|
PALMAZ XL TRANSHEPATIC BILIARY ST
|
Facility
|
IP
|
$3,106.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
40202229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,553.00 |
| Max. Negotiated Rate |
$1,553.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,553.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,553.00
|
|
|
PAMIDRONATE 3 MG/ML INJ
|
Facility
|
OP
|
$213.60
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
41644551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$138.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.16
|
| Rate for Payer: Aetna Government |
$9.16
|
| Rate for Payer: Brighton Health Commercial |
$128.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.82
|
| Rate for Payer: Group Health Inc Commercial |
$106.80
|
| Rate for Payer: Group Health Inc Medicare |
$74.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.94
|
| Rate for Payer: SOMOS Essential |
$14.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.84
|
|
|
PAMIDRONATE 3 MG/ML INJ
|
Facility
|
OP
|
$213.60
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
41654551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$138.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.16
|
| Rate for Payer: Aetna Government |
$9.16
|
| Rate for Payer: Brighton Health Commercial |
$128.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.82
|
| Rate for Payer: Group Health Inc Commercial |
$106.80
|
| Rate for Payer: Group Health Inc Medicare |
$74.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.94
|
| Rate for Payer: SOMOS Essential |
$14.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.84
|
|
|
PAMIDRONATE 3 MG/ML INJ
|
Facility
|
IP
|
$213.60
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
41644551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$106.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.80
|
|
|
PAMIDRONATE 3 MG/ML INJ
|
Facility
|
IP
|
$213.60
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
41654551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$106.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.80
|
|
|
PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN [32589]
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
67457043010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.16
|
| Rate for Payer: Aetna Government |
$9.16
|
| Rate for Payer: Brighton Health Commercial |
$1.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.86
|
| Rate for Payer: EmblemHealth Commercial |
$1.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$1.62
|
| Rate for Payer: Group Health Inc Medicare |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.11
|
|
|
PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN [32589]
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
67457043010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.62
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$65,131.73
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$22,026.37 |
| Max. Negotiated Rate |
$65,131.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42,574.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47,368.53
|
| Rate for Payer: Aetna Government |
$47,368.53
|
| Rate for Payer: Brighton Health Commercial |
$41,867.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48,315.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49,862.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41,148.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$45,000.10
|
| Rate for Payer: EmblemHealth Commercial |
$24,759.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$47,368.53
|
| Rate for Payer: Group Health Inc Commercial |
$47,368.53
|
| Rate for Payer: Group Health Inc Medicare |
$47,368.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47,368.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22,026.37
|
| Rate for Payer: Humana Medicare |
$65,131.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47,368.53
|
| Rate for Payer: United Healthcare Commercial |
$57,421.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47,368.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47,368.53
|
| Rate for Payer: Wellcare Medicare |
$45,000.10
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$115,047.05
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$38,906.82 |
| Max. Negotiated Rate |
$115,047.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81,174.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83,670.58
|
| Rate for Payer: Aetna Government |
$83,670.58
|
| Rate for Payer: Brighton Health Commercial |
$79,825.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85,343.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$95,069.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78,455.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$79,487.05
|
| Rate for Payer: EmblemHealth Commercial |
$47,207.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$83,670.58
|
| Rate for Payer: Group Health Inc Commercial |
$83,670.58
|
| Rate for Payer: Group Health Inc Medicare |
$83,670.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83,670.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38,906.82
|
| Rate for Payer: Humana Medicare |
$115,047.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83,670.58
|
| Rate for Payer: United Healthcare Commercial |
$109,481.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83,670.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83,670.58
|
| Rate for Payer: Wellcare Medicare |
$79,487.05
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$51,090.31
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$17,277.81 |
| Max. Negotiated Rate |
$51,090.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31,716.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37,156.59
|
| Rate for Payer: Aetna Government |
$37,156.59
|
| Rate for Payer: Brighton Health Commercial |
$31,189.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,899.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37,145.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30,654.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$35,298.76
|
| Rate for Payer: EmblemHealth Commercial |
$18,444.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$37,156.59
|
| Rate for Payer: Group Health Inc Commercial |
$37,156.59
|
| Rate for Payer: Group Health Inc Medicare |
$37,156.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37,156.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,277.81
|
| Rate for Payer: Humana Medicare |
$51,090.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37,156.59
|
| Rate for Payer: United Healthcare Commercial |
$42,776.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,156.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37,156.59
|
| Rate for Payer: Wellcare Medicare |
$35,298.76
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$95,728.06
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$34,447.15 |
| Max. Negotiated Rate |
$95,728.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70,976.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74,079.89
|
| Rate for Payer: Aetna Government |
$74,079.89
|
| Rate for Payer: Brighton Health Commercial |
$69,797.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75,561.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$83,126.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68,599.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$70,375.90
|
| Rate for Payer: EmblemHealth Commercial |
$41,276.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$74,079.89
|
| Rate for Payer: Group Health Inc Commercial |
$74,079.89
|
| Rate for Payer: Group Health Inc Medicare |
$74,079.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74,079.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34,447.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74,079.89
|
| Rate for Payer: United Healthcare Commercial |
$95,728.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74,079.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74,079.89
|
| Rate for Payer: Wellcare Medicare |
$70,375.90
|
|
|
PANCREATIC ELASTASE, FECAL
|
Facility
|
IP
|
$28.83
|
|
|
Service Code
|
HCPCS 82656
|
| Hospital Charge Code |
40609066
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.53
|
|
|
PANCREATIC ELASTASE, FECAL
|
Facility
|
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 82656
|
| Hospital Charge Code |
40609066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$21.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.07
|
| Rate for Payer: Brighton Health Commercial |
$21.62
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
PANCRELIPASE (LIP-PROT-AMYL) 5000-24000 UNITS PO CPEP [151365]
|
Facility
|
OP
|
$2.29
|
|
|
Service Code
|
NDC 00023611501
|
| Hospital Charge Code |
00023611501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.14
|
| Rate for Payer: Aetna Government |
$1.14
|
| Rate for Payer: Brighton Health Commercial |
$1.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.55
|
| Rate for Payer: Group Health Inc Commercial |
$1.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.49
|
|
|
PANCRELIPASE (LIP-PROT-AMYL) 5000-24000 UNITS PO CPEP [151365]
|
Facility
|
OP
|
$2.48
|
|
|
Service Code
|
NDC 73562011501
|
| Hospital Charge Code |
73562011501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.24
|
| Rate for Payer: Aetna Government |
$1.24
|
| Rate for Payer: Brighton Health Commercial |
$1.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.69
|
| Rate for Payer: Group Health Inc Commercial |
$1.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.61
|
|
|
PANCURONIUM 2 MG/ML INJ
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41655114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
PANCURONIUM 2 MG/ML INJ
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41645114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
PANEL 083904
|
Facility
|
OP
|
$22.23
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
40609149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$22.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$22.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.10
|
| Rate for Payer: Amida Care Medicaid |
$10.10
|
| Rate for Payer: Brighton Health Commercial |
$16.67
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,010.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.60
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.89
|
| Rate for Payer: Healthfirst QHP |
$10.10
|
| Rate for Payer: Humana Medicare |
$9.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: SOMOS Essential |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$22.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$11.11
|
| Rate for Payer: United Healthcare Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.00
|
|
|
PANEL 083904
|
Facility
|
IP
|
$22.23
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
40609149
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$8.89
|
|
|
PANITUMUMAB 100MG/5ML INJ
|
Facility
|
OP
|
$177.40
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
41646057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.70 |
| Max. Negotiated Rate |
$160.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.66
|
| Rate for Payer: Aetna Government |
$150.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$105.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$105.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$105.46
|
| Rate for Payer: Brighton Health Commercial |
$106.44
|
| Rate for Payer: Cash Price |
$150.66
|
| Rate for Payer: Cash Price |
$150.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$150.66
|
| Rate for Payer: EmblemHealth Commercial |
$150.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.19
|
| Rate for Payer: Group Health Inc Commercial |
$150.66
|
| Rate for Payer: Group Health Inc Medicare |
$150.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.06
|
| Rate for Payer: Healthfirst QHP |
$150.66
|
| Rate for Payer: Humana Medicare |
$153.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.31
|
| Rate for Payer: SOMOS Essential |
$160.31
|
| Rate for Payer: United Healthcare Commercial |
$143.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$120.53
|
| Rate for Payer: Wellcare Medicare |
$143.13
|
|
|
PANITUMUMAB 100MG/5ML INJ
|
Facility
|
OP
|
$177.40
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
41656057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.70 |
| Max. Negotiated Rate |
$160.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.66
|
| Rate for Payer: Aetna Government |
$150.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$105.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$105.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$105.46
|
| Rate for Payer: Brighton Health Commercial |
$106.44
|
| Rate for Payer: Cash Price |
$150.66
|
| Rate for Payer: Cash Price |
$150.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$150.66
|
| Rate for Payer: EmblemHealth Commercial |
$150.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.19
|
| Rate for Payer: Group Health Inc Commercial |
$150.66
|
| Rate for Payer: Group Health Inc Medicare |
$150.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.06
|
| Rate for Payer: Healthfirst QHP |
$150.66
|
| Rate for Payer: Humana Medicare |
$153.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.31
|
| Rate for Payer: SOMOS Essential |
$160.31
|
| Rate for Payer: United Healthcare Commercial |
$143.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$120.53
|
| Rate for Payer: Wellcare Medicare |
$143.13
|
|
|
PANITUMUMAB 100MG/5ML INJ
|
Facility
|
IP
|
$177.40
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
41656057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.70 |
| Max. Negotiated Rate |
$88.70 |
| Rate for Payer: Cash Price |
$150.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.70
|
|
|
PANITUMUMAB 100MG/5ML INJ
|
Facility
|
IP
|
$177.40
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
41646057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.70 |
| Max. Negotiated Rate |
$88.70 |
| Rate for Payer: Cash Price |
$150.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.70
|
|
|
PANITUMUMAB 100 MG/5ML IV SOLN [108055]
|
Facility
|
IP
|
$395.50
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
55513095401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.75 |
| Max. Negotiated Rate |
$197.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.75
|
|
|
PANITUMUMAB 100 MG/5ML IV SOLN [108055]
|
Facility
|
OP
|
$395.50
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
55513095401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$257.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$217.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.66
|
| Rate for Payer: Aetna Government |
$150.66
|
| Rate for Payer: Brighton Health Commercial |
$237.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$197.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$227.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$150.66
|
| Rate for Payer: EmblemHealth Commercial |
$197.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.66
|
| Rate for Payer: Group Health Inc Commercial |
$150.66
|
| Rate for Payer: Group Health Inc Medicare |
$150.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.06
|
| Rate for Payer: Healthfirst QHP |
$150.66
|
| Rate for Payer: Humana Medicare |
$153.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$120.53
|
|
