|
PERPHENAZINE 8 MG TAB
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
HCPCS Q0175
|
| Hospital Charge Code |
41650963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.14
|
|
|
PERQ & IC ALLG TEST DRUGS/BIOL
|
Facility
|
IP
|
$101.25
|
|
|
Service Code
|
HCPCS 95018
|
| Hospital Charge Code |
30305749
|
|
Hospital Revenue Code
|
924
|
| Rate for Payer: Cash Price |
$46.38
|
|
|
PERQ & IC ALLG TEST DRUGS/BIOL
|
Facility
|
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 95018
|
| Hospital Charge Code |
30305749
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.38
|
| Rate for Payer: Aetna Government |
$46.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$32.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$32.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.47
|
| Rate for Payer: Brighton Health Commercial |
$75.94
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.38
|
| Rate for Payer: EmblemHealth Commercial |
$46.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.28
|
| Rate for Payer: Group Health Inc Commercial |
$46.38
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.42
|
| Rate for Payer: Healthfirst QHP |
$46.38
|
| Rate for Payer: Humana Medicare |
$47.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.38
|
| Rate for Payer: United Healthcare Commercial |
$50.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.10
|
| Rate for Payer: Wellcare Medicare |
$44.06
|
|
|
PERQ & ICUT ALLG TEST VENOMS
|
Facility
|
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 95017
|
| Hospital Charge Code |
30305748
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$55.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.10
|
| Rate for Payer: Brighton Health Commercial |
$52.22
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.64
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.27
|
| Rate for Payer: Healthfirst QHP |
$34.43
|
| Rate for Payer: Humana Medicare |
$35.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: United Healthcare Commercial |
$34.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$32.71
|
|
|
PERQ & ICUT ALLG TEST VENOMS
|
Facility
|
IP
|
$69.63
|
|
|
Service Code
|
HCPCS 95017
|
| Hospital Charge Code |
30305748
|
|
Hospital Revenue Code
|
924
|
| Rate for Payer: Cash Price |
$34.43
|
|
|
PERSONA KNEE SYS 35MMX9.0
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40004700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$960.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$800.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$920.00
|
| Rate for Payer: EmblemHealth Commercial |
$800.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,680.00
|
| Rate for Payer: Group Health Inc Commercial |
$800.00
|
| Rate for Payer: Group Health Inc Medicare |
$560.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,040.00
|
|
|
PERSONA KNEE SYS 35MMX9.0
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40004700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
|
|
PERTNL/COMPOSITE-OUTPAT/INUNIT
|
Facility
|
OP
|
$383.08
|
|
| Hospital Charge Code |
42901831
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$134.08 |
| Max. Negotiated Rate |
$306.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.54
|
| Rate for Payer: Aetna Government |
$191.54
|
| Rate for Payer: Brighton Health Commercial |
$287.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.49
|
| Rate for Payer: Group Health Inc Commercial |
$191.54
|
| Rate for Payer: Group Health Inc Medicare |
$134.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.54
|
|
|
PERTUZ-TRASTUZ-HYALURON-ZZXF 60-60-2000 MG-MG-U/ML SC SOLN [174455]
|
Facility
|
OP
|
$1,047.02
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
50242026001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$837.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$575.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.05
|
| Rate for Payer: Aetna Government |
$67.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$46.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$46.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$46.94
|
| Rate for Payer: Brighton Health Commercial |
$785.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$837.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$711.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$67.05
|
| Rate for Payer: EmblemHealth Commercial |
$67.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.68
|
| Rate for Payer: Group Health Inc Commercial |
$67.05
|
| Rate for Payer: Group Health Inc Medicare |
$67.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$523.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.99
|
| Rate for Payer: Healthfirst QHP |
$67.05
|
| Rate for Payer: Humana Medicare |
$68.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.64
|
| Rate for Payer: Wellcare Medicare |
$63.70
|
|
|
PERTUZ-TRASTUZ-HYALURON-ZZXF 80-40-2000 MG-MG-U/ML SC SOLN [174456]
|
Facility
|
OP
|
$1,047.06
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
50242024501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$837.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$575.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.05
|
| Rate for Payer: Aetna Government |
$67.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$46.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$46.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$46.94
|
| Rate for Payer: Brighton Health Commercial |
$785.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$837.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$712.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$67.05
|
| Rate for Payer: EmblemHealth Commercial |
$67.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.68
|
| Rate for Payer: Group Health Inc Commercial |
$67.05
|
| Rate for Payer: Group Health Inc Medicare |
$67.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$523.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.99
|
| Rate for Payer: Healthfirst QHP |
$67.05
|
| Rate for Payer: Humana Medicare |
$68.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.64
|
| Rate for Payer: Wellcare Medicare |
$63.70
|
|
|
PERTUZUMAB 420 MG/14ML IV SOLN [116596]
|
Facility
|
OP
|
$559.44
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
50242014501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$307.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.43
|
| Rate for Payer: Aetna Government |
$15.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.32
|
| Rate for Payer: Amida Care Medicaid |
$10.32
|
| Rate for Payer: Brighton Health Commercial |
$335.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$279.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$321.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.43
|
| Rate for Payer: EmblemHealth Commercial |
$279.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,032.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.84
|
| Rate for Payer: Group Health Inc Commercial |
$15.43
|
| Rate for Payer: Group Health Inc Medicare |
$15.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.32
|
| Rate for Payer: Healthfirst Essential Plan |
$23.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.11
|
| Rate for Payer: Healthfirst QHP |
$10.32
|
| Rate for Payer: Humana Medicare |
$15.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.32
|
| Rate for Payer: SOMOS Essential |
$10.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$23.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$11.35
|
| Rate for Payer: United Healthcare Medicaid |
$10.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$363.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.34
|
|
|
PERTUZUMAB 420 MG/14ML IV SOLN [116596]
|
Facility
|
IP
|
$559.44
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
50242014501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.72 |
| Max. Negotiated Rate |
$279.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.72
|
|
|
PESSARY 5 FOLD RNG W/SUP MILEX
|
Facility
|
OP
|
$144.83
|
|
| Hospital Charge Code |
64903415
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$115.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.42
|
| Rate for Payer: Aetna Government |
$72.42
|
| Rate for Payer: Brighton Health Commercial |
$108.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$115.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.48
|
| Rate for Payer: Group Health Inc Commercial |
$72.42
|
| Rate for Payer: Group Health Inc Medicare |
$50.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.42
|
|
|
PESSARY,NON-RUBBER
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
40205439
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$59.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.21
|
| Rate for Payer: Aetna Government |
$30.21
|
| Rate for Payer: Brighton Health Commercial |
$55.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.32
|
| Rate for Payer: Group Health Inc Commercial |
$37.00
|
| Rate for Payer: Group Health Inc Medicare |
$25.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.00
|
|
|
PESSARY, NON RUBBER (MCARE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
30301404
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.21
|
| Rate for Payer: Aetna Government |
$30.21
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.60
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
|
|
PESSARY RING W/SUPPRT SIL FOLDING
|
Facility
|
OP
|
$144.83
|
|
| Hospital Charge Code |
64903004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$115.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.42
|
| Rate for Payer: Aetna Government |
$72.42
|
| Rate for Payer: Brighton Health Commercial |
$108.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$115.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.48
|
| Rate for Payer: Group Health Inc Commercial |
$72.42
|
| Rate for Payer: Group Health Inc Medicare |
$50.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.42
|
|
|
PESSARY, RUBBER
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS A4561
|
| Hospital Charge Code |
40205438
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$59.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.13
|
| Rate for Payer: Aetna Government |
$12.13
|
| Rate for Payer: Brighton Health Commercial |
$55.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.32
|
| Rate for Payer: Group Health Inc Commercial |
$37.00
|
| Rate for Payer: Group Health Inc Medicare |
$25.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.00
|
|
|
PESSARY,RUBBER(MCARE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS A4561
|
| Hospital Charge Code |
30301403
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.13
|
| Rate for Payer: Aetna Government |
$12.13
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.60
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
|
|
PETROLATUM OINT 5 GRAMS
|
Facility
|
OP
|
$0.10
|
|
| Hospital Charge Code |
41651637
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
PETROLATUM OINT 5 GRAMS
|
Facility
|
OP
|
$0.10
|
|
| Hospital Charge Code |
41641637
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
PEZZAR
|
Facility
|
OP
|
$50.67
|
|
| Hospital Charge Code |
40204833
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.73 |
| Max. Negotiated Rate |
$40.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.34
|
| Rate for Payer: Aetna Government |
$25.34
|
| Rate for Payer: Brighton Health Commercial |
$38.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.46
|
| Rate for Payer: Group Health Inc Commercial |
$25.34
|
| Rate for Payer: Group Health Inc Medicare |
$17.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.34
|
|
|
PFIZER ADULT ADMIN
|
Facility
|
OP
|
$102.55
|
|
|
Service Code
|
HCPCS 0004A
|
| Hospital Charge Code |
30302521
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Brighton Health Commercial |
$76.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.73
|
| 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 |
$51.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.28
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
PFIZER COVID19 VAC ADMIN 1ST DOSE
|
Facility
|
OP
|
$102.55
|
|
|
Service Code
|
HCPCS 0001A
|
| Hospital Charge Code |
30300253
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Brighton Health Commercial |
$76.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.73
|
| 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 |
$51.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.28
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
PFIZER COVID19 VAC ADMIN 2ND DOSE
|
Facility
|
OP
|
$102.55
|
|
|
Service Code
|
HCPCS 0002A
|
| Hospital Charge Code |
30300254
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Brighton Health Commercial |
$76.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.73
|
| 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 |
$51.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.28
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
PFIZER PEDS ADMIN 1ST DOSE
|
Facility
|
OP
|
$102.55
|
|
| Hospital Charge Code |
30302522
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.28
|
| Rate for Payer: Aetna Government |
$51.28
|
| Rate for Payer: Brighton Health Commercial |
$76.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.73
|
| 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 |
$51.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.28
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
