|
PHENOSENSE GT (R)
|
Facility
|
OP
|
$325.88
|
|
|
Service Code
|
HCPCS 87900
|
| Hospital Charge Code |
40609154
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.24 |
| Max. Negotiated Rate |
$244.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.35
|
| Rate for Payer: Aetna Government |
$130.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$91.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$91.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$91.24
|
| Rate for Payer: Brighton Health Commercial |
$244.41
|
| Rate for Payer: Cash Price |
$130.35
|
| Rate for Payer: Cash Price |
$130.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$207.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$130.35
|
| Rate for Payer: EmblemHealth Commercial |
$130.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.01
|
| Rate for Payer: Group Health Inc Commercial |
$130.35
|
| Rate for Payer: Group Health Inc Medicare |
$130.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.35
|
| Rate for Payer: Healthfirst QHP |
$130.35
|
| Rate for Payer: Humana Medicare |
$132.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.35
|
| Rate for Payer: United Healthcare Commercial |
$165.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.28
|
| Rate for Payer: Wellcare Medicare |
$117.32
|
|
|
PHENOSENSE GT (R)
|
Facility
|
IP
|
$325.88
|
|
|
Service Code
|
HCPCS 87900
|
| Hospital Charge Code |
40609154
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$130.35
|
|
|
PHENOSENSE(R)
|
Facility
|
OP
|
$1,221.65
|
|
|
Service Code
|
HCPCS 87903
|
| Hospital Charge Code |
40619868
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$342.06 |
| Max. Negotiated Rate |
$916.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$671.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$488.66
|
| Rate for Payer: Aetna Government |
$488.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$342.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$342.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$342.06
|
| Rate for Payer: Brighton Health Commercial |
$916.24
|
| Rate for Payer: Cash Price |
$488.66
|
| Rate for Payer: Cash Price |
$488.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$776.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$657.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$488.66
|
| Rate for Payer: EmblemHealth Commercial |
$488.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$415.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.91
|
| Rate for Payer: Group Health Inc Commercial |
$488.66
|
| Rate for Payer: Group Health Inc Medicare |
$488.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$610.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$488.66
|
| Rate for Payer: Healthfirst QHP |
$488.66
|
| Rate for Payer: Humana Medicare |
$498.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.66
|
| Rate for Payer: United Healthcare Commercial |
$618.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$390.93
|
| Rate for Payer: Wellcare Medicare |
$439.79
|
|
|
PHENOSENSE(R)
|
Facility
|
IP
|
$1,221.65
|
|
|
Service Code
|
HCPCS 87903
|
| Hospital Charge Code |
40619868
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$488.66
|
|
|
PHENOTYPE DNA HIV W/CULTURE
|
Facility
|
IP
|
$1,221.65
|
|
|
Service Code
|
HCPCS 87903
|
| Hospital Charge Code |
40609611
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$488.66
|
|
|
PHENOTYPE DNA HIV W/CULTURE
|
Facility
|
OP
|
$1,221.65
|
|
|
Service Code
|
HCPCS 87903
|
| Hospital Charge Code |
40609611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$342.06 |
| Max. Negotiated Rate |
$916.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$671.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$488.66
|
| Rate for Payer: Aetna Government |
$488.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$342.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$342.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$342.06
|
| Rate for Payer: Brighton Health Commercial |
$916.24
|
| Rate for Payer: Cash Price |
$488.66
|
| Rate for Payer: Cash Price |
$488.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$776.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$657.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$488.66
|
| Rate for Payer: EmblemHealth Commercial |
$488.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$415.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.91
|
| Rate for Payer: Group Health Inc Commercial |
$488.66
|
| Rate for Payer: Group Health Inc Medicare |
$488.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$610.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$488.66
|
| Rate for Payer: Healthfirst QHP |
$488.66
|
| Rate for Payer: Humana Medicare |
$498.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.66
|
| Rate for Payer: United Healthcare Commercial |
$618.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$390.93
|
| Rate for Payer: Wellcare Medicare |
$439.79
|
|
|
PHENOTYPE INFECT AGENT DRG
|
Facility
|
IP
|
$325.88
|
|
|
Service Code
|
HCPCS 87900
|
| Hospital Charge Code |
40609633
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$130.35
|
|
|
PHENOTYPE INFECT AGENT DRG
|
Facility
|
OP
|
$325.88
|
|
|
Service Code
|
HCPCS 87900
|
| Hospital Charge Code |
40609633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.24 |
| Max. Negotiated Rate |
$244.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.35
|
| Rate for Payer: Aetna Government |
$130.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$91.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$91.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$91.24
|
| Rate for Payer: Brighton Health Commercial |
$244.41
|
| Rate for Payer: Cash Price |
$130.35
|
| Rate for Payer: Cash Price |
$130.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$207.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$130.35
|
| Rate for Payer: EmblemHealth Commercial |
$130.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.01
|
| Rate for Payer: Group Health Inc Commercial |
$130.35
|
| Rate for Payer: Group Health Inc Medicare |
$130.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.35
|
| Rate for Payer: Healthfirst QHP |
$130.35
|
| Rate for Payer: Humana Medicare |
$132.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.35
|
| Rate for Payer: United Healthcare Commercial |
$165.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.28
|
| Rate for Payer: Wellcare Medicare |
$117.32
|
|
|
PHENOTYPE INFECT AGENT DRUG
|
Facility
|
OP
|
$325.88
|
|
|
Service Code
|
HCPCS 87900
|
| Hospital Charge Code |
40609609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.24 |
| Max. Negotiated Rate |
$244.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.35
|
| Rate for Payer: Aetna Government |
$130.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$91.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$91.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$91.24
|
| Rate for Payer: Brighton Health Commercial |
$244.41
|
| Rate for Payer: Cash Price |
$130.35
|
| Rate for Payer: Cash Price |
$130.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$207.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$130.35
|
| Rate for Payer: EmblemHealth Commercial |
$130.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.01
|
| Rate for Payer: Group Health Inc Commercial |
$130.35
|
| Rate for Payer: Group Health Inc Medicare |
$130.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.35
|
| Rate for Payer: Healthfirst QHP |
$130.35
|
| Rate for Payer: Humana Medicare |
$132.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.35
|
| Rate for Payer: United Healthcare Commercial |
$165.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.28
|
| Rate for Payer: Wellcare Medicare |
$117.32
|
|
|
PHENOTYPE INFECT AGENT DRUG
|
Facility
|
IP
|
$325.88
|
|
|
Service Code
|
HCPCS 87900
|
| Hospital Charge Code |
40609609
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$130.35
|
|
|
PHENOXYBENZAMINE 10 MG CAP
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
41652673
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
|
PHENOXYBENZAMINE 10 MG CAP
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
41642673
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
|
PHENOXYBENZAMINE HCL 10 MG PO CAPS [10945]
|
Facility
|
OP
|
$129.45
|
|
|
Service Code
|
NDC 49884003801
|
| Hospital Charge Code |
49884003801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$103.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.72
|
| Rate for Payer: Aetna Government |
$64.72
|
| Rate for Payer: Brighton Health Commercial |
$97.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$103.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.02
|
| Rate for Payer: Group Health Inc Commercial |
$64.72
|
| Rate for Payer: Group Health Inc Medicare |
$45.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.14
|
|
|
PHENTOLAMINE 5 MG INJ
|
Facility
|
IP
|
$149.22
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
41643613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$74.61 |
| Rate for Payer: Cash Price |
$446.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.61
|
|
|
PHENTOLAMINE 5 MG INJ
|
Facility
|
OP
|
$149.22
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
41653613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$470.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$446.80
|
| Rate for Payer: Aetna Government |
$446.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$312.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$312.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$312.76
|
| Rate for Payer: Brighton Health Commercial |
$89.53
|
| Rate for Payer: Cash Price |
$446.80
|
| Rate for Payer: Cash Price |
$446.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$446.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$446.80
|
| Rate for Payer: EmblemHealth Commercial |
$446.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$446.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$446.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$469.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$469.14
|
| Rate for Payer: Group Health Inc Commercial |
$446.80
|
| Rate for Payer: Group Health Inc Medicare |
$446.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$379.78
|
| Rate for Payer: Healthfirst QHP |
$446.80
|
| Rate for Payer: Humana Medicare |
$455.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$446.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$470.98
|
| Rate for Payer: SOMOS Essential |
$470.98
|
| Rate for Payer: United Healthcare Commercial |
$450.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$446.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$357.44
|
| Rate for Payer: Wellcare Medicare |
$424.46
|
|
|
PHENTOLAMINE 5 MG INJ
|
Facility
|
IP
|
$149.22
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
41653613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$74.61 |
| Rate for Payer: Cash Price |
$446.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.61
|
|
|
PHENTOLAMINE 5 MG INJ
|
Facility
|
OP
|
$149.22
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
41643613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$470.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$446.80
|
| Rate for Payer: Aetna Government |
$446.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$312.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$312.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$312.76
|
| Rate for Payer: Brighton Health Commercial |
$89.53
|
| Rate for Payer: Cash Price |
$446.80
|
| Rate for Payer: Cash Price |
$446.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$446.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$446.80
|
| Rate for Payer: EmblemHealth Commercial |
$446.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$446.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$446.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$469.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$469.14
|
| Rate for Payer: Group Health Inc Commercial |
$446.80
|
| Rate for Payer: Group Health Inc Medicare |
$446.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$379.78
|
| Rate for Payer: Healthfirst QHP |
$446.80
|
| Rate for Payer: Humana Medicare |
$455.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$446.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$470.98
|
| Rate for Payer: SOMOS Essential |
$470.98
|
| Rate for Payer: United Healthcare Commercial |
$450.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$446.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$357.44
|
| Rate for Payer: Wellcare Medicare |
$424.46
|
|
|
PHENTOLAMINE MESYLATE 5 MG IJ SOLR [10947]
|
Facility
|
OP
|
$587.95
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
00143956401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$293.98 |
| Max. Negotiated Rate |
$470.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$323.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$446.80
|
| Rate for Payer: Aetna Government |
$446.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$312.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$312.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$312.76
|
| Rate for Payer: Brighton Health Commercial |
$440.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$446.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$470.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$399.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$446.80
|
| Rate for Payer: EmblemHealth Commercial |
$446.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$379.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$397.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$397.65
|
| Rate for Payer: Group Health Inc Commercial |
$446.80
|
| Rate for Payer: Group Health Inc Medicare |
$446.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$446.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$379.78
|
| Rate for Payer: Healthfirst QHP |
$446.80
|
| Rate for Payer: Humana Medicare |
$455.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$444.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$470.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$470.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$470.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$446.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$446.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$382.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$357.44
|
| Rate for Payer: Wellcare Medicare |
$424.46
|
|
|
PHENYLALANINE, QN, P
|
Facility
|
IP
|
$57.45
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
40609876
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$22.98
|
|
|
PHENYLALANINE, QN, P
|
Facility
|
OP
|
$57.45
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
40609876
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$43.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.98
|
| Rate for Payer: Aetna Government |
$22.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.09
|
| Rate for Payer: Brighton Health Commercial |
$43.09
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.98
|
| Rate for Payer: EmblemHealth Commercial |
$22.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.45
|
| Rate for Payer: Group Health Inc Commercial |
$22.98
|
| Rate for Payer: Group Health Inc Medicare |
$22.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.98
|
| Rate for Payer: Healthfirst QHP |
$22.98
|
| Rate for Payer: Humana Medicare |
$23.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.98
|
| Rate for Payer: United Healthcare Commercial |
$21.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.38
|
| Rate for Payer: Wellcare Medicare |
$20.68
|
|
|
PHENYLALANINE+TYROSINE, QN, PL
|
Facility
|
IP
|
$49.03
|
|
|
Service Code
|
HCPCS 82136
|
| Hospital Charge Code |
40609817
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$19.61
|
|
|
PHENYLALANINE+TYROSINE, QN, PL
|
Facility
|
OP
|
$49.03
|
|
|
Service Code
|
HCPCS 82136
|
| Hospital Charge Code |
40609817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$36.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.61
|
| Rate for Payer: Aetna Government |
$19.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.73
|
| Rate for Payer: Brighton Health Commercial |
$36.77
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.61
|
| Rate for Payer: EmblemHealth Commercial |
$19.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.45
|
| Rate for Payer: Group Health Inc Commercial |
$19.61
|
| Rate for Payer: Group Health Inc Medicare |
$19.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.61
|
| Rate for Payer: Healthfirst QHP |
$19.61
|
| Rate for Payer: Humana Medicare |
$20.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.61
|
| Rate for Payer: United Healthcare Commercial |
$21.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.69
|
| Rate for Payer: Wellcare Medicare |
$17.65
|
|
|
PHENYLEPHRINE 10 MG/ML INJ 1 ML
|
Facility
|
OP
|
$6.25
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
41643631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.04
|
| Rate for Payer: Aetna Government |
$3.04
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
| Rate for Payer: Group Health Inc Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
|
|
PHENYLEPHRINE 10 MG/ML INJ 1 ML
|
Facility
|
IP
|
$6.25
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
41643631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
|
|
PHENYLEPHRINE 10 MG/ML INJ 2 ML
|
Facility
|
OP
|
$6.25
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
41653631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.04
|
| Rate for Payer: Aetna Government |
$3.04
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
| Rate for Payer: Group Health Inc Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
|
