|
FIDAXOMICIN 200 MG PO TABS
|
Facility
|
OP
|
$204.70
|
|
|
Service Code
|
NDC 0480259634
|
| Hospital Charge Code |
0480259634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.64 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$112.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.35
|
| Rate for Payer: Aetna Government |
$102.35
|
| Rate for Payer: Brighton Health Commercial |
$153.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$163.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$139.20
|
| Rate for Payer: EmblemHealth Commercial |
$102.35
|
| Rate for Payer: Group Health Inc Commercial |
$102.35
|
| Rate for Payer: Group Health Inc Medicare |
$71.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.06
|
|
|
FIDAXOMICIN 200 MG PO TABS
|
Facility
|
IP
|
$298.85
|
|
|
Service Code
|
NDC 5201508001
|
| Hospital Charge Code |
5201508001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$149.42 |
| Max. Negotiated Rate |
$149.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.42
|
|
|
FIDAXOMICIN 200 MG PO TABS
|
Facility
|
IP
|
$204.70
|
|
|
Service Code
|
NDC 0480259634
|
| Hospital Charge Code |
0480259634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.35 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.35
|
|
|
FILGRASTIM 300 MCG/ML IJ SOLN
|
Facility
|
IP
|
$377.80
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
5551353001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$188.90 |
| Max. Negotiated Rate |
$188.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.90
|
|
|
FILGRASTIM 300 MCG/ML IJ SOLN
|
Facility
|
IP
|
$377.80
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
5551353010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$188.90 |
| Max. Negotiated Rate |
$188.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.90
|
|
|
FILGRASTIM 300 MCG/ML IJ SOLN
|
Facility
|
OP
|
$377.80
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
5551353010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$302.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.70
|
| Rate for Payer: Brighton Health Commercial |
$283.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$302.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$256.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.00
|
| Rate for Payer: EmblemHealth Commercial |
$1.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.89
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.85
|
| Rate for Payer: Healthfirst QHP |
$1.00
|
| Rate for Payer: Humana Medicare |
$1.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.95
|
| Rate for Payer: Wellcare Medicare |
$0.95
|
|
|
FILGRASTIM 300 MCG/ML IJ SOLN
|
Facility
|
OP
|
$377.80
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
5551353001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$302.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.70
|
| Rate for Payer: Brighton Health Commercial |
$283.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$302.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$256.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.00
|
| Rate for Payer: EmblemHealth Commercial |
$1.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.89
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.85
|
| Rate for Payer: Healthfirst QHP |
$1.00
|
| Rate for Payer: Humana Medicare |
$1.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.95
|
| Rate for Payer: Wellcare Medicare |
$0.95
|
|
|
FILGRASTIM 480 MCG/1.6ML IJ SOLN
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
5551354610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$300.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.70
|
| Rate for Payer: Brighton Health Commercial |
$282.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$300.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.00
|
| Rate for Payer: EmblemHealth Commercial |
$1.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.89
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.85
|
| Rate for Payer: Healthfirst QHP |
$1.00
|
| Rate for Payer: Humana Medicare |
$1.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.95
|
| Rate for Payer: Wellcare Medicare |
$0.95
|
|
|
FILGRASTIM 480 MCG/1.6ML IJ SOLN
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
5551354610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.00
|
|
|
FILGRASTIM 480 MCG/1.6ML IJ SOLN
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
5551354601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$188.00 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.00
|
|
|
FILGRASTIM 480 MCG/1.6ML IJ SOLN
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
5551354601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$300.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.70
|
| Rate for Payer: Brighton Health Commercial |
$282.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$300.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.00
|
| Rate for Payer: EmblemHealth Commercial |
$1.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.89
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.85
|
| Rate for Payer: Healthfirst QHP |
$1.00
|
| Rate for Payer: Humana Medicare |
$1.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.95
|
| Rate for Payer: Wellcare Medicare |
$0.95
|
|
|
FILGRASTIM-AAFI 300 MCG/0.5ML IJ SOSY
|
Facility
|
IP
|
$525.60
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.80
|
|
|
FILGRASTIM-AAFI 300 MCG/0.5ML IJ SOSY
|
Facility
|
OP
|
$525.60
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$289.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$394.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$420.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$357.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.26
|
| Rate for Payer: Healthfirst QHP |
$0.30
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: Wellcare Medicare |
$0.29
|
|
|
FILGRASTIM-AAFI 300 MCG/0.5ML IJ SOSY
|
Facility
|
OP
|
$525.60
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$289.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$394.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$420.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$357.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.26
|
| Rate for Payer: Healthfirst QHP |
$0.30
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: Wellcare Medicare |
$0.29
|
|
|
FILGRASTIM-AAFI 300 MCG/0.5ML IJ SOSY
|
Facility
|
IP
|
$525.60
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.80
|
|
|
FILGRASTIM-AAFI 300 MCG/ML IJ SOLN
|
Facility
|
OP
|
$262.80
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$210.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$197.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$210.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.26
|
| Rate for Payer: Healthfirst QHP |
$0.30
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: Wellcare Medicare |
$0.29
|
|
|
FILGRASTIM-AAFI 300 MCG/ML IJ SOLN
|
Facility
|
IP
|
$262.80
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.40
|
|
|
FILGRASTIM-AAFI 300 MCG/ML IJ SOLN
|
Facility
|
IP
|
$262.80
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.40
|
|
|
FILGRASTIM-AAFI 300 MCG/ML IJ SOLN
|
Facility
|
OP
|
$262.80
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$210.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$197.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$210.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.26
|
| Rate for Payer: Healthfirst QHP |
$0.30
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: Wellcare Medicare |
$0.29
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8ML IJ SOSY
|
Facility
|
OP
|
$525.60
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$289.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$394.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$420.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$357.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.26
|
| Rate for Payer: Healthfirst QHP |
$0.30
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: Wellcare Medicare |
$0.29
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8ML IJ SOSY
|
Facility
|
IP
|
$525.60
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.80
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8ML IJ SOSY
|
Facility
|
IP
|
$525.60
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.80
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8ML IJ SOSY
|
Facility
|
OP
|
$525.60
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$289.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$394.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$420.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$357.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.26
|
| Rate for Payer: Healthfirst QHP |
$0.30
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: Wellcare Medicare |
$0.29
|
|
|
FILGRASTIM-AAFI 480 MCG/1.6ML IJ SOLN
|
Facility
|
IP
|
$262.80
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.40
|
|
|
FILGRASTIM-AAFI 480 MCG/1.6ML IJ SOLN
|
Facility
|
OP
|
$262.80
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
0069029410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$210.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$197.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$210.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.26
|
| Rate for Payer: Healthfirst QHP |
$0.30
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.29
|
| Rate for Payer: Wellcare Medicare |
$0.29
|
|
