|
PACLITAXEL 30 MG/5ML IV CONC
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
6170334209
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
|
|
PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
2497971051
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$10.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.54
|
| Rate for Payer: Aetna Government |
$10.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.38
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.54
|
| Rate for Payer: EmblemHealth Commercial |
$10.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.38
|
| Rate for Payer: Group Health Inc Commercial |
$10.54
|
| Rate for Payer: Group Health Inc Medicare |
$10.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.96
|
| Rate for Payer: Healthfirst QHP |
$10.54
|
| Rate for Payer: Humana Medicare |
$10.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.01
|
| Rate for Payer: Wellcare Medicare |
$10.01
|
|
|
PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
2497971051
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
6881713450
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$10.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.54
|
| Rate for Payer: Aetna Government |
$10.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.38
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.54
|
| Rate for Payer: EmblemHealth Commercial |
$10.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.38
|
| Rate for Payer: Group Health Inc Commercial |
$10.54
|
| Rate for Payer: Group Health Inc Medicare |
$10.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.96
|
| Rate for Payer: Healthfirst QHP |
$10.54
|
| Rate for Payer: Humana Medicare |
$10.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.01
|
| Rate for Payer: Wellcare Medicare |
$10.01
|
|
|
PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
6881713450
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
PAIN
|
Facility
|
OP
|
$242.07
|
|
|
Service Code
|
EAPG 00663
|
| Min. Negotiated Rate |
$175.89 |
| Max. Negotiated Rate |
$242.07 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.89
|
| Rate for Payer: Healthfirst Commercial |
$242.07
|
|
|
PALIPERIDONE PALMITATE ER 117 MG/0.75ML IM SUSY
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045856201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
PALIPERIDONE PALMITATE ER 117 MG/0.75ML IM SUSY
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045856201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.11
|
| Rate for Payer: Aetna Government |
$15.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.58
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.11
|
| Rate for Payer: EmblemHealth Commercial |
$15.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.45
|
| Rate for Payer: Group Health Inc Commercial |
$15.11
|
| Rate for Payer: Group Health Inc Medicare |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.84
|
| Rate for Payer: Healthfirst QHP |
$15.11
|
| Rate for Payer: Humana Medicare |
$15.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.35
|
| Rate for Payer: Wellcare Medicare |
$14.35
|
|
|
PALIPERIDONE PALMITATE ER 156 MG/ML IM SUSY
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045856301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
PALIPERIDONE PALMITATE ER 156 MG/ML IM SUSY
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045856301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.11
|
| Rate for Payer: Aetna Government |
$15.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.58
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.11
|
| Rate for Payer: EmblemHealth Commercial |
$15.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.45
|
| Rate for Payer: Group Health Inc Commercial |
$15.11
|
| Rate for Payer: Group Health Inc Medicare |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.84
|
| Rate for Payer: Healthfirst QHP |
$15.11
|
| Rate for Payer: Humana Medicare |
$15.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.35
|
| Rate for Payer: Wellcare Medicare |
$14.35
|
|
|
PALIPERIDONE PALMITATE ER 234 MG/1.5ML IM SUSY
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045856401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
PALIPERIDONE PALMITATE ER 234 MG/1.5ML IM SUSY
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045856401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.11
|
| Rate for Payer: Aetna Government |
$15.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.58
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.11
|
| Rate for Payer: EmblemHealth Commercial |
$15.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.45
|
| Rate for Payer: Group Health Inc Commercial |
$15.11
|
| Rate for Payer: Group Health Inc Medicare |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.84
|
| Rate for Payer: Healthfirst QHP |
$15.11
|
| Rate for Payer: Humana Medicare |
$15.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.35
|
| Rate for Payer: Wellcare Medicare |
$14.35
|
|
|
PALIPERIDONE PALMITATE ER 273 MG/0.88ML IM SUSY
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS j3490
|
| Hospital Charge Code |
5045860601
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| 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 |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| 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
|
|
|
PALIPERIDONE PALMITATE ER 273 MG/0.88ML IM SUSY
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS j3490
|
| Hospital Charge Code |
5045860601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
PALIPERIDONE PALMITATE ER 39 MG/0.25ML IM SUSY
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045856001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
PALIPERIDONE PALMITATE ER 39 MG/0.25ML IM SUSY
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045856001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.11
|
| Rate for Payer: Aetna Government |
$15.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.58
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.11
|
| Rate for Payer: EmblemHealth Commercial |
$15.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.45
|
| Rate for Payer: Group Health Inc Commercial |
$15.11
|
| Rate for Payer: Group Health Inc Medicare |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.84
|
| Rate for Payer: Healthfirst QHP |
$15.11
|
| Rate for Payer: Humana Medicare |
$15.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.35
|
| Rate for Payer: Wellcare Medicare |
$14.35
|
|
|
PALIPERIDONE PALMITATE ER 546 MG/1.75ML IM SUSY
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045860801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.11
|
| Rate for Payer: Aetna Government |
$15.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.58
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.11
|
| Rate for Payer: EmblemHealth Commercial |
$15.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.45
|
| Rate for Payer: Group Health Inc Commercial |
$15.11
|
| Rate for Payer: Group Health Inc Medicare |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.84
|
| Rate for Payer: Healthfirst QHP |
$15.11
|
| Rate for Payer: Humana Medicare |
$15.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.35
|
| Rate for Payer: Wellcare Medicare |
$14.35
|
|
|
PALIPERIDONE PALMITATE ER 546 MG/1.75ML IM SUSY
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045860801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
|
|
PALIPERIDONE PALMITATE ER 78 MG/0.5ML IM SUSY
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045856101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.11
|
| Rate for Payer: Aetna Government |
$15.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.58
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.11
|
| Rate for Payer: EmblemHealth Commercial |
$15.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.45
|
| Rate for Payer: Group Health Inc Commercial |
$15.11
|
| Rate for Payer: Group Health Inc Medicare |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.84
|
| Rate for Payer: Healthfirst QHP |
$15.11
|
| Rate for Payer: Humana Medicare |
$15.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.35
|
| Rate for Payer: Wellcare Medicare |
$14.35
|
|
|
PALIPERIDONE PALMITATE ER 78 MG/0.5ML IM SUSY
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
5045856101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
PALIVIZUMAB 100 MG/ML IM SOLN
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 6665823101
|
| Hospital Charge Code |
6665823101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: EmblemHealth Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
PALIVIZUMAB 100 MG/ML IM SOLN
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 6665823101
|
| Hospital Charge Code |
6665823101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
|
|
PALIVIZUMAB 50 MG/0.5ML IM SOLN
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 6665823001
|
| Hospital Charge Code |
6665823001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
|
|
PALIVIZUMAB 50 MG/0.5ML IM SOLN
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 6665823001
|
| Hospital Charge Code |
6665823001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: EmblemHealth Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
6745743010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.16
|
| Rate for Payer: Aetna Government |
$9.16
|
| Rate for Payer: Brighton Health Commercial |
$2.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.20
|
| Rate for Payer: EmblemHealth Commercial |
$1.62
|
| Rate for Payer: Group Health Inc Commercial |
$1.62
|
| Rate for Payer: Group Health Inc Medicare |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.11
|
|
