|
TOBRAMYCIN FORTIFIED OPHTH 13.6MG
|
Facility
OP
|
$12.65
|
|
| Hospital Charge Code |
41656634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.32
|
| Rate for Payer: Aetna Government |
$6.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.60
|
| Rate for Payer: Group Health Inc Commercial |
$6.32
|
| Rate for Payer: Group Health Inc Medicare |
$4.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.22
|
|
|
TOBRAMYCIN FORTIFIED OPTH 13.6MG
|
Facility
OP
|
$12.65
|
|
| Hospital Charge Code |
41646634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.32
|
| Rate for Payer: Aetna Government |
$6.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.60
|
| Rate for Payer: Group Health Inc Commercial |
$6.32
|
| Rate for Payer: Group Health Inc Medicare |
$4.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.22
|
|
|
TOBRAMYCIN RANDOM, SERUM
|
Facility
OP
|
$40.33
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
40609007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$25.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.13
|
| Rate for Payer: Aetna Government |
$16.13
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.13
|
| Rate for Payer: EmblemHealth Commercial |
$16.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.36
|
| Rate for Payer: Group Health Inc Commercial |
$16.13
|
| Rate for Payer: Group Health Inc Medicare |
$16.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.13
|
| Rate for Payer: Healthfirst QHP |
$16.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.90
|
| Rate for Payer: Wellcare Medicare |
$14.52
|
|
|
TOBRAMYCIN TROUGH, SERUM
|
Facility
OP
|
$40.33
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
40609006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$25.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.13
|
| Rate for Payer: Aetna Government |
$16.13
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.13
|
| Rate for Payer: EmblemHealth Commercial |
$16.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.36
|
| Rate for Payer: Group Health Inc Commercial |
$16.13
|
| Rate for Payer: Group Health Inc Medicare |
$16.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.13
|
| Rate for Payer: Healthfirst QHP |
$16.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.90
|
| Rate for Payer: Wellcare Medicare |
$14.52
|
|
|
TOCILIZUMAB 200MG/10ML
|
Facility
IP
|
$14.62
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41640245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.31
|
|
|
TOCILIZUMAB 200MG/10ML
|
Facility
IP
|
$14.62
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41650245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.31
|
|
|
TOCILIZUMAB 200MG/10ML
|
Facility
OP
|
$14.62
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41640245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.12
|
| Rate for Payer: Aetna Government |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.12
|
| Rate for Payer: EmblemHealth Commercial |
$6.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.43
|
| Rate for Payer: Group Health Inc Commercial |
$6.12
|
| Rate for Payer: Group Health Inc Medicare |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.20
|
| Rate for Payer: Healthfirst QHP |
$6.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.40
|
| Rate for Payer: SOMOS Essential |
$6.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.90
|
| Rate for Payer: Wellcare Medicare |
$5.81
|
|
|
TOCILIZUMAB 200MG/10ML
|
Facility
OP
|
$14.62
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41650245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.12
|
| Rate for Payer: Aetna Government |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.12
|
| Rate for Payer: EmblemHealth Commercial |
$6.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.43
|
| Rate for Payer: Group Health Inc Commercial |
$6.12
|
| Rate for Payer: Group Health Inc Medicare |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.20
|
| Rate for Payer: Healthfirst QHP |
$6.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.40
|
| Rate for Payer: SOMOS Essential |
$6.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.90
|
| Rate for Payer: Wellcare Medicare |
$5.81
|
|
|
TOCILIZUMAB 400MG/20ML
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41650228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
TOCILIZUMAB 400MG/20ML
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41650228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.12
|
| Rate for Payer: Aetna Government |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.12
|
| 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 |
$6.12
|
| Rate for Payer: EmblemHealth Commercial |
$6.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.43
|
| Rate for Payer: Group Health Inc Commercial |
$6.12
|
| Rate for Payer: Group Health Inc Medicare |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.20
|
| Rate for Payer: Healthfirst QHP |
$6.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.40
|
| Rate for Payer: SOMOS Essential |
$6.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.90
|
| Rate for Payer: Wellcare Medicare |
$5.81
|
|
|
TOCILIZUMAB 400MG/20ML
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41640228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.12
|
| Rate for Payer: Aetna Government |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.12
|
| 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 |
$6.12
|
| Rate for Payer: EmblemHealth Commercial |
$6.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.43
|
| Rate for Payer: Group Health Inc Commercial |
$6.12
|
| Rate for Payer: Group Health Inc Medicare |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.20
|
| Rate for Payer: Healthfirst QHP |
$6.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.40
|
| Rate for Payer: SOMOS Essential |
$6.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.90
|
| Rate for Payer: Wellcare Medicare |
$5.81
|
|
|
TOCILIZUMAB 400MG/20ML
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41640228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
TOCILIZUMAB 80MG/4ML
|
Facility
IP
|
$14.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41650246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.11
|
|
|
TOCILIZUMAB 80MG/4ML
|
Facility
OP
|
$14.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41650246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.12
|
| Rate for Payer: Aetna Government |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.12
|
| Rate for Payer: EmblemHealth Commercial |
$6.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.43
|
| Rate for Payer: Group Health Inc Commercial |
$6.12
|
| Rate for Payer: Group Health Inc Medicare |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.20
|
| Rate for Payer: Healthfirst QHP |
$6.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.40
|
| Rate for Payer: SOMOS Essential |
$6.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.90
|
| Rate for Payer: Wellcare Medicare |
$5.81
|
|
|
TOCILIZUMAB 80MG/4ML
|
Facility
OP
|
$14.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41640246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.12
|
| Rate for Payer: Aetna Government |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.12
|
| Rate for Payer: EmblemHealth Commercial |
$6.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.43
|
| Rate for Payer: Group Health Inc Commercial |
$6.12
|
| Rate for Payer: Group Health Inc Medicare |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.20
|
| Rate for Payer: Healthfirst QHP |
$6.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.40
|
| Rate for Payer: SOMOS Essential |
$6.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.90
|
| Rate for Payer: Wellcare Medicare |
$5.81
|
|
|
TOCILIZUMAB 80MG/4ML
|
Facility
IP
|
$14.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41640246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.11
|
|
|
TOCILIZUMAB/PLACEBO (TRIAL)
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41640350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.12
|
| Rate for Payer: Aetna Government |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.12
|
| 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 |
$6.12
|
| Rate for Payer: EmblemHealth Commercial |
$6.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.43
|
| Rate for Payer: Group Health Inc Commercial |
$6.12
|
| Rate for Payer: Group Health Inc Medicare |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.20
|
| Rate for Payer: Healthfirst QHP |
$6.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.40
|
| Rate for Payer: SOMOS Essential |
$6.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.90
|
| Rate for Payer: Wellcare Medicare |
$5.81
|
|
|
TOCILIZUMAB/PLACEBO (TRIAL)
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41650350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.12
|
| Rate for Payer: Aetna Government |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.12
|
| 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 |
$6.12
|
| Rate for Payer: EmblemHealth Commercial |
$6.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.43
|
| Rate for Payer: Group Health Inc Commercial |
$6.12
|
| Rate for Payer: Group Health Inc Medicare |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.20
|
| Rate for Payer: Healthfirst QHP |
$6.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.40
|
| Rate for Payer: SOMOS Essential |
$6.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.90
|
| Rate for Payer: Wellcare Medicare |
$5.81
|
|
|
TOCILIZUMAB/PLACEBO (TRIAL)
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41650350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
TOCILIZUMAB/PLACEBO (TRIAL)
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
41640350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
TOE IMPLANT, FLEX HINGED
|
Facility
OP
|
$315.75
|
|
| Hospital Charge Code |
40202112
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.51 |
| Max. Negotiated Rate |
$252.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.88
|
| Rate for Payer: Aetna Government |
$157.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$252.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$214.71
|
| Rate for Payer: Group Health Inc Commercial |
$157.88
|
| Rate for Payer: Group Health Inc Medicare |
$110.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.88
|
|
|
TOE IMPLANT, GREAT
|
Facility
OP
|
$282.44
|
|
| Hospital Charge Code |
40202122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.85 |
| Max. Negotiated Rate |
$225.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$155.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$141.22
|
| Rate for Payer: Aetna Government |
$141.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$192.06
|
| Rate for Payer: Group Health Inc Commercial |
$141.22
|
| Rate for Payer: Group Health Inc Medicare |
$98.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.22
|
|
|
TOE M-P JNT MED20MM POROUS COTED
|
Facility
IP
|
$2,150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.00 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,075.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,075.00
|
|
|
TOE M-P JNT MED20MM POROUS COTED
|
Facility
OP
|
$2,150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,257.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,182.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,075.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,236.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,257.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,075.00
|
| Rate for Payer: Group Health Inc Medicare |
$752.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,075.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,075.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,397.50
|
|
|
TOLVAPTAN 15 MG TAB
|
Facility
OP
|
$535.31
|
|
| Hospital Charge Code |
41655592
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$187.36 |
| Max. Negotiated Rate |
$428.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$294.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$267.66
|
| Rate for Payer: Aetna Government |
$267.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$428.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$364.01
|
| Rate for Payer: Group Health Inc Commercial |
$267.66
|
| Rate for Payer: Group Health Inc Medicare |
$187.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$347.95
|
|
