|
CYTOPATH SMEAR OTHER SOURCE
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
40635408
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.54 |
| Max. Negotiated Rate |
$92.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Brighton Health Commercial |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.64
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$34.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$30.99
|
|
|
CYTOPATH SMEARS OVER 5 SLIDES
|
Facility
OP
|
$152.95
|
|
|
Service Code
|
HCPCS 88162
|
| Hospital Charge Code |
40635472
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$142.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.66
|
| Rate for Payer: Aetna Government |
$62.66
|
| Rate for Payer: Brighton Health Commercial |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.66
|
| Rate for Payer: EmblemHealth Commercial |
$62.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.77
|
| Rate for Payer: Group Health Inc Commercial |
$62.66
|
| Rate for Payer: Group Health Inc Medicare |
$62.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$62.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare |
$56.39
|
|
|
CYTOPATH SPUTUM, ETC
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
40635471
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.54 |
| Max. Negotiated Rate |
$90.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Brighton Health Commercial |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.64
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$34.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$30.99
|
|
|
CYTOPATH SPUTUM, ETC
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
40635470
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.54 |
| Max. Negotiated Rate |
$90.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Brighton Health Commercial |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.64
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$34.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$30.99
|
|
|
CYTOPLASMIC (C-ANCA)
|
Facility
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86037
|
| Hospital Charge Code |
40729915
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$24.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: Wellcare Medicare |
$10.84
|
|
|
CYTP DX EVAL FNA 1ST EA SITE
|
Facility
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
40635427
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$239.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Brighton Health Commercial |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
CYTP FNA EVAL EACH ADDT'L
|
Facility
OP
|
$217.09
|
|
|
Service Code
|
HCPCS 88177
|
| Hospital Charge Code |
40635428
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$119.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.77
|
| Rate for Payer: Aetna Government |
$18.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.49
|
| Rate for Payer: Group Health Inc Commercial |
$108.54
|
| Rate for Payer: Group Health Inc Medicare |
$75.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.88
|
|
|
D001-IGE D PTERONYSSINUS
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729251
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
D002-IGE D FARINAE
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
D071-IGE LEPIDOGLYPHUS
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729278
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
DABIGATRAN 150 MG CAP
|
Facility
OP
|
$5.97
|
|
| Hospital Charge Code |
41655594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.98
|
| Rate for Payer: Aetna Government |
$2.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.88
|
|
|
DABIGATRAN 150 MG CAP
|
Facility
OP
|
$5.97
|
|
| Hospital Charge Code |
41645594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.98
|
| Rate for Payer: Aetna Government |
$2.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.88
|
|
|
DABIGATRAN 75 MG CAP
|
Facility
OP
|
$5.63
|
|
| Hospital Charge Code |
41645607
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.82
|
| Rate for Payer: Aetna Government |
$2.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.83
|
| Rate for Payer: Group Health Inc Commercial |
$2.82
|
| Rate for Payer: Group Health Inc Medicare |
$1.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.66
|
|
|
DABIGATRAN 75 MG CAP
|
Facility
OP
|
$5.63
|
|
| Hospital Charge Code |
41655607
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.82
|
| Rate for Payer: Aetna Government |
$2.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.83
|
| Rate for Payer: Group Health Inc Commercial |
$2.82
|
| Rate for Payer: Group Health Inc Medicare |
$1.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.66
|
|
|
DACARBAZINE 100 MJ INJ
|
Facility
OP
|
$5.17
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
41652884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.71
|
| Rate for Payer: Aetna Government |
$3.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.64
|
| Rate for Payer: Group Health Inc Commercial |
$2.58
|
| Rate for Payer: Group Health Inc Medicare |
$1.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.91
|
| Rate for Payer: SOMOS Essential |
$3.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.36
|
|
|
DACARBAZINE 100 MJ INJ
|
Facility
IP
|
$5.17
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
41652884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
|
|
DACARBRAZINE 100 MG INJ
|
Facility
OP
|
$5.17
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
41642884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.71
|
| Rate for Payer: Aetna Government |
$3.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.64
|
| Rate for Payer: Group Health Inc Commercial |
$2.58
|
| Rate for Payer: Group Health Inc Medicare |
$1.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.91
|
| Rate for Payer: SOMOS Essential |
$3.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.36
|
|
|
DACARBRAZINE 100 MG INJ
|
Facility
IP
|
$5.17
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
41642884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
|
|
DACTINOMYCIN 500 MCG INJ - NF
|
Facility
OP
|
$955.00
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
41654394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$477.50 |
| Max. Negotiated Rate |
$702.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$525.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$668.90
|
| Rate for Payer: Aetna Government |
$668.90
|
| Rate for Payer: Cash Price |
$668.90
|
| Rate for Payer: Cash Price |
$668.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$668.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$477.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$549.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$668.90
|
| Rate for Payer: EmblemHealth Commercial |
$668.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$668.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$668.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$702.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$668.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$702.35
|
| Rate for Payer: Group Health Inc Commercial |
$668.90
|
| Rate for Payer: Group Health Inc Medicare |
$668.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$594.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$568.57
|
| Rate for Payer: Healthfirst QHP |
$668.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$668.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$580.66
|
| Rate for Payer: SOMOS Essential |
$580.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$620.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$535.12
|
| Rate for Payer: Wellcare Medicare |
$635.46
|
|
|
DACTINOMYCIN 500 MCG INJ - NF
|
Facility
IP
|
$955.00
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
41644394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$477.50 |
| Max. Negotiated Rate |
$477.50 |
| Rate for Payer: Cash Price |
$668.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.50
|
|
|
DACTINOMYCIN 500 MCG INJ - NF
|
Facility
OP
|
$955.00
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
41644394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$477.50 |
| Max. Negotiated Rate |
$702.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$525.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$668.90
|
| Rate for Payer: Aetna Government |
$668.90
|
| Rate for Payer: Cash Price |
$668.90
|
| Rate for Payer: Cash Price |
$668.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$668.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$477.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$549.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$668.90
|
| Rate for Payer: EmblemHealth Commercial |
$668.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$668.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$668.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$702.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$668.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$702.35
|
| Rate for Payer: Group Health Inc Commercial |
$668.90
|
| Rate for Payer: Group Health Inc Medicare |
$668.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$594.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$568.57
|
| Rate for Payer: Healthfirst QHP |
$668.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$668.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$580.66
|
| Rate for Payer: SOMOS Essential |
$580.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$620.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$535.12
|
| Rate for Payer: Wellcare Medicare |
$635.46
|
|
|
DACTINOMYCIN 500 MCG INJ - NF
|
Facility
IP
|
$955.00
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
41654394
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$477.50 |
| Max. Negotiated Rate |
$477.50 |
| Rate for Payer: Cash Price |
$668.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.50
|
|
|
DALBAVANCIN POWDER 5MG
|
Facility
IP
|
$19.54
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
41650323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Cash Price |
$15.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.77
|
|
|
DALBAVANCIN POWDER 5MG
|
Facility
OP
|
$19.54
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
41650323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.29
|
| Rate for Payer: Aetna Government |
$15.29
|
| Rate for Payer: Cash Price |
$15.29
|
| Rate for Payer: Cash Price |
$15.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.29
|
| Rate for Payer: EmblemHealth Commercial |
$15.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.06
|
| Rate for Payer: Group Health Inc Commercial |
$15.29
|
| Rate for Payer: Group Health Inc Medicare |
$15.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.00
|
| Rate for Payer: Healthfirst QHP |
$15.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.03
|
| Rate for Payer: SOMOS Essential |
$16.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.23
|
| Rate for Payer: Wellcare Medicare |
$14.53
|
|
|
DALBAVANCIN POWDER 5MG
|
Facility
OP
|
$19.54
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
41640323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.29
|
| Rate for Payer: Aetna Government |
$15.29
|
| Rate for Payer: Cash Price |
$15.29
|
| Rate for Payer: Cash Price |
$15.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.29
|
| Rate for Payer: EmblemHealth Commercial |
$15.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.06
|
| Rate for Payer: Group Health Inc Commercial |
$15.29
|
| Rate for Payer: Group Health Inc Medicare |
$15.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.00
|
| Rate for Payer: Healthfirst QHP |
$15.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.03
|
| Rate for Payer: SOMOS Essential |
$16.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.23
|
| Rate for Payer: Wellcare Medicare |
$14.53
|
|
