|
CYCLOPENTOLATE 1% OPHTHALMIC SOLN 2 ML
|
Facility
OP
|
$0.48
|
|
| Hospital Charge Code |
41644186
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
CYCLOPENTOLATE 1% OPHTHALMIC SOLN 2 ML
|
Facility
OP
|
$0.48
|
|
| Hospital Charge Code |
41654186
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
CYCLOPENTOLATE 1% OPHTHALMIC SOLN 5 ML
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41652979
|
|
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
|
|
|
CYCLOPENTOLATE 1% OPHTHALMIC SOLN 5 ML
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41642979
|
|
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
|
|
|
CYCLOPENTOLATE 2% OPHTHALMIC SOLN 2 ML
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41640847
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
CYCLOPENTOLATE 2% OPHTHALMIC SOLN 2 ML
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41650847
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
CYCLOPHOSPHAMIDE 1000 MG INJ
|
Facility
IP
|
$661.05
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
41653750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$330.52 |
| Max. Negotiated Rate |
$330.52 |
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.52
|
|
|
CYCLOPHOSPHAMIDE 1000 MG INJ
|
Facility
OP
|
$661.05
|
|
| Hospital Charge Code |
41643750
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$231.37 |
| Max. Negotiated Rate |
$528.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$363.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$330.52
|
| Rate for Payer: Aetna Government |
$330.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$528.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$449.51
|
| Rate for Payer: Group Health Inc Commercial |
$330.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$429.68
|
|
|
CYCLOPHOSPHAMIDE 1000 MG INJ
|
Facility
OP
|
$661.05
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
41653750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$429.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$363.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.15
|
| Rate for Payer: Aetna Government |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$380.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.15
|
| Rate for Payer: EmblemHealth Commercial |
$20.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.16
|
| Rate for Payer: Group Health Inc Commercial |
$20.15
|
| Rate for Payer: Group Health Inc Medicare |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.13
|
| Rate for Payer: Healthfirst QHP |
$20.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$429.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.12
|
| Rate for Payer: Wellcare Medicare |
$19.15
|
|
|
CYCLOPHOSPHAMIDE 2000 MG INJ
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
41643828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$103.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.15
|
| Rate for Payer: Aetna Government |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.15
|
| Rate for Payer: EmblemHealth Commercial |
$20.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.16
|
| Rate for Payer: Group Health Inc Commercial |
$20.15
|
| Rate for Payer: Group Health Inc Medicare |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.13
|
| Rate for Payer: Healthfirst QHP |
$20.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.12
|
| Rate for Payer: Wellcare Medicare |
$19.15
|
|
|
CYCLOPHOSPHAMIDE 2000 MG INJ
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
41653828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.50
|
|
|
CYCLOPHOSPHAMIDE 2000 MG INJ
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
41653828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$103.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.15
|
| Rate for Payer: Aetna Government |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.15
|
| Rate for Payer: EmblemHealth Commercial |
$20.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.16
|
| Rate for Payer: Group Health Inc Commercial |
$20.15
|
| Rate for Payer: Group Health Inc Medicare |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.13
|
| Rate for Payer: Healthfirst QHP |
$20.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.12
|
| Rate for Payer: Wellcare Medicare |
$19.15
|
|
|
CYCLOPHOSPHAMIDE 2000 MG INJ
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
41643828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.50
|
|
|
CYCLOPHOSPHAMIDE 25 MG TAB
|
Facility
IP
|
$2.45
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
41651183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
|
|
CYCLOPHOSPHAMIDE 25 MG TAB
|
Facility
OP
|
$2.45
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
41641183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.81
|
| Rate for Payer: Aetna Government |
$0.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.86
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.91
|
| Rate for Payer: SOMOS Essential |
$0.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
CYCLOPHOSPHAMIDE 25 MG TAB
|
Facility
OP
|
$2.45
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
41651183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.81
|
| Rate for Payer: Aetna Government |
$0.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.86
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.91
|
| Rate for Payer: SOMOS Essential |
$0.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
CYCLOPHOSPHAMIDE 25 MG TAB
|
Facility
IP
|
$2.45
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
41641183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
|
|
CYCLOPHOSPHAMIDE 500 MG INJ
|
Facility
IP
|
$24.74
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
41643749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.37 |
| Max. Negotiated Rate |
$12.37 |
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.37
|
|
|
CYCLOPHOSPHAMIDE 500 MG INJ
|
Facility
IP
|
$24.74
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
41653749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.37 |
| Max. Negotiated Rate |
$12.37 |
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.37
|
|
|
CYCLOPHOSPHAMIDE 500 MG INJ
|
Facility
OP
|
$24.74
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
41643749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.37 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.15
|
| Rate for Payer: Aetna Government |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.15
|
| Rate for Payer: EmblemHealth Commercial |
$20.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.16
|
| Rate for Payer: Group Health Inc Commercial |
$20.15
|
| Rate for Payer: Group Health Inc Medicare |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.13
|
| Rate for Payer: Healthfirst QHP |
$20.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.12
|
| Rate for Payer: Wellcare Medicare |
$19.15
|
|
|
CYCLOPHOSPHAMIDE 500 MG INJ
|
Facility
OP
|
$24.74
|
|
|
Service Code
|
HCPCS J9070
|
| Hospital Charge Code |
41653749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.37 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.15
|
| Rate for Payer: Aetna Government |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Cash Price |
$20.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.15
|
| Rate for Payer: EmblemHealth Commercial |
$20.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.16
|
| Rate for Payer: Group Health Inc Commercial |
$20.15
|
| Rate for Payer: Group Health Inc Medicare |
$20.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.13
|
| Rate for Payer: Healthfirst QHP |
$20.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.12
|
| Rate for Payer: Wellcare Medicare |
$19.15
|
|
|
CYCLOSERINE 250 MG CAP - NF
|
Facility
OP
|
$14.84
|
|
| Hospital Charge Code |
41643697
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$11.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.42
|
| Rate for Payer: Aetna Government |
$7.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.09
|
| Rate for Payer: Group Health Inc Commercial |
$7.42
|
| Rate for Payer: Group Health Inc Medicare |
$5.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.65
|
|
|
CYCLOSERINE 250 MG CAP - NF
|
Facility
OP
|
$14.84
|
|
| Hospital Charge Code |
41653697
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$11.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.42
|
| Rate for Payer: Aetna Government |
$7.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.09
|
| Rate for Payer: Group Health Inc Commercial |
$7.42
|
| Rate for Payer: Group Health Inc Medicare |
$5.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.65
|
|
|
CYCLOSPORINE, BLOOD
|
Facility
OP
|
$45.13
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
40609001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$28.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.05
|
| Rate for Payer: Aetna Government |
$18.05
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.05
|
| Rate for Payer: EmblemHealth Commercial |
$18.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.06
|
| Rate for Payer: Group Health Inc Commercial |
$18.05
|
| Rate for Payer: Group Health Inc Medicare |
$18.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.05
|
| Rate for Payer: Healthfirst QHP |
$18.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.44
|
| Rate for Payer: Wellcare Medicare |
$16.24
|
|
|
CYCLOSPORINE (NEORAL) 100 MG CAP - NF
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
41650362
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
|
