|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC
|
Facility
|
IP
|
$51,521.25
|
|
|
Service Code
|
MSDRG 734
|
| Min. Negotiated Rate |
$17,423.55 |
| Max. Negotiated Rate |
$51,521.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32,049.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37,470.00
|
| Rate for Payer: Aetna Government |
$37,470.00
|
| Rate for Payer: Brighton Health Commercial |
$31,517.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38,219.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37,535.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30,976.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$35,596.50
|
| Rate for Payer: EmblemHealth Commercial |
$18,638.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$37,470.00
|
| Rate for Payer: Group Health Inc Commercial |
$37,470.00
|
| Rate for Payer: Group Health Inc Medicare |
$37,470.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37,470.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,423.55
|
| Rate for Payer: Humana Medicare |
$51,521.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37,470.00
|
| Rate for Payer: United Healthcare Commercial |
$43,226.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,470.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37,470.00
|
| Rate for Payer: Wellcare Medicare |
$35,596.50
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$34,104.83
|
|
|
Service Code
|
MSDRG 735
|
| Min. Negotiated Rate |
$10,806.20 |
| Max. Negotiated Rate |
$34,104.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,581.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,803.51
|
| Rate for Payer: Aetna Government |
$24,803.51
|
| Rate for Payer: Brighton Health Commercial |
$18,272.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,299.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,762.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,959.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,563.33
|
| Rate for Payer: EmblemHealth Commercial |
$10,806.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,803.51
|
| Rate for Payer: Group Health Inc Commercial |
$24,803.51
|
| Rate for Payer: Group Health Inc Medicare |
$24,803.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,803.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,533.63
|
| Rate for Payer: Humana Medicare |
$34,104.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,803.51
|
| Rate for Payer: United Healthcare Commercial |
$25,061.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,803.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,803.51
|
| Rate for Payer: Wellcare Medicare |
$23,563.33
|
|
|
Pelvic examination under anesthesia (other than local)
|
Facility
|
OP
|
$3,687.70
|
|
|
Service Code
|
CPT 57410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,687.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
PELVIC PLATE 14 HOLE
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$117.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.12
|
| Rate for Payer: EmblemHealth Commercial |
$97.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.75
|
| Rate for Payer: Group Health Inc Commercial |
$97.50
|
| Rate for Payer: Group Health Inc Medicare |
$68.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.75
|
|
|
PELVIC PLATE 14 HOLE
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.50
|
|
|
PELVIC TRACTION BELT
|
Facility
|
OP
|
$102.06
|
|
| Hospital Charge Code |
40204825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.03
|
| Rate for Payer: Aetna Government |
$51.03
|
| Rate for Payer: Brighton Health Commercial |
$76.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.40
|
| Rate for Payer: Group Health Inc Commercial |
$51.03
|
| Rate for Payer: Group Health Inc Medicare |
$35.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.03
|
|
|
PEMBROLIZUMAB 100 MG/4ML IV SOLN [127964]
|
Facility
|
OP
|
$1,700.60
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
00006302604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$1,105.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$935.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.73
|
| Rate for Payer: Aetna Government |
$55.73
|
| Rate for Payer: Brighton Health Commercial |
$1,020.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$850.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$977.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$55.73
|
| Rate for Payer: EmblemHealth Commercial |
$850.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.73
|
| Rate for Payer: Group Health Inc Commercial |
$55.73
|
| Rate for Payer: Group Health Inc Medicare |
$55.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$850.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.37
|
| Rate for Payer: Healthfirst QHP |
$55.73
|
| Rate for Payer: Humana Medicare |
$56.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,105.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44.58
|
|
|
PEMBROLIZUMAB 100 MG/4ML IV SOLN [127964]
|
Facility
|
IP
|
$1,700.60
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
00006302604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.30 |
| Max. Negotiated Rate |
$850.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$850.30
|
|
|
PEMBROLIZUMAB 100 MG/4ML IV SOLN [127964]
|
Facility
|
OP
|
$1,700.61
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
00006302602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$1,105.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$935.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.73
|
| Rate for Payer: Aetna Government |
$55.73
|
| Rate for Payer: Brighton Health Commercial |
$1,020.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$850.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$977.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$55.73
|
| Rate for Payer: EmblemHealth Commercial |
$850.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.73
|
| Rate for Payer: Group Health Inc Commercial |
$55.73
|
| Rate for Payer: Group Health Inc Medicare |
$55.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$850.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.37
|
| Rate for Payer: Healthfirst QHP |
$55.73
|
| Rate for Payer: Humana Medicare |
$56.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,105.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44.58
|
|
|
PEMBROLIZUMAB 100 MG/4ML IV SOLN [127964]
|
Facility
|
IP
|
$1,700.61
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
00006302602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.30 |
| Max. Negotiated Rate |
$850.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$850.30
|
|
|
PEMBROLIZUMAB 100MG/4ML PF INJ
|
Facility
|
IP
|
$35.53
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
41643889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.76
|
|
|
PEMBROLIZUMAB 100MG/4ML PF INJ
|
Facility
|
OP
|
$35.53
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
41643889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.73
|
| Rate for Payer: Aetna Government |
$55.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39.01
|
| Rate for Payer: Brighton Health Commercial |
$21.32
|
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$55.73
|
| Rate for Payer: EmblemHealth Commercial |
$55.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.52
|
| Rate for Payer: Group Health Inc Commercial |
$55.73
|
| Rate for Payer: Group Health Inc Medicare |
$55.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.37
|
| Rate for Payer: Healthfirst QHP |
$55.73
|
| Rate for Payer: Humana Medicare |
$56.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.75
|
| Rate for Payer: SOMOS Essential |
$60.75
|
| Rate for Payer: United Healthcare Commercial |
$53.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44.58
|
| Rate for Payer: Wellcare Medicare |
$52.94
|
|
|
PEMBROLIZUMAB 100MG/4ML PF INJ
|
Facility
|
OP
|
$35.53
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
41653889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.73
|
| Rate for Payer: Aetna Government |
$55.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39.01
|
| Rate for Payer: Brighton Health Commercial |
$21.32
|
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$55.73
|
| Rate for Payer: EmblemHealth Commercial |
$55.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.52
|
| Rate for Payer: Group Health Inc Commercial |
$55.73
|
| Rate for Payer: Group Health Inc Medicare |
$55.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.37
|
| Rate for Payer: Healthfirst QHP |
$55.73
|
| Rate for Payer: Humana Medicare |
$56.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.75
|
| Rate for Payer: SOMOS Essential |
$60.75
|
| Rate for Payer: United Healthcare Commercial |
$53.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44.58
|
| Rate for Payer: Wellcare Medicare |
$52.94
|
|
|
PEMBROLIZUMAB 100MG/4ML PF INJ
|
Facility
|
IP
|
$35.53
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
41653889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.76
|
|
|
PEMETREXED 500 MG INJ
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
41653670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.50 |
| Max. Negotiated Rate |
$99.50 |
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.50
|
|
|
PEMETREXED 500 MG INJ
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
41643670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.50 |
| Max. Negotiated Rate |
$99.50 |
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.50
|
|
|
PEMETREXED 500 MG INJ
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
41643670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.37
|
| Rate for Payer: Aetna Government |
$4.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.06
|
| Rate for Payer: Brighton Health Commercial |
$119.40
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$99.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.37
|
| Rate for Payer: EmblemHealth Commercial |
$4.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.59
|
| Rate for Payer: Group Health Inc Commercial |
$4.37
|
| Rate for Payer: Group Health Inc Medicare |
$4.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.72
|
| Rate for Payer: Healthfirst QHP |
$4.37
|
| Rate for Payer: Humana Medicare |
$4.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.21
|
| Rate for Payer: SOMOS Essential |
$4.21
|
| Rate for Payer: United Healthcare Commercial |
$27.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.50
|
| Rate for Payer: Wellcare Medicare |
$4.15
|
|
|
PEMETREXED 500 MG INJ
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
41653670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.37
|
| Rate for Payer: Aetna Government |
$4.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.06
|
| Rate for Payer: Brighton Health Commercial |
$119.40
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$99.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.37
|
| Rate for Payer: EmblemHealth Commercial |
$4.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.59
|
| Rate for Payer: Group Health Inc Commercial |
$4.37
|
| Rate for Payer: Group Health Inc Medicare |
$4.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.72
|
| Rate for Payer: Healthfirst QHP |
$4.37
|
| Rate for Payer: Humana Medicare |
$4.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.21
|
| Rate for Payer: SOMOS Essential |
$4.21
|
| Rate for Payer: United Healthcare Commercial |
$27.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.50
|
| Rate for Payer: Wellcare Medicare |
$4.15
|
|
|
PEMETREXED DISODIUM 500 MG IV SOLR [37894]
|
Facility
|
IP
|
$951.60
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
43598038711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.80 |
| Max. Negotiated Rate |
$475.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$475.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$475.80
|
|
|
PEMETREXED DISODIUM 500 MG IV SOLR [37894]
|
Facility
|
OP
|
$951.60
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
43598038711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$618.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$523.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.37
|
| Rate for Payer: Aetna Government |
$4.37
|
| Rate for Payer: Brighton Health Commercial |
$570.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$475.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.37
|
| Rate for Payer: EmblemHealth Commercial |
$475.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.37
|
| Rate for Payer: Group Health Inc Commercial |
$4.37
|
| Rate for Payer: Group Health Inc Medicare |
$4.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$475.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$475.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.72
|
| Rate for Payer: Healthfirst QHP |
$4.37
|
| Rate for Payer: Humana Medicare |
$4.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$618.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.50
|
|
|
PEMETREXED DISODIUM 500 MG IV SOLR [37894]
|
Facility
|
OP
|
$4,851.60
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
00002762301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3,153.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,668.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.37
|
| Rate for Payer: Aetna Government |
$4.37
|
| Rate for Payer: Brighton Health Commercial |
$2,910.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,425.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,789.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.37
|
| Rate for Payer: EmblemHealth Commercial |
$2,425.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.37
|
| Rate for Payer: Group Health Inc Commercial |
$4.37
|
| Rate for Payer: Group Health Inc Medicare |
$4.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,425.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,425.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.72
|
| Rate for Payer: Healthfirst QHP |
$4.37
|
| Rate for Payer: Humana Medicare |
$4.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,153.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.50
|
|
|
PEMETREXED DISODIUM 500 MG IV SOLR [37894]
|
Facility
|
IP
|
$4,851.60
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
00002762301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,425.80 |
| Max. Negotiated Rate |
$2,425.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,425.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,425.80
|
|
|
PENCIL ACCUVAC W/ROCKER SWITCH
|
Facility
|
OP
|
$604.00
|
|
| Hospital Charge Code |
40201035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$483.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$332.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$302.00
|
| Rate for Payer: Aetna Government |
$302.00
|
| Rate for Payer: Brighton Health Commercial |
$453.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$483.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$410.72
|
| Rate for Payer: Group Health Inc Commercial |
$302.00
|
| Rate for Payer: Group Health Inc Medicare |
$211.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302.00
|
|
|
PENCIL ELECTRO SURGICAL
|
Facility
|
OP
|
$7.02
|
|
| Hospital Charge Code |
64901679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.51
|
| Rate for Payer: Aetna Government |
$3.51
|
| Rate for Payer: Brighton Health Commercial |
$5.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.77
|
| Rate for Payer: Group Health Inc Commercial |
$3.51
|
| Rate for Payer: Group Health Inc Medicare |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.51
|
|
|
PENCIL HAND CTRL TRIP OPTN 10FT
|
Facility
|
OP
|
$138.82
|
|
| Hospital Charge Code |
64904350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$111.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$76.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.41
|
| Rate for Payer: Aetna Government |
$69.41
|
| Rate for Payer: Brighton Health Commercial |
$104.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$111.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$94.40
|
| Rate for Payer: Group Health Inc Commercial |
$69.41
|
| Rate for Payer: Group Health Inc Medicare |
$48.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.41
|
|
