|
DOCETAXEL 20 MG/ML IV CONC
|
Facility
|
IP
|
$365.15
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
4733532340
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$182.57 |
| Max. Negotiated Rate |
$182.57 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.57
|
|
|
DOCETAXEL 80 MG/4ML IV CONC
|
Facility
|
IP
|
$365.15
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
1672926764
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$182.57 |
| Max. Negotiated Rate |
$182.57 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.57
|
|
|
DOCETAXEL 80 MG/4ML IV CONC
|
Facility
|
OP
|
$83.74
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
0409036701
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$66.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$62.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.95
|
| Rate for Payer: EmblemHealth Commercial |
$41.87
|
| Rate for Payer: Group Health Inc Commercial |
$41.87
|
| Rate for Payer: Group Health Inc Medicare |
$29.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.43
|
|
|
DOCETAXEL 80 MG/4ML IV CONC
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
4596376552
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$180.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.20
|
| Rate for Payer: EmblemHealth Commercial |
$120.00
|
| Rate for Payer: Group Health Inc Commercial |
$120.00
|
| Rate for Payer: Group Health Inc Medicare |
$84.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.00
|
|
|
DOCETAXEL 80 MG/4ML IV CONC
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
4596376552
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.00
|
|
|
DOCETAXEL 80 MG/4ML IV CONC
|
Facility
|
OP
|
$365.15
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
1672926764
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$292.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$200.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$273.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$292.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$248.30
|
| Rate for Payer: EmblemHealth Commercial |
$182.57
|
| Rate for Payer: Group Health Inc Commercial |
$182.57
|
| Rate for Payer: Group Health Inc Medicare |
$127.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.35
|
|
|
DOCETAXEL 80 MG/4ML IV CONC
|
Facility
|
IP
|
$83.74
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
0409036701
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.87
|
|
|
DOCETAXEL 80 MG/8ML IV SOLN
|
Facility
|
IP
|
$41.25
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
6745753208
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$20.62 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.62
|
|
|
DOCETAXEL 80 MG/8ML IV SOLN
|
Facility
|
OP
|
$41.25
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
6745753208
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$30.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.05
|
| Rate for Payer: EmblemHealth Commercial |
$20.62
|
| Rate for Payer: Group Health Inc Commercial |
$20.62
|
| Rate for Payer: Group Health Inc Medicare |
$14.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.81
|
|
|
DOCUSATE SODIUM 100 MG/10ML PO LIQD
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0904727966
|
| Hospital Charge Code |
0904727966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
|
|
DOCUSATE SODIUM 100 MG/10ML PO LIQD
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 0121187010
|
| Hospital Charge Code |
0121187010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
DOCUSATE SODIUM 100 MG/10ML PO LIQD
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 0121187010
|
| Hospital Charge Code |
0121187010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
|
|
DOCUSATE SODIUM 100 MG/10ML PO LIQD
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0904727966
|
| Hospital Charge Code |
0904727966
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: EmblemHealth Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
DOCUSATE SODIUM 100 MG PO CAPS
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 6068712901
|
| Hospital Charge Code |
6068712901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
|
|
DOCUSATE SODIUM 100 MG PO CAPS
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 6373947802
|
| Hospital Charge Code |
6373947802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
DOCUSATE SODIUM 100 MG PO CAPS
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0904718361
|
| Hospital Charge Code |
0904718361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
|
|
DOCUSATE SODIUM 100 MG PO CAPS
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0904699880
|
| Hospital Charge Code |
0904699880
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| 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 |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DOCUSATE SODIUM 100 MG PO CAPS
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0904728060
|
| Hospital Charge Code |
0904728060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
DOCUSATE SODIUM 100 MG PO CAPS
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0904718361
|
| Hospital Charge Code |
0904718361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: EmblemHealth Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.04
|
|
|
DOCUSATE SODIUM 100 MG PO CAPS
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 6068712901
|
| Hospital Charge Code |
6068712901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
DOCUSATE SODIUM 100 MG PO CAPS
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0904699880
|
| Hospital Charge Code |
0904699880
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
DOCUSATE SODIUM 100 MG PO CAPS
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 6373947802
|
| Hospital Charge Code |
6373947802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
DOCUSATE SODIUM 100 MG PO CAPS
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0904728060
|
| Hospital Charge Code |
0904728060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| 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 |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DOCUSATE SODIUM 150 MG/15ML PO LIQD
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 4843322010
|
| Hospital Charge Code |
4843322010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
DOCUSATE SODIUM 150 MG/15ML PO LIQD
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 4843322010
|
| Hospital Charge Code |
4843322010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
|
