|
PAPAVERINE HCL 30 MG/ML IJ SOLN [6030]
|
Facility
|
OP
|
$22.50
|
|
|
Service Code
|
NDC 72516002410
|
| Hospital Charge Code |
72516002410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.25
|
| Rate for Payer: Aetna Government |
$11.25
|
| Rate for Payer: Brighton Health Commercial |
$16.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.30
|
| Rate for Payer: Group Health Inc Commercial |
$11.25
|
| Rate for Payer: Group Health Inc Medicare |
$7.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.62
|
|
|
PAPAVERINE HCL 30 MG/ML IJ SOLN [6030]
|
Facility
|
OP
|
$19.50
|
|
|
Service Code
|
NDC 54288014201
|
| Hospital Charge Code |
54288014201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.75
|
| Rate for Payer: Aetna Government |
$9.75
|
| Rate for Payer: Brighton Health Commercial |
$14.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.26
|
| Rate for Payer: Group Health Inc Commercial |
$9.75
|
| Rate for Payer: Group Health Inc Medicare |
$6.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.68
|
|
|
PAPAVERINE HCL 30 MG/ML IJ SOLN [6030]
|
Facility
|
OP
|
$24.85
|
|
|
Service Code
|
NDC 00517400225
|
| Hospital Charge Code |
00517400225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$19.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.42
|
| Rate for Payer: Aetna Government |
$12.42
|
| Rate for Payer: Brighton Health Commercial |
$18.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.90
|
| Rate for Payer: Group Health Inc Commercial |
$12.42
|
| Rate for Payer: Group Health Inc Medicare |
$8.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.15
|
|
|
PAPAVERINE HCL 30 MG/ML IJ SOLN [6030]
|
Facility
|
OP
|
$19.50
|
|
|
Service Code
|
NDC 54288014210
|
| Hospital Charge Code |
54288014210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.75
|
| Rate for Payer: Aetna Government |
$9.75
|
| Rate for Payer: Brighton Health Commercial |
$14.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.26
|
| Rate for Payer: Group Health Inc Commercial |
$9.75
|
| Rate for Payer: Group Health Inc Medicare |
$6.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.68
|
|
|
PAPER PRINTER GETINGE STERIL
|
Facility
|
OP
|
$15.72
|
|
| Hospital Charge Code |
64904650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$12.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.86
|
| Rate for Payer: Aetna Government |
$7.86
|
| Rate for Payer: Brighton Health Commercial |
$11.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.69
|
| Rate for Payer: Group Health Inc Commercial |
$7.86
|
| Rate for Payer: Group Health Inc Medicare |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.86
|
|
|
PAP SMEAR
|
Facility
|
IP
|
$37.80
|
|
|
Service Code
|
HCPCS 88150
|
| Hospital Charge Code |
40635412
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$17.76
|
|
|
PAP SMEAR
|
Facility
|
OP
|
$37.80
|
|
|
Service Code
|
HCPCS 88150
|
| Hospital Charge Code |
40635412
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.31
|
| Rate for Payer: Aetna Government |
$17.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.12
|
| Rate for Payer: Brighton Health Commercial |
$17.31
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.31
|
| Rate for Payer: EmblemHealth Commercial |
$17.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.41
|
| Rate for Payer: Group Health Inc Commercial |
$17.31
|
| Rate for Payer: Group Health Inc Medicare |
$17.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.31
|
| Rate for Payer: Healthfirst QHP |
$17.31
|
| Rate for Payer: Humana Medicare |
$17.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.85
|
| Rate for Payer: Wellcare Medicare |
$15.58
|
|
|
PAP SMEAR ABN W/MD - CHRG ONLY
|
Facility
|
OP
|
$32.60
|
|
|
Service Code
|
HCPCS 88141
|
| Hospital Charge Code |
40635491
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.25
|
| Rate for Payer: Aetna Government |
$20.25
|
| Rate for Payer: Brighton Health Commercial |
$24.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.60
|
| Rate for Payer: Group Health Inc Commercial |
$16.30
|
| Rate for Payer: Group Health Inc Medicare |
$11.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.30
|
|
|
PAP TEST 19005
|
Facility
|
IP
|
$50.64
|
|
|
Service Code
|
HCPCS 88142
|
| Hospital Charge Code |
40635464
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$20.26
|
|
|
PAP TEST 19005
|
Facility
|
OP
|
$50.64
|
|
|
Service Code
|
HCPCS 88142
|
| Hospital Charge Code |
40635464
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.26
|
| Rate for Payer: Aetna Government |
$20.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.18
|
| Rate for Payer: Brighton Health Commercial |
$20.26
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.26
|
| Rate for Payer: EmblemHealth Commercial |
$20.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.03
|
| Rate for Payer: Group Health Inc Commercial |
$20.26
|
| Rate for Payer: Group Health Inc Medicare |
$20.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.26
|
| Rate for Payer: Healthfirst QHP |
$20.26
|
| Rate for Payer: Humana Medicare |
$20.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.21
|
| Rate for Payer: Wellcare Medicare |
$18.23
|
|
|
PARACENTESIS
|
Facility
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
30102459
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
PARACENTESIS
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
40011330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| Rate for Payer: Brighton Health Commercial |
$1,785.26
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
PARACENTESIS
|
Facility
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
40011330
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
PARACENTESIS
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
30102459
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,048.28
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 65815
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,694.88
|
| Rate for Payer: Aetna Government |
$2,694.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,886.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,886.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,886.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,694.88
|
| 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: Elderplan Medicare Advantage |
$2,694.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,290.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,398.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,694.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,398.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,694.88
|
| Rate for Payer: Group Health Inc Medicare |
$2,694.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,694.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: Humana Medicare |
$2,748.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,694.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,694.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,155.90
|
| Rate for Payer: Wellcare Medicare |
$2,560.14
|
|
|
PARACENTESIS TRAY
|
Facility
|
OP
|
$45.36
|
|
| Hospital Charge Code |
40204810
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$36.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.68
|
| Rate for Payer: Aetna Government |
$22.68
|
| Rate for Payer: Brighton Health Commercial |
$34.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.84
|
| Rate for Payer: Group Health Inc Commercial |
$22.68
|
| Rate for Payer: Group Health Inc Medicare |
$15.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.68
|
|
|
PARACERVICAL BLOCK
|
Facility
|
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64435
|
| Hospital Charge Code |
30301253
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$559.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$559.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$559.80
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: Humana Medicare |
$815.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
PARACERVICAL BLOCK
|
Facility
|
IP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64435
|
| Hospital Charge Code |
30301253
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$799.72
|
|
|
PARACERVICAL(UTERINE)NERVE
|
Facility
|
IP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64435
|
| Hospital Charge Code |
30305033
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$799.72
|
|
|
PARACERVICAL(UTERINE)NERVE
|
Facility
|
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64435
|
| Hospital Charge Code |
30305033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$559.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$559.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$559.80
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: Humana Medicare |
$815.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
PARAGARD INTRAUTERINE COPPER IU IUD [6040]
|
Facility
|
OP
|
$1,302.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
59365512801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$455.70 |
| Max. Negotiated Rate |
$1,041.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$716.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$937.00
|
| Rate for Payer: Aetna Government |
$937.00
|
| Rate for Payer: Brighton Health Commercial |
$976.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,041.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$885.36
|
| Rate for Payer: Group Health Inc Commercial |
$651.00
|
| Rate for Payer: Group Health Inc Medicare |
$455.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$651.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$651.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.30
|
|
|
PARAGARD IUD
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
30301400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
|
|
PARAGARD IUD
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
30301400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$937.00
|
| Rate for Payer: Aetna Government |
$937.00
|
| Rate for Payer: Brighton Health Commercial |
$135.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.38
|
| Rate for Payer: Group Health Inc Commercial |
$112.50
|
| Rate for Payer: Group Health Inc Medicare |
$78.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.25
|
|
|
PARAINFLUENZA AG IF
|
Facility
|
IP
|
$41.08
|
|
|
Service Code
|
HCPCS 87279
|
| Hospital Charge Code |
40613061
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.43
|
|
|
PARAINFLUENZA AG IF
|
Facility
|
OP
|
$41.08
|
|
|
Service Code
|
HCPCS 87279
|
| Hospital Charge Code |
40613061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$30.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.43
|
| Rate for Payer: Aetna Government |
$16.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.50
|
| Rate for Payer: Brighton Health Commercial |
$30.81
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.43
|
| Rate for Payer: EmblemHealth Commercial |
$16.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.62
|
| Rate for Payer: Group Health Inc Commercial |
$16.43
|
| Rate for Payer: Group Health Inc Medicare |
$16.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.43
|
| Rate for Payer: Healthfirst QHP |
$16.43
|
| Rate for Payer: Humana Medicare |
$16.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.43
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.14
|
| Rate for Payer: Wellcare Medicare |
$14.79
|
|
