|
CARBAMAZEPINE 100 MG/5 ML SUSP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41645026
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CARBAMAZEPINE 100 MG/5 ML SUSP UDC
|
Facility
OP
|
$3.70
|
|
| Hospital Charge Code |
41654928
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.85
|
| Rate for Payer: Group Health Inc Medicare |
$1.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.40
|
|
|
CARBAMAZEPINE 100 MG/5 ML SUSP UDC
|
Facility
OP
|
$3.70
|
|
| Hospital Charge Code |
41644928
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.85
|
| Rate for Payer: Group Health Inc Medicare |
$1.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.40
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TAB
|
Facility
OP
|
$1.15
|
|
| Hospital Charge Code |
41655025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
CARBAMAZEPINE 100 MG CHEWABLE TAB
|
Facility
OP
|
$1.15
|
|
| Hospital Charge Code |
41645025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
CARBAMAZEPINE 200 MG/10 ML SUSP UDC
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41653436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
CARBAMAZEPINE 200 MG/10 ML SUSP UDC
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41643436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
CARBAMAZEPINE 200 MG TAB
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41654970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
CARBAMAZEPINE 200 MG TAB
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41644970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
CARBAMIDE PEROXIDE OTIC SOLN
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41640903
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
CARBAMIDE PEROXIDE OTIC SOLN
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41650903
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
CARB-EDGE MYO OP 6-3/4 17.1CM
|
Facility
OP
|
$92.10
|
|
| Hospital Charge Code |
64905678
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$73.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.05
|
| Rate for Payer: Aetna Government |
$46.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.63
|
| Rate for Payer: Group Health Inc Commercial |
$46.05
|
| Rate for Payer: Group Health Inc Medicare |
$32.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.05
|
|
|
CARBIDOPA + LEVODOPA 10 MG-100 MG TAB
|
Facility
OP
|
$1.71
|
|
| Hospital Charge Code |
41644436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Government |
$0.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.86
|
| Rate for Payer: Group Health Inc Medicare |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.11
|
|
|
CARBIDOPA + LEVODOPA 10 MG-100 MG TAB
|
Facility
OP
|
$1.71
|
|
| Hospital Charge Code |
41654436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Government |
$0.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.86
|
| Rate for Payer: Group Health Inc Medicare |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.11
|
|
|
CARBIDOPA + LEVODOPA 25 MG-100 MG TAB
|
Facility
OP
|
$1.93
|
|
| Hospital Charge Code |
41644439
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
| Rate for Payer: Aetna Government |
$0.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.97
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
|
CARBIDOPA + LEVODOPA 25 MG-100 MG TAB
|
Facility
OP
|
$1.93
|
|
| Hospital Charge Code |
41654439
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
| Rate for Payer: Aetna Government |
$0.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.97
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
|
CARBIDOPA + LEVODOPA 25 MG-250 MG TAB
|
Facility
OP
|
$2.45
|
|
| Hospital Charge Code |
41644438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.22
|
| Rate for Payer: Aetna Government |
$1.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
CARBIDOPA + LEVODOPA 25 MG-250 MG TAB
|
Facility
OP
|
$2.45
|
|
| Hospital Charge Code |
41654438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.22
|
| Rate for Payer: Aetna Government |
$1.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
CARBIDOPA + LEVODOPA 50 MG-200 MG CR
|
Facility
OP
|
$4.15
|
|
| Hospital Charge Code |
41641229
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.08
|
| Rate for Payer: Aetna Government |
$2.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.82
|
| Rate for Payer: Group Health Inc Commercial |
$2.08
|
| Rate for Payer: Group Health Inc Medicare |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.70
|
|
|
CARBIDOPA + LEVODOPA 50 MG-200 MG CR
|
Facility
OP
|
$4.15
|
|
| Hospital Charge Code |
41651229
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.08
|
| Rate for Payer: Aetna Government |
$2.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.82
|
| Rate for Payer: Group Health Inc Commercial |
$2.08
|
| Rate for Payer: Group Health Inc Medicare |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.70
|
|
|
CARBON ROD 300MM
|
Facility
OP
|
$1,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,119.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$586.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$533.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$612.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,119.30
|
| Rate for Payer: Group Health Inc Commercial |
$533.00
|
| Rate for Payer: Group Health Inc Medicare |
$373.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$533.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$533.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$692.90
|
|
|
CARBON ROD 300MM
|
Facility
IP
|
$1,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.00 |
| Max. Negotiated Rate |
$533.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$533.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$533.00
|
|
|
CARBOPLATIN 10 MG/ML INJ 45 ML
|
Facility
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
41654417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.64
|
| Rate for Payer: Aetna Government |
$2.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.95
|
| Rate for Payer: SOMOS Essential |
$3.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
|
|
CARBOPLATIN 10 MG/ML INJ 45 ML
|
Facility
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
41644417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.64
|
| Rate for Payer: Aetna Government |
$2.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.95
|
| Rate for Payer: SOMOS Essential |
$3.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
|
|
CARBOPLATIN 10 MG/ML INJ 45 ML
|
Facility
IP
|
$6.24
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
41644417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
|
