|
TOBRAMYCIN 80 MG IVPB PREMIX
|
Facility
|
OP
|
$17.45
|
|
| Hospital Charge Code |
41654279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$11.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.72
|
| Rate for Payer: Aetna Government |
$8.72
|
| Rate for Payer: Brighton Health Commercial |
$10.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.03
|
| Rate for Payer: Group Health Inc Commercial |
$8.72
|
| Rate for Payer: Group Health Inc Medicare |
$6.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.34
|
|
|
TOBRAMYCIN 80 MG IVPB PREMIX
|
Facility
|
IP
|
$17.45
|
|
| Hospital Charge Code |
41654279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.72
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3-0.05 % OP SUSP [105411]
|
Facility
|
OP
|
$57.10
|
|
|
Service Code
|
NDC 71776003505
|
| Hospital Charge Code |
71776003505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.55
|
| Rate for Payer: Aetna Government |
$28.55
|
| Rate for Payer: Brighton Health Commercial |
$42.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.83
|
| Rate for Payer: Group Health Inc Commercial |
$28.55
|
| Rate for Payer: Group Health Inc Medicare |
$19.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.11
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT [11566]
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
NDC 00078087601
|
| Hospital Charge Code |
00078087601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$74.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.50
|
| Rate for Payer: Aetna Government |
$46.50
|
| Rate for Payer: Brighton Health Commercial |
$69.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.24
|
| Rate for Payer: Group Health Inc Commercial |
$46.50
|
| Rate for Payer: Group Health Inc Medicare |
$32.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.45
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT [11566]
|
Facility
|
OP
|
$52.81
|
|
|
Service Code
|
NDC 49999017435
|
| Hospital Charge Code |
49999017435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.40
|
| Rate for Payer: Aetna Government |
$26.40
|
| Rate for Payer: Brighton Health Commercial |
$39.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.91
|
| Rate for Payer: Group Health Inc Commercial |
$26.40
|
| Rate for Payer: Group Health Inc Medicare |
$18.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.32
|
|
|
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: Brighton Health Commercial |
$9.49
|
| 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: Brighton Health Commercial |
$9.49
|
| 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
|
IP
|
$40.33
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
40609007
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.13
|
|
|
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 |
$30.25 |
| 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: Brighton Health Commercial |
$30.25
|
| 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 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 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 SULFATE 1.2 G IJ SOLR [11565]
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
39822041201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Brighton Health Commercial |
$75.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.00
|
|
|
TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN [97790]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
63323030630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Brighton Health Commercial |
$0.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.44
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.57
|
|
|
TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN [39918]
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
63323030626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Brighton Health Commercial |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: Group Health Inc Commercial |
$0.47
|
| Rate for Payer: Group Health Inc Medicare |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.60
|
|
|
TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN [39918]
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
67457047300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Brighton Health Commercial |
$0.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.81
|
| Rate for Payer: Group Health Inc Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.77
|
|
|
TOBRAMYCIN TROUGH, SERUM
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
40609006
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.13
|
|
|
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 |
$30.25 |
| 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: Brighton Health Commercial |
$30.25
|
| 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 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 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
|
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: Brighton Health Commercial |
$8.77
|
| 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 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
|
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 |
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: Brighton Health Commercial |
$8.77
|
| 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 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 |
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 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: Brighton Health Commercial |
$0.01
|
| 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 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 |
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: Brighton Health Commercial |
$0.01
|
| 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 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 400 MG/20ML IV SOLN [108063]
|
Facility
|
OP
|
$159.35
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
50242013701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$103.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.12
|
| Rate for Payer: Aetna Government |
$6.12
|
| Rate for Payer: Brighton Health Commercial |
$95.61
|
| 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 |
$79.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.12
|
| Rate for Payer: EmblemHealth Commercial |
$79.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.12
|
| 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 |
$79.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.67
|
| 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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.90
|
|
|
TOCILIZUMAB 400 MG/20ML IV SOLN [108063]
|
Facility
|
IP
|
$159.35
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
50242013701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.67 |
| Max. Negotiated Rate |
$79.67 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.67
|
|
