|
ASYMMETRICAL PATELLA SER A
|
Facility
OP
|
$1,852.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64903855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,945.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,018.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$926.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,065.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,945.12
|
| Rate for Payer: Group Health Inc Commercial |
$926.25
|
| Rate for Payer: Group Health Inc Medicare |
$648.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$926.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$926.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,204.12
|
|
|
ATAZANAVIR 100 MG CAP
|
Facility
OP
|
$29.00
|
|
| Hospital Charge Code |
41643075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$23.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.50
|
| Rate for Payer: Aetna Government |
$14.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.72
|
| Rate for Payer: Group Health Inc Commercial |
$14.50
|
| Rate for Payer: Group Health Inc Medicare |
$10.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
|
|
ATAZANAVIR 100 MG CAP
|
Facility
OP
|
$29.00
|
|
| Hospital Charge Code |
41653075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$23.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.50
|
| Rate for Payer: Aetna Government |
$14.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.72
|
| Rate for Payer: Group Health Inc Commercial |
$14.50
|
| Rate for Payer: Group Health Inc Medicare |
$10.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
|
|
ATAZANAVIR 200 MG CAP
|
Facility
OP
|
$32.33
|
|
| Hospital Charge Code |
41643076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$25.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.16
|
| Rate for Payer: Aetna Government |
$16.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.98
|
| Rate for Payer: Group Health Inc Commercial |
$16.16
|
| Rate for Payer: Group Health Inc Medicare |
$11.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.01
|
|
|
ATAZANAVIR 200 MG CAP
|
Facility
OP
|
$32.33
|
|
| Hospital Charge Code |
41653076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$25.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.16
|
| Rate for Payer: Aetna Government |
$16.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.98
|
| Rate for Payer: Group Health Inc Commercial |
$16.16
|
| Rate for Payer: Group Health Inc Medicare |
$11.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.01
|
|
|
ATAZANAVIR 300 MG CAP
|
Facility
OP
|
$64.15
|
|
| Hospital Charge Code |
41644695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$51.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.08
|
| Rate for Payer: Aetna Government |
$32.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.62
|
| Rate for Payer: Group Health Inc Commercial |
$32.08
|
| Rate for Payer: Group Health Inc Medicare |
$22.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.70
|
|
|
ATAZANAVIR 300 MG CAP
|
Facility
OP
|
$64.15
|
|
| Hospital Charge Code |
41654695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$51.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.08
|
| Rate for Payer: Aetna Government |
$32.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.62
|
| Rate for Payer: Group Health Inc Commercial |
$32.08
|
| Rate for Payer: Group Health Inc Medicare |
$22.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.70
|
|
|
ATAZANAVIR/COBICISTAT 300-150MG
|
Facility
OP
|
$133.74
|
|
| Hospital Charge Code |
41647813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.87
|
| Rate for Payer: Aetna Government |
$66.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.94
|
| Rate for Payer: Group Health Inc Commercial |
$66.87
|
| Rate for Payer: Group Health Inc Medicare |
$46.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.93
|
|
|
ATAZANAVIR/COBICISTAT 300-150MG
|
Facility
OP
|
$133.74
|
|
| Hospital Charge Code |
41657813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.87
|
| Rate for Payer: Aetna Government |
$66.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.94
|
| Rate for Payer: Group Health Inc Commercial |
$66.87
|
| Rate for Payer: Group Health Inc Medicare |
$46.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.93
|
|
|
ATENOLOL 25 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650832
|
|
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: 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
|
|
|
ATENOLOL 25 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640832
|
|
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: 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
|
|
|
ATENOLOL 50 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640644
|
|
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: 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
|
|
|
ATENOLOL 50 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650644
|
|
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: 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
|
|
|
ATEZOLIZUMAB 1200 MG INJECTION
|
Facility
OP
|
$179.58
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41649596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.01 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$98.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.01
|
| Rate for Payer: Aetna Government |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.01
|
| Rate for Payer: EmblemHealth Commercial |
$85.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.26
|
| Rate for Payer: Group Health Inc Commercial |
$85.01
|
| Rate for Payer: Group Health Inc Medicare |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.26
|
| Rate for Payer: Healthfirst QHP |
$85.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.97
|
| Rate for Payer: SOMOS Essential |
$88.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.01
|
| Rate for Payer: Wellcare Medicare |
$80.76
|
|
|
ATEZOLIZUMAB 1200 MG INJECTION
|
Facility
IP
|
$179.58
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41649596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.79 |
| Max. Negotiated Rate |
$89.79 |
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.79
|
|
|
ATEZOLIZUMAB 1200MG INJECTION
|
Facility
IP
|
$179.58
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41659596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.79 |
| Max. Negotiated Rate |
$89.79 |
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.79
|
|
|
ATEZOLIZUMAB 1200MG INJECTION
|
Facility
OP
|
$179.58
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41659596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.01 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$98.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.01
|
| Rate for Payer: Aetna Government |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.01
|
| Rate for Payer: EmblemHealth Commercial |
$85.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.26
|
| Rate for Payer: Group Health Inc Commercial |
$85.01
|
| Rate for Payer: Group Health Inc Medicare |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.26
|
| Rate for Payer: Healthfirst QHP |
$85.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.97
|
| Rate for Payer: SOMOS Essential |
$88.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.01
|
| Rate for Payer: Wellcare Medicare |
$80.76
|
|
|
ATEZOLIZUMAB 840MG INJ
|
Facility
OP
|
$187.80
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41647858
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.01 |
| Max. Negotiated Rate |
$122.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.01
|
| Rate for Payer: Aetna Government |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$107.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.01
|
| Rate for Payer: EmblemHealth Commercial |
$85.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.26
|
| Rate for Payer: Group Health Inc Commercial |
$85.01
|
| Rate for Payer: Group Health Inc Medicare |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.26
|
| Rate for Payer: Healthfirst QHP |
$85.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.97
|
| Rate for Payer: SOMOS Essential |
$88.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.01
|
| Rate for Payer: Wellcare Medicare |
$80.76
|
|
|
ATEZOLIZUMAB 840MG INJ
|
Facility
IP
|
$187.80
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41657858
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.90 |
| Max. Negotiated Rate |
$93.90 |
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.90
|
|
|
ATEZOLIZUMAB 840MG INJ
|
Facility
IP
|
$187.80
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41647858
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.90 |
| Max. Negotiated Rate |
$93.90 |
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.90
|
|
|
ATEZOLIZUMAB 840MG INJ
|
Facility
OP
|
$187.80
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41657858
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.01 |
| Max. Negotiated Rate |
$122.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.01
|
| Rate for Payer: Aetna Government |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$107.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.01
|
| Rate for Payer: EmblemHealth Commercial |
$85.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.26
|
| Rate for Payer: Group Health Inc Commercial |
$85.01
|
| Rate for Payer: Group Health Inc Medicare |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.26
|
| Rate for Payer: Healthfirst QHP |
$85.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.97
|
| Rate for Payer: SOMOS Essential |
$88.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.01
|
| Rate for Payer: Wellcare Medicare |
$80.76
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
IP
|
$23,332.06
|
|
|
Service Code
|
MS-DRG 302
|
| Min. Negotiated Rate |
$9,613.43 |
| Max. Negotiated Rate |
$23,332.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,530.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,874.57
|
| Rate for Payer: Aetna Government |
$22,874.57
|
| Rate for Payer: Brighton Health Commercial |
$16,255.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,332.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,360.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,976.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,730.84
|
| Rate for Payer: EmblemHealth Commercial |
$9,613.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,874.57
|
| Rate for Payer: Group Health Inc Commercial |
$22,874.57
|
| Rate for Payer: Group Health Inc Medicare |
$22,874.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,874.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,636.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,874.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,874.57
|
| Rate for Payer: Wellcare Medicare |
$21,730.84
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
IP
|
$16,783.05
|
|
|
Service Code
|
MS-DRG 303
|
| Min. Negotiated Rate |
$5,643.21 |
| Max. Negotiated Rate |
$16,783.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,703.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,453.97
|
| Rate for Payer: Aetna Government |
$16,453.97
|
| Rate for Payer: Brighton Health Commercial |
$9,542.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,783.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,364.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,378.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,631.27
|
| Rate for Payer: EmblemHealth Commercial |
$5,643.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,453.97
|
| Rate for Payer: Group Health Inc Commercial |
$16,453.97
|
| Rate for Payer: Group Health Inc Medicare |
$16,453.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,453.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,651.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,453.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,453.97
|
| Rate for Payer: Wellcare Medicare |
$15,631.27
|
|
|
ATOMOXETINE 40 MG CAP
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41653896
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
ATOMOXETINE 40 MG CAP
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41643896
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
