|
PROCAINAMIDE 250 MG CAP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41642965
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
PROCAINAMIDE 500 MG ERT
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41642967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
PROCAINAMIDE 500 MG ERT
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41652967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
PROCAINAMIDE 750 MG ERT
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41652966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
PROCAINAMIDE 750 MG ERT
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41642966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
PROCAINAMIDE HCL 100 MG/ML IJ SOLN [6562]
|
Facility
|
OP
|
$11.05
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
00409190211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$198.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$146.32
|
| Rate for Payer: Aetna Government |
$146.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$102.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$102.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$102.42
|
| Rate for Payer: Brighton Health Commercial |
$8.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$146.32
|
| Rate for Payer: EmblemHealth Commercial |
$146.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.22
|
| Rate for Payer: Group Health Inc Commercial |
$146.32
|
| Rate for Payer: Group Health Inc Medicare |
$146.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.37
|
| Rate for Payer: Healthfirst QHP |
$146.32
|
| Rate for Payer: Humana Medicare |
$149.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$198.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$117.05
|
| Rate for Payer: Wellcare Medicare |
$139.00
|
|
|
PROCAINAMIDE HCL 500 MG/ML IJ SOLN [6563]
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
14789090007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.42 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$198.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$146.32
|
| Rate for Payer: Aetna Government |
$146.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$102.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$102.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$102.42
|
| Rate for Payer: Brighton Health Commercial |
$270.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$288.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$244.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$146.32
|
| Rate for Payer: EmblemHealth Commercial |
$146.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.22
|
| Rate for Payer: Group Health Inc Commercial |
$146.32
|
| Rate for Payer: Group Health Inc Medicare |
$146.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.37
|
| Rate for Payer: Healthfirst QHP |
$146.32
|
| Rate for Payer: Humana Medicare |
$149.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$198.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$234.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$117.05
|
| Rate for Payer: Wellcare Medicare |
$139.00
|
|
|
PROCAINAMIDE HCL 500 MG/ML IJ SOLN [6563]
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
14789090002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.42 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$198.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$146.32
|
| Rate for Payer: Aetna Government |
$146.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$102.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$102.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$102.42
|
| Rate for Payer: Brighton Health Commercial |
$270.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$288.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$244.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$146.32
|
| Rate for Payer: EmblemHealth Commercial |
$146.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.22
|
| Rate for Payer: Group Health Inc Commercial |
$146.32
|
| Rate for Payer: Group Health Inc Medicare |
$146.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.37
|
| Rate for Payer: Healthfirst QHP |
$146.32
|
| Rate for Payer: Humana Medicare |
$149.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$198.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$234.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$117.05
|
| Rate for Payer: Wellcare Medicare |
$139.00
|
|
|
PROCALCITONIN
|
Facility
|
OP
|
$68.05
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
40609757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.22
|
| Rate for Payer: Aetna Government |
$27.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.05
|
| Rate for Payer: Brighton Health Commercial |
$51.04
|
| Rate for Payer: Cash Price |
$27.22
|
| Rate for Payer: Cash Price |
$27.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.22
|
| Rate for Payer: EmblemHealth Commercial |
$27.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.23
|
| Rate for Payer: Group Health Inc Commercial |
$27.22
|
| Rate for Payer: Group Health Inc Medicare |
$27.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.22
|
| Rate for Payer: Healthfirst QHP |
$27.22
|
| Rate for Payer: Humana Medicare |
$27.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.22
|
| Rate for Payer: United Healthcare Commercial |
$33.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.78
|
| Rate for Payer: Wellcare Medicare |
$24.50
|
|
|
PROCALCITONIN
|
Facility
|
IP
|
$68.05
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
40609757
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$27.22
|
|
|
PROCALCITONIN TEST
|
Facility
|
OP
|
$68.05
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
40601421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.22
|
| Rate for Payer: Aetna Government |
$27.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.05
|
| Rate for Payer: Brighton Health Commercial |
$51.04
|
| Rate for Payer: Cash Price |
$27.22
|
| Rate for Payer: Cash Price |
$27.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.22
|
| Rate for Payer: EmblemHealth Commercial |
$27.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.23
|
| Rate for Payer: Group Health Inc Commercial |
$27.22
|
| Rate for Payer: Group Health Inc Medicare |
$27.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.22
|
| Rate for Payer: Healthfirst QHP |
$27.22
|
| Rate for Payer: Humana Medicare |
$27.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.22
|
| Rate for Payer: United Healthcare Commercial |
$33.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.78
|
| Rate for Payer: Wellcare Medicare |
$24.50
|
|
|
PROCALCITONIN TEST
|
Facility
|
IP
|
$68.05
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
40601421
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$27.22
|
|
|
PROCARBAZINE 50 MG CAP
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41643888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Brighton Health Commercial |
$7.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.90
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
PROCARBAZINE 50 MG CAP
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41653888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Brighton Health Commercial |
$7.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.90
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
PROCARBAZINE 50 MG CAP
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41643888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
|
|
PROCARBAZINE 50 MG CAP
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41653888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
|
|
PR OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$1,108.31
|
|
|
Service Code
|
HCPCS 58615
|
| Min. Negotiated Rate |
$831.23 |
| Max. Negotiated Rate |
$831.23 |
| Rate for Payer: Cash Price |
$299.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$831.23
|
| Rate for Payer: SOMOS Essential |
$831.23
|
|
|
PR OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT
|
Professional
|
Both
|
$4,703.48
|
|
|
Service Code
|
HCPCS 65782
|
| Min. Negotiated Rate |
$3,527.61 |
| Max. Negotiated Rate |
$3,527.61 |
| Rate for Payer: Cash Price |
$1,295.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,527.61
|
| Rate for Payer: SOMOS Essential |
$3,527.61
|
|
|
PR OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS
|
Professional
|
Both
|
$407.96
|
|
|
Service Code
|
HCPCS 97167
|
| Min. Negotiated Rate |
$305.97 |
| Max. Negotiated Rate |
$305.97 |
| Rate for Payer: Cash Price |
$113.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$305.97
|
| Rate for Payer: SOMOS Essential |
$305.97
|
|
|
PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$407.96
|
|
|
Service Code
|
HCPCS 97165
|
| Min. Negotiated Rate |
$305.97 |
| Max. Negotiated Rate |
$305.97 |
| Rate for Payer: Cash Price |
$113.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$305.97
|
| Rate for Payer: SOMOS Essential |
$305.97
|
|
|
PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$407.96
|
|
|
Service Code
|
HCPCS 97166
|
| Min. Negotiated Rate |
$305.97 |
| Max. Negotiated Rate |
$305.97 |
| Rate for Payer: Cash Price |
$113.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$305.97
|
| Rate for Payer: SOMOS Essential |
$305.97
|
|
|
PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Professional
|
Both
|
$285.01
|
|
|
Service Code
|
HCPCS 97168
|
| Min. Negotiated Rate |
$213.76 |
| Max. Negotiated Rate |
$213.76 |
| Rate for Payer: Cash Price |
$78.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.76
|
| Rate for Payer: SOMOS Essential |
$213.76
|
|
|
PROCEDURE SETS STERILE
|
Facility
|
OP
|
$8,500.00
|
|
| Hospital Charge Code |
40200894
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,975.00 |
| Max. Negotiated Rate |
$6,800.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,675.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,250.00
|
| Rate for Payer: Aetna Government |
$4,250.00
|
| Rate for Payer: Brighton Health Commercial |
$6,375.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,800.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,780.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,250.00
|
|
|
PROCHLORPERAZINE 10 MG/2 ML INJ
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
41650187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.74
|
| Rate for Payer: Aetna Government |
$4.74
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.75
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.18
|
| Rate for Payer: SOMOS Essential |
$4.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
PROCHLORPERAZINE 10 MG/2 ML INJ
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
41650187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
