|
PHOSPHOROUS 24 HOUR URINE
|
Facility
|
OP
|
$14.45
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
40602640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.78
|
| Rate for Payer: Aetna Government |
$5.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.05
|
| Rate for Payer: Brighton Health Commercial |
$10.84
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.78
|
| Rate for Payer: EmblemHealth Commercial |
$5.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.78
|
| Rate for Payer: Group Health Inc Medicare |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.78
|
| Rate for Payer: Healthfirst QHP |
$5.78
|
| Rate for Payer: Humana Medicare |
$5.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.62
|
| Rate for Payer: Wellcare Medicare |
$5.20
|
|
|
PHOSPHO-TRIN 250 NEUTRAL 155-852-130 MG PO TABS [137671]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 39328010710
|
| Hospital Charge Code |
39328010710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.32
|
|
|
PHOSPHO-TRIN 250 NEUTRAL 155-852-130 MG PO TABS [137671]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 64980010401
|
| Hospital Charge Code |
64980010401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
|
PHOXILLUM BK 4/2.5
|
Facility
|
IP
|
$115.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.78 |
| Max. Negotiated Rate |
$57.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.78
|
|
|
PHOXILLUM BK 4/2.5
|
Facility
|
IP
|
$115.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.78 |
| Max. Negotiated Rate |
$57.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.78
|
|
|
PHOXILLUM BK 4/2.5
|
Facility
|
OP
|
$115.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$75.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.78
|
| Rate for Payer: Aetna Government |
$57.78
|
| Rate for Payer: Brighton Health Commercial |
$69.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.44
|
| Rate for Payer: Group Health Inc Commercial |
$57.78
|
| Rate for Payer: Group Health Inc Medicare |
$40.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.11
|
|
|
PHOXILLUM BK 4/2.5
|
Facility
|
OP
|
$115.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$75.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.78
|
| Rate for Payer: Aetna Government |
$57.78
|
| Rate for Payer: Brighton Health Commercial |
$69.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.44
|
| Rate for Payer: Group Health Inc Commercial |
$57.78
|
| Rate for Payer: Group Health Inc Medicare |
$40.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.11
|
|
|
PHOXILLUM BK4/2.5 32-4-2.5-1 MEQ-MMOL/L APHERESIS SOLN [181366]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 24571011606
|
| Hospital Charge Code |
24571011606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
PH PROBE DUAL CHANNEL
|
Facility
|
IP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 91035 TC
|
| Hospital Charge Code |
30301308
|
|
Hospital Revenue Code
|
750
|
| Rate for Payer: Cash Price |
$619.82
|
|
|
PH PROBE DUAL CHANNEL
|
Facility
|
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 91035 TC
|
| Hospital Charge Code |
30301308
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$433.87 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$433.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$433.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$433.87
|
| Rate for Payer: Brighton Health Commercial |
$1,103.10
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| 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 |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
PH PROBE SIMPLE
|
Facility
|
IP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 91034 TC
|
| Hospital Charge Code |
30301309
|
|
Hospital Revenue Code
|
750
|
| Rate for Payer: Cash Price |
$619.82
|
|
|
PH PROBE SIMPLE
|
Facility
|
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 91034 TC
|
| Hospital Charge Code |
30301309
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$433.87 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$433.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$433.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$433.87
|
| Rate for Payer: Brighton Health Commercial |
$1,103.10
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| 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 |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
PH STOOL
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
40609105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
PH STOOL
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
40609105
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$3.58
|
|
|
PHYCOANALYSIS
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90845
|
| Hospital Charge Code |
30305368
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.07
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
PHYCOANALYSIS
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90845
|
| Hospital Charge Code |
30305368
|
|
Hospital Revenue Code
|
914
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
PHYSICIAN SERVICE W ECG MONITORIN
|
Facility
|
OP
|
$333.25
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
41701005
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$266.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$183.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$152.81
|
| Rate for Payer: Aetna Government |
$152.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$106.97
|
| Rate for Payer: Brighton Health Commercial |
$249.94
|
| Rate for Payer: Cash Price |
$152.81
|
| Rate for Payer: Cash Price |
$152.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$266.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$152.81
|
| Rate for Payer: EmblemHealth Commercial |
$152.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.00
|
| Rate for Payer: Group Health Inc Commercial |
$152.81
|
| Rate for Payer: Group Health Inc Medicare |
$152.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.89
|
| Rate for Payer: Healthfirst QHP |
$152.81
|
| Rate for Payer: Humana Medicare |
$155.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.81
|
| Rate for Payer: United Healthcare Commercial |
$166.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$122.25
|
| Rate for Payer: Wellcare Medicare |
$145.17
|
|
|
PHYSICIAN SERVICE W ECG MONITORIN
|
Facility
|
IP
|
$333.25
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
41701005
|
|
Hospital Revenue Code
|
943
|
| Rate for Payer: Cash Price |
$152.81
|
|
|
PHYSICIAN SERV W/O ECG MONITORING
|
Facility
|
OP
|
$333.25
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
41701006
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$266.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$183.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$152.81
|
| Rate for Payer: Aetna Government |
$152.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$106.97
|
| Rate for Payer: Brighton Health Commercial |
$249.94
|
| Rate for Payer: Cash Price |
$152.81
|
| Rate for Payer: Cash Price |
$152.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$266.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$152.81
|
| Rate for Payer: EmblemHealth Commercial |
$152.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.00
|
| Rate for Payer: Group Health Inc Commercial |
$152.81
|
| Rate for Payer: Group Health Inc Medicare |
$152.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.89
|
| Rate for Payer: Healthfirst QHP |
$152.81
|
| Rate for Payer: Humana Medicare |
$155.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.81
|
| Rate for Payer: United Healthcare Commercial |
$166.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$122.25
|
| Rate for Payer: Wellcare Medicare |
$145.17
|
|
|
PHYSICIAN SERV W/O ECG MONITORING
|
Facility
|
IP
|
$333.25
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
41701006
|
|
Hospital Revenue Code
|
943
|
| Rate for Payer: Cash Price |
$152.81
|
|
|
PHYSOSTIGMINE 2 MG/2 ML INJ
|
Facility
|
OP
|
$8.34
|
|
| Hospital Charge Code |
41643427
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.17
|
| Rate for Payer: Aetna Government |
$4.17
|
| Rate for Payer: Brighton Health Commercial |
$6.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.67
|
| Rate for Payer: Group Health Inc Commercial |
$4.17
|
| Rate for Payer: Group Health Inc Medicare |
$2.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.42
|
|
|
PHYSOSTIGMINE 2 MG/2 ML INJ
|
Facility
|
OP
|
$8.34
|
|
| Hospital Charge Code |
41653427
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.17
|
| Rate for Payer: Aetna Government |
$4.17
|
| Rate for Payer: Brighton Health Commercial |
$6.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.67
|
| Rate for Payer: Group Health Inc Commercial |
$4.17
|
| Rate for Payer: Group Health Inc Medicare |
$2.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.42
|
|
|
PHYSOSTIGMINE SALICYLATE 1 MG/ML IJ SOLN [6270]
|
Facility
|
OP
|
$46.97
|
|
|
Service Code
|
NDC 17478051002
|
| Hospital Charge Code |
17478051002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.44 |
| Max. Negotiated Rate |
$37.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.49
|
| Rate for Payer: Aetna Government |
$23.49
|
| Rate for Payer: Brighton Health Commercial |
$35.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.94
|
| Rate for Payer: Group Health Inc Commercial |
$23.49
|
| Rate for Payer: Group Health Inc Medicare |
$16.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.53
|
|
|
PHYTONADIONE 10 MG/ML IJ SOLN [11023]
|
Facility
|
OP
|
$51.32
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
69097070896
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$41.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.56
|
| Rate for Payer: Aetna Government |
$3.56
|
| Rate for Payer: Brighton Health Commercial |
$38.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.90
|
| Rate for Payer: Group Health Inc Commercial |
$25.66
|
| Rate for Payer: Group Health Inc Medicare |
$17.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.36
|
|
|
PHYTONADIONE 10 MG/ML INJ
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
41654294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.50
|
|
