|
VIAL2BAG DC BLUE
|
Facility
OP
|
$5.71
|
|
| Hospital Charge Code |
64902120
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.86
|
| Rate for Payer: Aetna Government |
$2.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.88
|
| Rate for Payer: Group Health Inc Commercial |
$2.86
|
| Rate for Payer: Group Health Inc Medicare |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.86
|
|
|
VIAL2BAG DC BLUE 20MM
|
Facility
OP
|
$4.88
|
|
| Hospital Charge Code |
64902180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.44
|
| Rate for Payer: Aetna Government |
$2.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.32
|
| Rate for Payer: Group Health Inc Commercial |
$2.44
|
| Rate for Payer: Group Health Inc Medicare |
$1.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
|
|
VIAL2BAG DC ORANGE 13MM
|
Facility
OP
|
$4.88
|
|
| Hospital Charge Code |
64902178
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.44
|
| Rate for Payer: Aetna Government |
$2.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.32
|
| Rate for Payer: Group Health Inc Commercial |
$2.44
|
| Rate for Payer: Group Health Inc Medicare |
$1.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
|
|
VIAL2BAG ORANGE 13MM
|
Facility
OP
|
$285.46
|
|
| Hospital Charge Code |
64902115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.91 |
| Max. Negotiated Rate |
$228.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$157.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$142.73
|
| Rate for Payer: Aetna Government |
$142.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$228.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$194.11
|
| Rate for Payer: Group Health Inc Commercial |
$142.73
|
| Rate for Payer: Group Health Inc Medicare |
$99.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.73
|
|
|
VIAL 2 BAG PROG
|
Facility
OP
|
$6.22
|
|
| Hospital Charge Code |
64901571
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.11
|
| Rate for Payer: Aetna Government |
$3.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.23
|
| Rate for Payer: Group Health Inc Commercial |
$3.11
|
| Rate for Payer: Group Health Inc Medicare |
$2.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.11
|
|
|
VIDEO/SPEECH EVAL
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 70371 TC
|
| Hospital Charge Code |
30304096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.38 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.38
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.75
|
|
|
VINBLASTINE 10 MG INJ
|
Facility
IP
|
$1.96
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
41652886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
|
|
VINBLASTINE 10 MG INJ
|
Facility
OP
|
$1.96
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
41642886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna Government |
$3.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.98
|
| Rate for Payer: Group Health Inc Medicare |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.32
|
| Rate for Payer: SOMOS Essential |
$5.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.27
|
|
|
VINBLASTINE 10 MG INJ
|
Facility
IP
|
$1.96
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
41642886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
|
|
VINBLASTINE 10 MG INJ
|
Facility
OP
|
$1.96
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
41652886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna Government |
$3.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.98
|
| Rate for Payer: Group Health Inc Medicare |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.32
|
| Rate for Payer: SOMOS Essential |
$5.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.27
|
|
|
VINCRISTINE 1 MG/ML INJ 1 ML
|
Facility
OP
|
$6.11
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
41654133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$8.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.03
|
| Rate for Payer: Aetna Government |
$5.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.74
|
| Rate for Payer: Group Health Inc Commercial |
$3.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.39
|
| Rate for Payer: SOMOS Essential |
$8.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.97
|
|
|
VINCRISTINE 1 MG/ML INJ 1 ML
|
Facility
IP
|
$6.11
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
41654133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
|
|
VINCRISTINE 1 MG/ML INJ 1 ML
|
Facility
OP
|
$6.11
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
41644133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$8.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.03
|
| Rate for Payer: Aetna Government |
$5.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.74
|
| Rate for Payer: Group Health Inc Commercial |
$3.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.39
|
| Rate for Payer: SOMOS Essential |
$8.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.97
|
|
|
VINCRISTINE 1 MG/ML INJ 1 ML
|
Facility
IP
|
$6.11
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
41644133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
|
|
VINCRISTINE 1 MG/ML INJ 2 ML
|
Facility
OP
|
$6.11
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
41640655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$8.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.03
|
| Rate for Payer: Aetna Government |
$5.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.74
|
| Rate for Payer: Group Health Inc Commercial |
$3.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.39
|
| Rate for Payer: SOMOS Essential |
$8.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.97
|
|
|
VINCRISTINE 1 MG/ML INJ 2 ML
|
Facility
IP
|
$6.11
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
41640655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
|
|
VINCRISTINE 1 MG/ML INJ 2 ML
|
Facility
IP
|
$6.11
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
41650655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
|
|
VINCRISTINE 1 MG/ML INJ 2 ML
|
Facility
OP
|
$6.11
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
41650655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$8.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.03
|
| Rate for Payer: Aetna Government |
$5.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.74
|
| Rate for Payer: Group Health Inc Commercial |
$3.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.39
|
| Rate for Payer: SOMOS Essential |
$8.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.97
|
|
|
VINORELBINE 10 MG/ML INJ 1ML
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41644589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.01
|
| Rate for Payer: Aetna Government |
$10.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.44
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.01
|
| Rate for Payer: SOMOS Essential |
$9.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.00
|
|
|
VINORELBINE 10 MG/ML INJ 1ML
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41644589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
|
|
VINORELBINE 10 MG/ML INJ 1ML
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41654589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.01
|
| Rate for Payer: Aetna Government |
$10.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.44
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.01
|
| Rate for Payer: SOMOS Essential |
$9.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.00
|
|
|
VINORELBINE 10 MG/ML INJ 1ML
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41654589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
|
|
VINORELBINE 10 MG/ML INJ 5 ML
|
Facility
OP
|
$14.82
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41644335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.01
|
| Rate for Payer: Aetna Government |
$10.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.44
|
| Rate for Payer: Group Health Inc Commercial |
$7.41
|
| Rate for Payer: Group Health Inc Medicare |
$5.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.01
|
| Rate for Payer: SOMOS Essential |
$9.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.63
|
|
|
VINORELBINE 10 MG/ML INJ 5 ML
|
Facility
OP
|
$14.82
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41654335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.01
|
| Rate for Payer: Aetna Government |
$10.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.44
|
| Rate for Payer: Group Health Inc Commercial |
$7.41
|
| Rate for Payer: Group Health Inc Medicare |
$5.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.01
|
| Rate for Payer: SOMOS Essential |
$9.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.63
|
|
|
VINORELBINE 10 MG/ML INJ 5 ML
|
Facility
IP
|
$14.82
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41644335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.41
|
|
