|
DOXEPIN HCL 10 MG PO CAPS
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 5107943620
|
| Hospital Charge Code |
5107943620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$0.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.43
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.42
|
|
|
DOXEPIN HCL 25 MG PO CAPS
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 0904705361
|
| Hospital Charge Code |
0904705361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.48
|
|
|
DOXEPIN HCL 25 MG PO CAPS
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 0904705361
|
| Hospital Charge Code |
0904705361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.65
|
| Rate for Payer: EmblemHealth Commercial |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.48
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
DOXEPIN HCL 50 MG PO CAPS
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
NDC 5965117501
|
| Hospital Charge Code |
5965117501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.59
|
| Rate for Payer: Aetna Government |
$0.59
|
| Rate for Payer: Brighton Health Commercial |
$0.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.80
|
| Rate for Payer: EmblemHealth Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.77
|
|
|
DOXEPIN HCL 50 MG PO CAPS
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
NDC 5965117501
|
| Hospital Charge Code |
5965117501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
|
|
DOXEPIN HCL 50 MG PO CAPS
|
Facility
|
IP
|
$1.33
|
|
|
Service Code
|
NDC 0904705461
|
| Hospital Charge Code |
0904705461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
|
|
DOXEPIN HCL 50 MG PO CAPS
|
Facility
|
OP
|
$1.33
|
|
|
Service Code
|
NDC 0904705461
|
| Hospital Charge Code |
0904705461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
| Rate for Payer: Aetna Government |
$0.67
|
| Rate for Payer: Brighton Health Commercial |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.91
|
| Rate for Payer: EmblemHealth Commercial |
$0.67
|
| Rate for Payer: Group Health Inc Commercial |
$0.67
|
| Rate for Payer: Group Health Inc Medicare |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.87
|
|
|
DOXERCALCIFEROL 4 MCG/2ML IV SOLN
|
Facility
|
IP
|
$2.44
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
0409133001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
|
|
DOXERCALCIFEROL 4 MCG/2ML IV SOLN
|
Facility
|
IP
|
$2.44
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
0409133011
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
|
|
DOXERCALCIFEROL 4 MCG/2ML IV SOLN
|
Facility
|
OP
|
$2.44
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
0409133001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna Government |
$0.41
|
| Rate for Payer: Brighton Health Commercial |
$1.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.66
|
| Rate for Payer: EmblemHealth Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.58
|
|
|
DOXERCALCIFEROL 4 MCG/2ML IV SOLN
|
Facility
|
OP
|
$2.44
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
0409133011
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna Government |
$0.41
|
| Rate for Payer: Brighton Health Commercial |
$1.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.66
|
| Rate for Payer: EmblemHealth Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.58
|
|
|
DOXORUBICIN HCL 2 MG/ML IV SOLN
|
Facility
|
OP
|
$2.44
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
0069303020
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Brighton Health Commercial |
$1.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.66
|
| Rate for Payer: EmblemHealth Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.58
|
|
|
DOXORUBICIN HCL 2 MG/ML IV SOLN
|
Facility
|
IP
|
$2.44
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
0069303020
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
|
|
DOXORUBICIN HCL 2 MG/ML IV SOLN
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
0069303220
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Brighton Health Commercial |
$0.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.80
|
| Rate for Payer: EmblemHealth Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.77
|
|
|
DOXORUBICIN HCL 2 MG/ML IV SOLN
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
6332388305
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.08
|
|
|
DOXORUBICIN HCL 2 MG/ML IV SOLN
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
6332388330
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
|
|
DOXORUBICIN HCL 2 MG/ML IV SOLN
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
6332388305
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Brighton Health Commercial |
$1.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.47
|
| Rate for Payer: EmblemHealth Commercial |
$1.08
|
| Rate for Payer: Group Health Inc Commercial |
$1.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.40
|
|
|
DOXORUBICIN HCL 2 MG/ML IV SOLN
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
0143908601
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
|
|
DOXORUBICIN HCL 2 MG/ML IV SOLN
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
0143908601
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Brighton Health Commercial |
$1.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
DOXORUBICIN HCL 2 MG/ML IV SOLN
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
0069303220
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
|
|
DOXORUBICIN HCL 2 MG/ML IV SOLN
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
6332388330
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Brighton Health Commercial |
$1.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.09
|
| Rate for Payer: EmblemHealth Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Medicare |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.04
|
|
|
DOXORUBICIN HCL 50 MG IV SOLR
|
Facility
|
IP
|
$315.64
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
0143909301
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$157.82 |
| Max. Negotiated Rate |
$157.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.82
|
|
|
DOXORUBICIN HCL 50 MG IV SOLR
|
Facility
|
OP
|
$315.64
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
0143909301
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$252.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Brighton Health Commercial |
$236.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$252.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$214.64
|
| Rate for Payer: EmblemHealth Commercial |
$157.82
|
| Rate for Payer: Group Health Inc Commercial |
$157.82
|
| Rate for Payer: Group Health Inc Medicare |
$110.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.17
|
|
|
DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
0338006301
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$110.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$108.47
|
| Rate for Payer: Aetna Government |
$108.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$75.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$75.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$75.93
|
| Rate for Payer: Brighton Health Commercial |
$59.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$108.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$108.47
|
| Rate for Payer: EmblemHealth Commercial |
$108.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$108.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.54
|
| Rate for Payer: Group Health Inc Commercial |
$108.47
|
| Rate for Payer: Group Health Inc Medicare |
$108.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.20
|
| Rate for Payer: Healthfirst QHP |
$108.47
|
| Rate for Payer: Humana Medicare |
$110.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$108.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$103.05
|
| Rate for Payer: Wellcare Medicare |
$103.05
|
|
|
DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
0338006301
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$39.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.78
|
|
