|
CETIRIZINE HCL 5 MG/5ML PO SOLN [124409]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 00904676520
|
| Hospital Charge Code |
00904676520
|
|
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 |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| 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
|
|
|
CETIRIZINE HCL 5 MG/5ML PO SOLN [124409]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 51672407008
|
| Hospital Charge Code |
51672407008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
CETIRIZINE HCL 5 MG/5ML PO SOLN [124409]
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 68094000462
|
| Hospital Charge Code |
68094000462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Brighton Health Commercial |
$0.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.39
|
| Rate for Payer: Group Health Inc Commercial |
$0.29
|
| Rate for Payer: Group Health Inc Medicare |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.37
|
|
|
CETIRIZINE HCL 5 MG PO TABS [15349]
|
Facility
|
OP
|
$2.49
|
|
|
Service Code
|
NDC 16571040110
|
| Hospital Charge Code |
16571040110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Brighton Health Commercial |
$1.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.62
|
|
|
CETUXIMAB 100 MG/50ML IV SOLN [37989]
|
Facility
|
IP
|
$18.92
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
66733094823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$9.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.46
|
|
|
CETUXIMAB 100 MG/50ML IV SOLN [37989]
|
Facility
|
OP
|
$18.92
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
66733094823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.72
|
| Rate for Payer: Aetna Government |
$73.72
|
| Rate for Payer: Brighton Health Commercial |
$11.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$73.72
|
| Rate for Payer: EmblemHealth Commercial |
$9.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.72
|
| Rate for Payer: Group Health Inc Commercial |
$73.72
|
| Rate for Payer: Group Health Inc Medicare |
$73.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$73.72
|
| Rate for Payer: Humana Medicare |
$75.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.98
|
|
|
CETUXIMAB 200 MG/100ML IV SOLN [108072]
|
Facility
|
OP
|
$18.92
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
66733095823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.72
|
| Rate for Payer: Aetna Government |
$73.72
|
| Rate for Payer: Brighton Health Commercial |
$11.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$73.72
|
| Rate for Payer: EmblemHealth Commercial |
$9.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.72
|
| Rate for Payer: Group Health Inc Commercial |
$73.72
|
| Rate for Payer: Group Health Inc Medicare |
$73.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$73.72
|
| Rate for Payer: Humana Medicare |
$75.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.98
|
|
|
CETUXIMAB 200 MG/100ML IV SOLN [108072]
|
Facility
|
IP
|
$18.92
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
66733095823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$9.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.46
|
|
|
CETUXIMAB 2 MG/ML INJ 100 ML
|
Facility
|
IP
|
$100.40
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
41644923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$50.20 |
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.20
|
|
|
CETUXIMAB 2 MG/ML INJ 100 ML
|
Facility
|
IP
|
$100.40
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
41654923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$50.20 |
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.20
|
|
|
CETUXIMAB 2 MG/ML INJ 100 ML
|
Facility
|
OP
|
$100.40
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
41654923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.72
|
| Rate for Payer: Aetna Government |
$73.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$51.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$51.60
|
| Rate for Payer: Brighton Health Commercial |
$60.24
|
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$73.72
|
| Rate for Payer: EmblemHealth Commercial |
$73.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.41
|
| Rate for Payer: Group Health Inc Commercial |
$73.72
|
| Rate for Payer: Group Health Inc Medicare |
$73.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$73.72
|
| Rate for Payer: Humana Medicare |
$75.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.90
|
| Rate for Payer: SOMOS Essential |
$77.90
|
| Rate for Payer: United Healthcare Commercial |
$70.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.98
|
| Rate for Payer: Wellcare Medicare |
$70.03
|
|
|
CETUXIMAB 2 MG/ML INJ 100 ML
|
Facility
|
OP
|
$100.40
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
41644923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.72
|
| Rate for Payer: Aetna Government |
$73.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$51.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$51.60
|
| Rate for Payer: Brighton Health Commercial |
$60.24
|
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$73.72
|
| Rate for Payer: EmblemHealth Commercial |
$73.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.41
|
| Rate for Payer: Group Health Inc Commercial |
$73.72
|
| Rate for Payer: Group Health Inc Medicare |
$73.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$73.72
|
| Rate for Payer: Humana Medicare |
$75.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.90
|
| Rate for Payer: SOMOS Essential |
$77.90
|
| Rate for Payer: United Healthcare Commercial |
$70.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.98
|
| Rate for Payer: Wellcare Medicare |
$70.03
|
|
|
CETUXIMAB 2 MG/ML INJ 50 ML
|
Facility
|
OP
|
$100.40
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
41643412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.72
|
| Rate for Payer: Aetna Government |
$73.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$51.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$51.60
|
| Rate for Payer: Brighton Health Commercial |
$60.24
|
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$73.72
|
| Rate for Payer: EmblemHealth Commercial |
$73.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.41
|
| Rate for Payer: Group Health Inc Commercial |
$73.72
|
| Rate for Payer: Group Health Inc Medicare |
$73.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$73.72
|
| Rate for Payer: Humana Medicare |
$75.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.90
|
| Rate for Payer: SOMOS Essential |
$77.90
|
| Rate for Payer: United Healthcare Commercial |
$70.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.98
|
| Rate for Payer: Wellcare Medicare |
$70.03
|
|
|
CETUXIMAB 2 MG/ML INJ 50 ML
|
Facility
|
IP
|
$100.40
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
41643412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$50.20 |
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.20
|
|
|
CETUXIMAB 2 MG/ML INJ 50 ML
|
Facility
|
OP
|
$100.40
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
41653412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.72
|
| Rate for Payer: Aetna Government |
$73.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$51.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$51.60
|
| Rate for Payer: Brighton Health Commercial |
$60.24
|
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$73.72
|
| Rate for Payer: EmblemHealth Commercial |
$73.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.41
|
| Rate for Payer: Group Health Inc Commercial |
$73.72
|
| Rate for Payer: Group Health Inc Medicare |
$73.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$73.72
|
| Rate for Payer: Humana Medicare |
$75.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.90
|
| Rate for Payer: SOMOS Essential |
$77.90
|
| Rate for Payer: United Healthcare Commercial |
$70.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.98
|
| Rate for Payer: Wellcare Medicare |
$70.03
|
|
|
CETUXIMAB 2 MG/ML INJ 50 ML
|
Facility
|
IP
|
$100.40
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
41653412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$50.20 |
| Rate for Payer: Cash Price |
$73.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.20
|
|
|
CFEPIME 500MG IM
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41655917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$4.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.60
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.42
|
| Rate for Payer: SOMOS Essential |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
CFEPIME 500MG IM
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41655917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
|
|
C+/GC NAA PHARYNGEAL
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
40619911
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
C+/GC NAA PHARYNGEAL
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
40619911
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$35.09
|
|
|
CHAMBER,AEROSOL POCKET
|
Facility
|
OP
|
$13.70
|
|
| Hospital Charge Code |
64901228
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.85
|
| Rate for Payer: Aetna Government |
$6.85
|
| Rate for Payer: Brighton Health Commercial |
$10.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.32
|
| Rate for Payer: Group Health Inc Commercial |
$6.85
|
| Rate for Payer: Group Health Inc Medicare |
$4.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.85
|
|
|
CHAMBER CANNULA ANTERIOR 27G
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
64906281
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$46.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.00
|
| Rate for Payer: Aetna Government |
$29.00
|
| Rate for Payer: Brighton Health Commercial |
$43.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.44
|
| Rate for Payer: Group Health Inc Commercial |
$29.00
|
| Rate for Payer: Group Health Inc Medicare |
$20.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.00
|
|
|
CHAMBER RESP AUTO FEED DISP MR290
|
Facility
|
OP
|
$25.12
|
|
| Hospital Charge Code |
64902413
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$20.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.56
|
| Rate for Payer: Aetna Government |
$12.56
|
| Rate for Payer: Brighton Health Commercial |
$18.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.08
|
| Rate for Payer: Group Health Inc Commercial |
$12.56
|
| Rate for Payer: Group Health Inc Medicare |
$8.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.56
|
|
|
CHANGE G-TUBE TO G-J
|
Facility
|
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 49446
|
| Hospital Charge Code |
41103135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,537.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,540.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,540.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,540.32
|
| Rate for Payer: Brighton Health Commercial |
$3,537.74
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$2,200.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Humana Medicare |
$2,244.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
CHANGE G-TUBE TO G-J
|
Facility
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 49446
|
| Hospital Charge Code |
41103135
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
