|
ROLLING HEAT SEALER
|
Facility
|
OP
|
$5,782.38
|
|
| Hospital Charge Code |
64905291
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,023.83 |
| Max. Negotiated Rate |
$4,625.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,180.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,891.19
|
| Rate for Payer: Aetna Government |
$2,891.19
|
| Rate for Payer: Brighton Health Commercial |
$4,336.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,625.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,932.02
|
| Rate for Payer: Group Health Inc Commercial |
$2,891.19
|
| Rate for Payer: Group Health Inc Medicare |
$2,023.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,891.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,891.19
|
|
|
ROLL STERILIZATION 4INW X 100FTL
|
Facility
|
OP
|
$15.99
|
|
| Hospital Charge Code |
64905301
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$12.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Brighton Health Commercial |
$11.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.87
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
|
|
ROMIPLOSTIM 250MCG - PER 10MCG
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
41648428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.00
|
|
|
ROMIPLOSTIM 250MCG - PER 10MCG
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
41658428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.03
|
| Rate for Payer: Aetna Government |
$96.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.22
|
| Rate for Payer: Brighton Health Commercial |
$111.60
|
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$106.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$96.03
|
| Rate for Payer: EmblemHealth Commercial |
$96.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.83
|
| Rate for Payer: Group Health Inc Commercial |
$96.03
|
| Rate for Payer: Group Health Inc Medicare |
$96.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.62
|
| Rate for Payer: Healthfirst QHP |
$96.03
|
| Rate for Payer: Humana Medicare |
$97.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.16
|
| Rate for Payer: SOMOS Essential |
$102.16
|
| Rate for Payer: United Healthcare Commercial |
$91.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$76.82
|
| Rate for Payer: Wellcare Medicare |
$91.23
|
|
|
ROMIPLOSTIM 250MCG - PER 10MCG
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
41648428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.03
|
| Rate for Payer: Aetna Government |
$96.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.22
|
| Rate for Payer: Brighton Health Commercial |
$111.60
|
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$106.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$96.03
|
| Rate for Payer: EmblemHealth Commercial |
$96.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.83
|
| Rate for Payer: Group Health Inc Commercial |
$96.03
|
| Rate for Payer: Group Health Inc Medicare |
$96.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.62
|
| Rate for Payer: Healthfirst QHP |
$96.03
|
| Rate for Payer: Humana Medicare |
$97.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.16
|
| Rate for Payer: SOMOS Essential |
$102.16
|
| Rate for Payer: United Healthcare Commercial |
$91.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$76.82
|
| Rate for Payer: Wellcare Medicare |
$91.23
|
|
|
ROMIPLOSTIM 250MCG - PER 10MCG
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
41658428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.00
|
|
|
ROMIPLOSTIM 250 MCG SC SOLR [93566]
|
Facility
|
OP
|
$3,005.06
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
55513022101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$2,404.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,652.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.03
|
| Rate for Payer: Aetna Government |
$96.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.22
|
| Rate for Payer: Brighton Health Commercial |
$2,253.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,404.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,043.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$96.03
|
| Rate for Payer: EmblemHealth Commercial |
$96.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.46
|
| Rate for Payer: Group Health Inc Commercial |
$96.03
|
| Rate for Payer: Group Health Inc Medicare |
$96.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,502.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.62
|
| Rate for Payer: Healthfirst QHP |
$96.03
|
| Rate for Payer: Humana Medicare |
$97.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,953.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$76.82
|
| Rate for Payer: Wellcare Medicare |
$91.23
|
|
|
ROMIPLOSTIM 500MCG - PER 10MCG
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
41648429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.00
|
|
|
ROMIPLOSTIM 500MCG - PER 10MCG
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
41648429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.03
|
| Rate for Payer: Aetna Government |
$96.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.22
|
| Rate for Payer: Brighton Health Commercial |
$111.60
|
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$106.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$96.03
|
| Rate for Payer: EmblemHealth Commercial |
$96.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.83
|
| Rate for Payer: Group Health Inc Commercial |
$96.03
|
| Rate for Payer: Group Health Inc Medicare |
$96.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.62
|
| Rate for Payer: Healthfirst QHP |
$96.03
|
| Rate for Payer: Humana Medicare |
$97.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.16
|
| Rate for Payer: SOMOS Essential |
$102.16
|
| Rate for Payer: United Healthcare Commercial |
$91.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$76.82
|
| Rate for Payer: Wellcare Medicare |
$91.23
|
|
|
ROMIPLOSTIM 500MCG - PER 10MCG
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
41658429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.00
|
|
|
ROMIPLOSTIM 500MCG - PER 10MCG
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
41658429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.03
|
| Rate for Payer: Aetna Government |
$96.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.22
|
| Rate for Payer: Brighton Health Commercial |
$111.60
|
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Cash Price |
$96.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$106.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$96.03
|
| Rate for Payer: EmblemHealth Commercial |
$96.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.83
|
| Rate for Payer: Group Health Inc Commercial |
$96.03
|
| Rate for Payer: Group Health Inc Medicare |
$96.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.62
|
| Rate for Payer: Healthfirst QHP |
$96.03
|
| Rate for Payer: Humana Medicare |
$97.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.16
|
| Rate for Payer: SOMOS Essential |
$102.16
|
| Rate for Payer: United Healthcare Commercial |
$91.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$76.82
|
| Rate for Payer: Wellcare Medicare |
$91.23
|
|
|
ROMIPLOSTIM 500 MCG SC SOLR [93567]
|
Facility
|
OP
|
$6,010.12
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
55513022201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$4,808.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,305.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.03
|
| Rate for Payer: Aetna Government |
$96.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.22
|
| Rate for Payer: Brighton Health Commercial |
$4,507.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,808.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,086.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$96.03
|
| Rate for Payer: EmblemHealth Commercial |
$96.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.46
|
| Rate for Payer: Group Health Inc Commercial |
$96.03
|
| Rate for Payer: Group Health Inc Medicare |
$96.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,005.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.62
|
| Rate for Payer: Healthfirst QHP |
$96.03
|
| Rate for Payer: Humana Medicare |
$97.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,906.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$76.82
|
| Rate for Payer: Wellcare Medicare |
$91.23
|
|
|
ROMOSOZUMAB-AQQG
|
Facility
|
IP
|
$27.61
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
41640282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$13.80 |
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.80
|
|
|
ROMOSOZUMAB-AQQG
|
Facility
|
OP
|
$27.61
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
41640282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Government |
$10.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.51
|
| Rate for Payer: Brighton Health Commercial |
$16.57
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.73
|
| Rate for Payer: EmblemHealth Commercial |
$10.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.26
|
| Rate for Payer: Group Health Inc Commercial |
$10.73
|
| Rate for Payer: Group Health Inc Medicare |
$10.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.12
|
| Rate for Payer: Healthfirst QHP |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.33
|
| Rate for Payer: SOMOS Essential |
$11.33
|
| Rate for Payer: United Healthcare Commercial |
$9.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.58
|
| Rate for Payer: Wellcare Medicare |
$10.19
|
|
|
ROMOSOZUMAB-AQQG
|
Facility
|
OP
|
$27.61
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
41650282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Government |
$10.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.51
|
| Rate for Payer: Brighton Health Commercial |
$16.57
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.73
|
| Rate for Payer: EmblemHealth Commercial |
$10.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.26
|
| Rate for Payer: Group Health Inc Commercial |
$10.73
|
| Rate for Payer: Group Health Inc Medicare |
$10.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.12
|
| Rate for Payer: Healthfirst QHP |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.33
|
| Rate for Payer: SOMOS Essential |
$11.33
|
| Rate for Payer: United Healthcare Commercial |
$9.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.58
|
| Rate for Payer: Wellcare Medicare |
$10.19
|
|
|
ROMOSOZUMAB-AQQG
|
Facility
|
IP
|
$27.61
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
41650282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$13.80 |
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.80
|
|
|
ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY [167848]
|
Facility
|
OP
|
$1,248.39
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
55513088002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$998.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$686.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Government |
$10.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.51
|
| Rate for Payer: Brighton Health Commercial |
$936.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$998.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$848.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.73
|
| Rate for Payer: EmblemHealth Commercial |
$10.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.55
|
| Rate for Payer: Group Health Inc Commercial |
$10.73
|
| Rate for Payer: Group Health Inc Medicare |
$10.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$624.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.12
|
| Rate for Payer: Healthfirst QHP |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$811.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.58
|
| Rate for Payer: Wellcare Medicare |
$10.19
|
|
|
ROOT AMPUTATION-PER ROOT
|
Facility
|
IP
|
$409.66
|
|
|
Service Code
|
HCPCS D3450
|
| Hospital Charge Code |
42300795
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
ROOT AMPUTATION-PER ROOT
|
Facility
|
OP
|
$409.66
|
|
|
Service Code
|
HCPCS D3450
|
| Hospital Charge Code |
42300795
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.83 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$225.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$307.24
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
ROOT CANAL-ANTERIOR(EXCLUDING FIN
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS D3310
|
| Hospital Charge Code |
42300710
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$312.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$468.75
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
ROOT CANAL-ANTERIOR(EXCLUDING FIN
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS D3310
|
| Hospital Charge Code |
42300710
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
ROOT CANAL-BICUSPID(EXCLUDING FIN
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS D3320
|
| Hospital Charge Code |
42300715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$412.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$562.50
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
ROOT CANAL-BICUSPID(EXCLUDING FIN
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS D3320
|
| Hospital Charge Code |
42300715
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
ROOT CANAL-MOLAR (EXCLUDING FINAL
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS D3330
|
| Hospital Charge Code |
42300720
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
ROOT CANAL-MOLAR (EXCLUDING FINAL
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS D3330
|
| Hospital Charge Code |
42300720
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$750.00
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
