|
PR ATRIAL SEPTECTOMY/SEPTOSTOMY CLOSED HEART
|
Professional
|
Both
|
$5,776.89
|
|
|
Service Code
|
HCPCS 33735
|
| Min. Negotiated Rate |
$1,068.04 |
| Max. Negotiated Rate |
$3,432.98 |
| Rate for Payer: Cash Price |
$1,540.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,525.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,373.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,373.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,449.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,525.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,449.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,525.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,525.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,144.33
|
| Rate for Payer: Healthfirst Commercial |
$1,525.77
|
| Rate for Payer: Healthfirst Essential Plan |
$3,432.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,449.48
|
| Rate for Payer: Healthfirst QHP |
$1,525.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,068.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,525.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,296.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,068.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,525.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,144.33
|
| Rate for Payer: SOMOS Essential |
$1,144.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,525.77
|
|
|
PR ATRIAL SEPTECTOMY/SEPTOSTOMY OPEN HEART W/BYPASS
|
Professional
|
Both
|
$6,269.48
|
|
|
Service Code
|
HCPCS 33736
|
| Min. Negotiated Rate |
$1,158.39 |
| Max. Negotiated Rate |
$3,723.41 |
| Rate for Payer: Cash Price |
$1,670.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,654.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,489.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,489.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,572.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,654.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,572.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,654.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,654.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,241.14
|
| Rate for Payer: Healthfirst Commercial |
$1,654.85
|
| Rate for Payer: Healthfirst Essential Plan |
$3,723.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,572.11
|
| Rate for Payer: Healthfirst QHP |
$1,654.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,158.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,654.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,406.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,158.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,654.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,241.14
|
| Rate for Payer: SOMOS Essential |
$1,241.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,654.85
|
|
|
PR ATRIAL SEPTECT/SEPTOST OPN HRT W/INFL OCCLUSION
|
Professional
|
Both
|
$5,784.00
|
|
|
Service Code
|
HCPCS 33737
|
| Rate for Payer: Cash Price |
$1,541.49
|
|
|
PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$294.28
|
|
|
Service Code
|
HCPCS 99464
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$177.34 |
| Rate for Payer: Amida Care Medicaid |
$38.33
|
| Rate for Payer: Cash Price |
$80.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.12
|
| Rate for Payer: Healthfirst Commercial |
$78.82
|
| Rate for Payer: Healthfirst Essential Plan |
$177.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.88
|
| Rate for Payer: Healthfirst QHP |
$78.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.12
|
| Rate for Payer: SOMOS Essential |
$59.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.82
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$845.60
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$155.07 |
| Max. Negotiated Rate |
$498.44 |
| Rate for Payer: Cash Price |
$225.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.15
|
| Rate for Payer: Healthfirst Commercial |
$221.53
|
| Rate for Payer: Healthfirst Essential Plan |
$498.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.45
|
| Rate for Payer: Healthfirst QHP |
$221.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$155.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$188.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$155.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.15
|
| Rate for Payer: SOMOS Essential |
$166.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.53
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$764.12
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$140.75 |
| Max. Negotiated Rate |
$452.41 |
| Rate for Payer: Cash Price |
$201.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$201.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$191.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$191.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.80
|
| Rate for Payer: Healthfirst Commercial |
$201.07
|
| Rate for Payer: Healthfirst Essential Plan |
$452.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.02
|
| Rate for Payer: Healthfirst QHP |
$201.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$201.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$201.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.80
|
| Rate for Payer: SOMOS Essential |
$150.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.07
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$7,267.23
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$1,364.01 |
| Max. Negotiated Rate |
$4,384.31 |
| Rate for Payer: Cash Price |
$1,957.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,948.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,753.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,753.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,851.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,948.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,851.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,948.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,948.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,461.43
|
| Rate for Payer: Healthfirst Commercial |
$1,948.58
|
| Rate for Payer: Healthfirst Essential Plan |
$4,384.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,851.15
|
| Rate for Payer: Healthfirst QHP |
$1,948.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,364.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,948.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,656.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,364.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,948.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,461.43
|
| Rate for Payer: SOMOS Essential |
$1,461.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,948.58
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$222.11
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$134.44 |
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.81
|
| Rate for Payer: Healthfirst Commercial |
$59.75
|
| Rate for Payer: Healthfirst Essential Plan |
$134.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.76
|
| Rate for Payer: Healthfirst QHP |
$59.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.81
|
| Rate for Payer: SOMOS Essential |
$44.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.75
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$71.47
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$41.49 |
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.83
|
| Rate for Payer: Healthfirst Commercial |
$18.44
|
| Rate for Payer: Healthfirst Essential Plan |
$41.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.52
|
| Rate for Payer: Healthfirst QHP |
$18.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.83
|
| Rate for Payer: SOMOS Essential |
$13.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.44
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$3,974.60
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$740.89 |
| Max. Negotiated Rate |
$2,381.45 |
| Rate for Payer: Cash Price |
$1,065.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,058.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$952.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$952.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,005.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,058.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,005.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,058.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,058.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$793.82
|
| Rate for Payer: Healthfirst Commercial |
$1,058.42
|
| Rate for Payer: Healthfirst Essential Plan |
$2,381.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.50
|
| Rate for Payer: Healthfirst QHP |
$1,058.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$740.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,058.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$899.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$740.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,058.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$793.82
|
| Rate for Payer: SOMOS Essential |
$793.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,058.42
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$3,162.60
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$589.51 |
| Max. Negotiated Rate |
$1,894.86 |
| Rate for Payer: Cash Price |
$848.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$842.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$757.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$757.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$800.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$842.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$800.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$842.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$631.62
|
| Rate for Payer: Healthfirst Commercial |
$842.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,894.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$800.05
|
| Rate for Payer: Healthfirst QHP |
$842.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$589.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$842.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$715.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$589.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$842.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$631.62
|
| Rate for Payer: SOMOS Essential |
$631.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$842.16
|
|
|
PRAZIQUANTEL 600 MG PO TABS
|
Facility
|
IP
|
$89.68
|
|
|
Service Code
|
NDC 4988423183
|
| Hospital Charge Code |
4988423183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$44.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.84
|
|
|
PRAZIQUANTEL 600 MG PO TABS
|
Facility
|
OP
|
$89.68
|
|
|
Service Code
|
NDC 4988423183
|
| Hospital Charge Code |
4988423183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$71.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.84
|
| Rate for Payer: Aetna Government |
$44.84
|
| Rate for Payer: Brighton Health Commercial |
$67.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.98
|
| Rate for Payer: EmblemHealth Commercial |
$44.84
|
| Rate for Payer: Group Health Inc Commercial |
$44.84
|
| Rate for Payer: Group Health Inc Medicare |
$31.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.29
|
|
|
PRAZOSIN HCL 1 MG PO CAPS
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
NDC 6808499611
|
| Hospital Charge Code |
6808499611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
|
|
PRAZOSIN HCL 1 MG PO CAPS
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
NDC 6808499601
|
| Hospital Charge Code |
6808499601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
|
|
PRAZOSIN HCL 1 MG PO CAPS
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
NDC 6808499601
|
| Hospital Charge Code |
6808499601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Brighton Health Commercial |
$1.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.16
|
|
|
PRAZOSIN HCL 1 MG PO CAPS
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
NDC 6808499611
|
| Hospital Charge Code |
6808499611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Brighton Health Commercial |
$1.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.16
|
|
|
PRAZOSIN HCL 1 MG PO CAPS
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
NDC 0904702061
|
| Hospital Charge Code |
0904702061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
|
|
PRAZOSIN HCL 1 MG PO CAPS
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 0904702061
|
| Hospital Charge Code |
0904702061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.81
|
| Rate for Payer: Aetna Government |
$0.81
|
| Rate for Payer: Brighton Health Commercial |
$1.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.10
|
| Rate for Payer: EmblemHealth Commercial |
$0.81
|
| Rate for Payer: Group Health Inc Commercial |
$0.81
|
| Rate for Payer: Group Health Inc Medicare |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.05
|
|
|
PR B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA
|
Professional
|
Both
|
$5,180.42
|
|
|
Service Code
|
HCPCS 27170
|
| Min. Negotiated Rate |
$970.06 |
| Max. Negotiated Rate |
$3,118.05 |
| Rate for Payer: Cash Price |
$1,391.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,385.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,247.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,247.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,316.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,385.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,316.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,385.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,385.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,039.35
|
| Rate for Payer: Healthfirst Commercial |
$1,385.80
|
| Rate for Payer: Healthfirst Essential Plan |
$3,118.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,316.51
|
| Rate for Payer: Healthfirst QHP |
$1,385.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$970.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,385.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,177.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$970.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,385.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,039.35
|
| Rate for Payer: SOMOS Essential |
$1,039.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,385.80
|
|
|
PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS
|
Professional
|
Both
|
$6,307.84
|
|
|
Service Code
|
HCPCS 61630
|
| Min. Negotiated Rate |
$1,156.66 |
| Max. Negotiated Rate |
$3,717.83 |
| Rate for Payer: Cash Price |
$1,665.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,652.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,487.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,487.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,652.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,652.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,652.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,239.28
|
| Rate for Payer: Healthfirst Commercial |
$1,652.37
|
| Rate for Payer: Healthfirst Essential Plan |
$3,717.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,569.75
|
| Rate for Payer: Healthfirst QHP |
$1,652.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,156.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,652.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,404.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,156.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,652.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,239.28
|
| Rate for Payer: SOMOS Essential |
$1,239.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,652.37
|
|
|
PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT
|
Professional
|
Both
|
$554.19
|
|
|
Service Code
|
HCPCS 47542
|
| Min. Negotiated Rate |
$103.55 |
| Max. Negotiated Rate |
$332.84 |
| Rate for Payer: Cash Price |
$148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.95
|
| Rate for Payer: Healthfirst Commercial |
$147.93
|
| Rate for Payer: Healthfirst Essential Plan |
$332.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.53
|
| Rate for Payer: Healthfirst QHP |
$147.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.95
|
| Rate for Payer: SOMOS Essential |
$110.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.93
|
|
|
PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I
|
Professional
|
Both
|
$735.18
|
|
|
Service Code
|
HCPCS 50706
|
| Min. Negotiated Rate |
$138.40 |
| Max. Negotiated Rate |
$444.85 |
| Rate for Payer: Cash Price |
$198.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.28
|
| Rate for Payer: Healthfirst Commercial |
$197.71
|
| Rate for Payer: Healthfirst Essential Plan |
$444.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.82
|
| Rate for Payer: Healthfirst QHP |
$197.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$197.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$168.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.28
|
| Rate for Payer: SOMOS Essential |
$148.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.71
|
|
|
PR BANDING PULMONARY ARTERY
|
Professional
|
Both
|
$5,355.46
|
|
|
Service Code
|
HCPCS 33690
|
| Min. Negotiated Rate |
$990.77 |
| Max. Negotiated Rate |
$3,184.63 |
| Rate for Payer: Cash Price |
$1,428.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,415.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,273.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,273.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,344.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,415.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,344.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,415.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,415.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,061.54
|
| Rate for Payer: Healthfirst Commercial |
$1,415.39
|
| Rate for Payer: Healthfirst Essential Plan |
$3,184.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,344.62
|
| Rate for Payer: Healthfirst QHP |
$1,415.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$990.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,415.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,203.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$990.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,415.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,061.54
|
| Rate for Payer: SOMOS Essential |
$1,061.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,415.39
|
|
|
PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Professional
|
Both
|
$21.42
|
|
|
Service Code
|
HCPCS 96127
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.25
|
| Rate for Payer: Healthfirst Commercial |
$5.66
|
| Rate for Payer: Healthfirst Essential Plan |
$12.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$5.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.25
|
| Rate for Payer: SOMOS Essential |
$4.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.66
|
|
