|
PHESGO 10ML
|
Facility
|
OP
|
$211.78
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
41650261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$137.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.48
|
| 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 |
$127.07
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| 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 |
$105.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$67.05
|
| Rate for Payer: EmblemHealth Commercial |
$67.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.40
|
| 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 |
$105.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.89
|
| 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: Senior Whole Health Medicare Advantage |
$67.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.24
|
| Rate for Payer: SOMOS Essential |
$69.24
|
| Rate for Payer: United Healthcare Commercial |
$69.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.64
|
| Rate for Payer: Wellcare Medicare |
$63.70
|
|
|
PHESGO 10ML
|
Facility
|
IP
|
$211.78
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
41650261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.89 |
| Max. Negotiated Rate |
$105.89 |
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.89
|
|
|
PHESGO 10ML
|
Facility
|
IP
|
$211.78
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
41640261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.89 |
| Max. Negotiated Rate |
$105.89 |
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.89
|
|
|
PHESGO 10ML
|
Facility
|
OP
|
$211.78
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
41640261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$137.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.48
|
| 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 |
$127.07
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| 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 |
$105.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$67.05
|
| Rate for Payer: EmblemHealth Commercial |
$67.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.40
|
| 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 |
$105.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.89
|
| 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: Senior Whole Health Medicare Advantage |
$67.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.24
|
| Rate for Payer: SOMOS Essential |
$69.24
|
| Rate for Payer: United Healthcare Commercial |
$69.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.64
|
| Rate for Payer: Wellcare Medicare |
$63.70
|
|
|
PHESGO 15ML
|
Facility
|
IP
|
$381.21
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
41640262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.60 |
| Max. Negotiated Rate |
$190.60 |
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.60
|
|
|
PHESGO 15ML
|
Facility
|
OP
|
$381.21
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
41640262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$247.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$209.67
|
| 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 |
$228.73
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| 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 |
$190.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$219.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$67.05
|
| Rate for Payer: EmblemHealth Commercial |
$67.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.40
|
| 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 |
$190.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.60
|
| 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: Senior Whole Health Medicare Advantage |
$67.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.24
|
| Rate for Payer: SOMOS Essential |
$69.24
|
| Rate for Payer: United Healthcare Commercial |
$69.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.64
|
| Rate for Payer: Wellcare Medicare |
$63.70
|
|
|
PHESGO 15ML
|
Facility
|
IP
|
$381.21
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
41650262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.60 |
| Max. Negotiated Rate |
$190.60 |
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.60
|
|
|
PHESGO 15ML
|
Facility
|
OP
|
$381.21
|
|
|
Service Code
|
HCPCS J9316
|
| Hospital Charge Code |
41650262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$247.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$209.67
|
| 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 |
$228.73
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| 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 |
$190.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$219.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$67.05
|
| Rate for Payer: EmblemHealth Commercial |
$67.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.40
|
| 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 |
$190.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.60
|
| 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: Senior Whole Health Medicare Advantage |
$67.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.24
|
| Rate for Payer: SOMOS Essential |
$69.24
|
| Rate for Payer: United Healthcare Commercial |
$69.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.64
|
| Rate for Payer: Wellcare Medicare |
$63.70
|
|
|
PH FLUID.
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
40602390
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$3.58
|
|
|
PH FLUID.
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
40602390
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Government |
$3.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.51
|
| Rate for Payer: Brighton Health Commercial |
$6.71
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.58
|
| Rate for Payer: EmblemHealth Commercial |
$3.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.19
|
| Rate for Payer: Group Health Inc Commercial |
$3.58
|
| Rate for Payer: Group Health Inc Medicare |
$3.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.58
|
| Rate for Payer: Healthfirst QHP |
$3.58
|
| Rate for Payer: Humana Medicare |
$3.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.58
|
| Rate for Payer: United Healthcare Commercial |
$4.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.86
|
| Rate for Payer: Wellcare Medicare |
$3.22
|
|
|
PHILADELPHIA COLLAR
|
Facility
|
OP
|
$51.74
|
|
| Hospital Charge Code |
40207632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$41.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.87
|
| Rate for Payer: Aetna Government |
$25.87
|
| Rate for Payer: Brighton Health Commercial |
$38.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.18
|
| Rate for Payer: Group Health Inc Commercial |
$25.87
|
| Rate for Payer: Group Health Inc Medicare |
$18.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.87
|
|
|
PHISOHEX
|
Facility
|
OP
|
$127.58
|
|
| Hospital Charge Code |
40204835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.65 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.79
|
| Rate for Payer: Aetna Government |
$63.79
|
| Rate for Payer: Brighton Health Commercial |
$95.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$102.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.75
|
| Rate for Payer: Group Health Inc Commercial |
$63.79
|
| Rate for Payer: Group Health Inc Medicare |
$44.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.79
|
|
|
PHLEBOTOMY
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
40509890
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$165.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
PHLEBOTOMY
|
Facility
|
IP
|
$9.71
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30103225
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$8.83
|
|
|
PHLEBOTOMY
|
Facility
|
OP
|
$9.71
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30103225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$926.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.57
|
| Rate for Payer: Aetna Government |
$8.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.26
|
| Rate for Payer: Amida Care Medicaid |
$9.26
|
| Rate for Payer: Brighton Health Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.57
|
| Rate for Payer: EmblemHealth Commercial |
$8.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$926.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Group Health Inc Commercial |
$8.57
|
| Rate for Payer: Group Health Inc Medicare |
$8.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.26
|
| Rate for Payer: Healthfirst Essential Plan |
$20.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.28
|
| Rate for Payer: Healthfirst QHP |
$9.26
|
| Rate for Payer: Humana Medicare |
$8.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.26
|
| Rate for Payer: SOMOS Essential |
$20.84
|
| Rate for Payer: United Healthcare Commercial |
$2.70
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$20.84
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$10.19
|
| Rate for Payer: United Healthcare Medicaid |
$9.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.86
|
| Rate for Payer: Wellcare Medicare |
$7.71
|
|
|
PHLEBOTOMY
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
40509890
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
PHLEBOTOMY
|
Facility
|
OP
|
$9.71
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30303059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$926.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.57
|
| Rate for Payer: Aetna Government |
$8.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.26
|
| Rate for Payer: Amida Care Medicaid |
$9.26
|
| Rate for Payer: Brighton Health Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.57
|
| Rate for Payer: EmblemHealth Commercial |
$8.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$926.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Group Health Inc Commercial |
$8.57
|
| Rate for Payer: Group Health Inc Medicare |
$8.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.26
|
| Rate for Payer: Healthfirst Essential Plan |
$20.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.28
|
| Rate for Payer: Healthfirst QHP |
$9.26
|
| Rate for Payer: Humana Medicare |
$8.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.26
|
| Rate for Payer: SOMOS Essential |
$20.84
|
| Rate for Payer: United Healthcare Commercial |
$2.70
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$20.84
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$10.19
|
| Rate for Payer: United Healthcare Medicaid |
$9.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.86
|
| Rate for Payer: Wellcare Medicare |
$7.71
|
|
|
PHLEBOTOMY
|
Facility
|
IP
|
$9.71
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30303059
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$8.83
|
|
|
PHOSPHATES ENEMA (ADULT) SOLN
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41644079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
PHOSPHATES ENEMA (ADULT) SOLN
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41654079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
PHOSPHATES ENEMA (PEDIATRIC) SOLN
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41651424
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
PHOSPHATES ENEMA (PEDIATRIC) SOLN
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41641424
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
PHOSPHOROUS
|
Facility
|
OP
|
$11.85
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
40602105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.74
|
| Rate for Payer: Aetna Government |
$4.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.32
|
| Rate for Payer: Brighton Health Commercial |
$8.89
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.74
|
| Rate for Payer: EmblemHealth Commercial |
$4.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.22
|
| Rate for Payer: Group Health Inc Commercial |
$4.74
|
| Rate for Payer: Group Health Inc Medicare |
$4.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.74
|
| Rate for Payer: Healthfirst QHP |
$4.74
|
| Rate for Payer: Humana Medicare |
$4.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.74
|
| Rate for Payer: United Healthcare Commercial |
$6.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.79
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
|
|
PHOSPHOROUS
|
Facility
|
IP
|
$11.85
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
40602105
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$4.74
|
|
|
PHOSPHOROUS 24 HOUR URINE
|
Facility
|
IP
|
$14.45
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
40602640
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$5.78
|
|
