
Facility
|
IP
|
$3,728.53
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41644604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,864.26 |
| Max. Negotiated Rate |
$1,864.26 |
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,864.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,864.26
|
|
|
PALIVIZUMAB 50 MG/0.5ML IM SOLN [108060]
|
Facility
|
OP
|
$4,369.58
|
|
|
Service Code
|
NDC 66658023001
|
| Hospital Charge Code |
66658023001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,529.35 |
| Max. Negotiated Rate |
$3,495.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,403.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,184.79
|
| Rate for Payer: Aetna Government |
$2,184.79
|
| Rate for Payer: Brighton Health Commercial |
$3,277.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,495.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,971.31
|
| Rate for Payer: Group Health Inc Commercial |
$2,184.79
|
| Rate for Payer: Group Health Inc Medicare |
$1,529.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,184.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,184.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,840.23
|
|
|
PALIVIZUMAB 50 MG/0.5 ML INJ
|
Facility
|
OP
|
$3,728.53
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41644605
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.78 |
| Max. Negotiated Rate |
$2,423.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,050.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.68
|
| Rate for Payer: Aetna Government |
$339.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$237.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$237.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$237.78
|
| Rate for Payer: Brighton Health Commercial |
$2,237.12
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$339.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,864.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,143.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$339.68
|
| Rate for Payer: EmblemHealth Commercial |
$339.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$339.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.66
|
| Rate for Payer: Group Health Inc Commercial |
$339.68
|
| Rate for Payer: Group Health Inc Medicare |
$339.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,864.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,864.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$288.73
|
| Rate for Payer: Healthfirst QHP |
$339.68
|
| Rate for Payer: Humana Medicare |
$346.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$339.68
|
| Rate for Payer: United Healthcare Commercial |
$339.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,423.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$271.74
|
| Rate for Payer: Wellcare Medicare |
$322.70
|
|
|
PALIVIZUMAB 50 MG/0.5 ML INJ
|
Facility
|
OP
|
$3,728.53
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41654605
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.78 |
| Max. Negotiated Rate |
$2,423.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,050.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.68
|
| Rate for Payer: Aetna Government |
$339.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$237.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$237.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$237.78
|
| Rate for Payer: Brighton Health Commercial |
$2,237.12
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$339.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,864.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,143.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$339.68
|
| Rate for Payer: EmblemHealth Commercial |
$339.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$339.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.66
|
| Rate for Payer: Group Health Inc Commercial |
$339.68
|
| Rate for Payer: Group Health Inc Medicare |
$339.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,864.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,864.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$288.73
|
| Rate for Payer: Healthfirst QHP |
$339.68
|
| Rate for Payer: Humana Medicare |
$346.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$339.68
|
| Rate for Payer: United Healthcare Commercial |
$339.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,423.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$271.74
|
| Rate for Payer: Wellcare Medicare |
$322.70
|
|
|
PALIVIZUMAB 50 MG/0.5 ML INJ
|
Facility
|
IP
|
$3,728.53
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41644605
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,864.26 |
| Max. Negotiated Rate |
$1,864.26 |
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,864.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,864.26
|
|
|
PALIVIZUMAB 50 MG/0.5 ML INJ
|
Facility
|
IP
|
$3,728.53
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
41654605
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,864.26 |
| Max. Negotiated Rate |
$1,864.26 |
| Rate for Payer: Cash Price |
$339.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,864.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,864.26
|
|
|
PALLIATIVE (EMERG) TX DENTAL PAIN
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
HCPCS D9110
|
| Hospital Charge Code |
42302280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.31
|
| Rate for Payer: Aetna Government |
$28.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$219.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$219.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$97.60
|
| Rate for Payer: Amida Care Medicaid |
$97.60
|
| Rate for Payer: Brighton Health Commercial |
$46.88
|
| 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: Fidelis CHP/HARP/Medicaid |
$9,760.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.48
|
| Rate for Payer: Group Health Inc Commercial |
$31.25
|
| Rate for Payer: Group Health Inc Medicare |
$21.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.60
|
| Rate for Payer: Healthfirst Essential Plan |
$219.60
|
| Rate for Payer: Healthfirst QHP |
$97.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.60
|
| Rate for Payer: SOMOS Essential |
$219.60
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$219.60
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$107.36
|
| Rate for Payer: United Healthcare Medicaid |
$97.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$97.60
|
|
|
PALMAZ XL TRANSHEPATIC BILIARY ST
|
Facility
|
OP
|
$3,106.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
40202229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$3,261.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,708.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Brighton Health Commercial |
$1,863.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,553.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,785.95
|
| Rate for Payer: EmblemHealth Commercial |
$1,553.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,261.30
|
| Rate for Payer: Group Health Inc Commercial |
$1,553.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,087.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,553.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,553.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,018.90
|
|
