|
TACROLIMUS 0.5 MG CAP
|
Facility
OP
|
$5.32
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41654127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$2.66
|
| Rate for Payer: Group Health Inc Medicare |
$1.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS Essential |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.46
|
|
|
TACROLIMUS 0.5 MG CAP
|
Facility
OP
|
$5.32
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41644127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$2.66
|
| Rate for Payer: Group Health Inc Medicare |
$1.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS Essential |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.46
|
|
|
TACROLIMUS 0.5 MG CAP
|
Facility
IP
|
$5.32
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41644127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.66
|
|
|
TACROLIMUS 0.5 MG/ML SUSP
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41643347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
TACROLIMUS 0.5 MG/ML SUSP
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41643347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.26
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS Essential |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
TACROLIMUS 0.5 MG/ML SUSP
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41653347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
TACROLIMUS 0.5 MG/ML SUSP
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41653347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.26
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS Essential |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
TACROLIMUS 1 MG CAP
|
Facility
OP
|
$5.22
|
|
| Hospital Charge Code |
41643973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.61
|
| Rate for Payer: Aetna Government |
$2.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.61
|
| Rate for Payer: Group Health Inc Medicare |
$1.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.39
|
|
|
TACROLIMUS 1 MG CAP
|
Facility
OP
|
$5.22
|
|
| Hospital Charge Code |
41653973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.61
|
| Rate for Payer: Aetna Government |
$2.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.61
|
| Rate for Payer: Group Health Inc Medicare |
$1.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.39
|
|
|
TACROLIMUS 1 MG CAP
|
Facility
IP
|
$5.22
|
|
| Hospital Charge Code |
41643973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.61
|
|
|
TACROLIMUS 1 MG CAP
|
Facility
IP
|
$5.22
|
|
| Hospital Charge Code |
41653973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.61
|
|
|
TACROLIMUS 5MG CAP
|
Facility
OP
|
$2.46
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41656551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$1.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS Essential |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.60
|
|
|
TACROLIMUS 5MG CAP
|
Facility
IP
|
$2.46
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41646551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
|
|
TACROLIMUS 5MG CAP
|
Facility
OP
|
$2.46
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41646551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$1.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.29
|
| Rate for Payer: SOMOS Essential |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.60
|
|
|
TACROLIMUS 5MG CAP
|
Facility
IP
|
$2.46
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41656551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
|
|
TACROLIMUS (FK506), BLOOD
|
Facility
OP
|
$34.33
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
40609005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.73
|
| Rate for Payer: Aetna Government |
$13.73
|
| Rate for Payer: Cash Price |
$13.73
|
| Rate for Payer: Cash Price |
$13.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.73
|
| Rate for Payer: EmblemHealth Commercial |
$13.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.22
|
| Rate for Payer: Group Health Inc Commercial |
$13.73
|
| Rate for Payer: Group Health Inc Medicare |
$13.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.73
|
| Rate for Payer: Healthfirst QHP |
$13.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.98
|
| Rate for Payer: Wellcare Medicare |
$12.36
|
|
|
TAILOR BUNIONECTOMY
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28292
|
| Hospital Charge Code |
40082750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$520.56 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$520.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$578.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
TAKING STATIN OR REC'D ORDER
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9664
|
| Hospital Charge Code |
30307873
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
TALAR-FIT IMPLANT 11MM
|
Facility
OP
|
$2,750.00
|
|
| Hospital Charge Code |
40200174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$962.50 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,512.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,375.00
|
| Rate for Payer: Aetna Government |
$1,375.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,870.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,375.00
|
| Rate for Payer: Group Health Inc Medicare |
$962.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,375.00
|
|
|
TAMIFLU 6MG PER ML
|
Facility
OP
|
$3.36
|
|
| Hospital Charge Code |
41648041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.28
|
| Rate for Payer: Group Health Inc Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.18
|
|
|
TAMIFLU 6MG PER ML
|
Facility
OP
|
$3.36
|
|
| Hospital Charge Code |
41658041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.28
|
| Rate for Payer: Group Health Inc Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.18
|
|
|
TAMOXIFEN 10 MGTAB
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41655106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
|
|
TAMOXIFEN 10 MGTAB
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41645106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
|
|
TAMOXIFEN 10 MGTAB
|
Facility
OP
|
$0.28
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41645106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
|
TAMOXIFEN 10 MGTAB
|
Facility
OP
|
$0.28
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41655106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
