|
DALBAVANCIN POWDER 5MG
|
Facility
IP
|
$19.54
|
|
|
Service Code
|
HCPCS J0875
|
| Hospital Charge Code |
41640323
|
|
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
|
|
|
DALFOPRISTIN + QUINUPRISTIN 500 MG INJ
|
Facility
OP
|
$340.05
|
|
|
Service Code
|
HCPCS J2770
|
| Hospital Charge Code |
41653096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.02 |
| Max. Negotiated Rate |
$518.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$187.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$493.97
|
| Rate for Payer: Aetna Government |
$493.97
|
| Rate for Payer: Cash Price |
$493.97
|
| Rate for Payer: Cash Price |
$493.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$493.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$170.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$493.97
|
| Rate for Payer: EmblemHealth Commercial |
$493.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$493.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$493.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$518.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$493.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$518.67
|
| Rate for Payer: Group Health Inc Commercial |
$493.97
|
| Rate for Payer: Group Health Inc Medicare |
$493.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$419.87
|
| Rate for Payer: Healthfirst QHP |
$493.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$493.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$395.18
|
| Rate for Payer: Wellcare Medicare |
$469.27
|
|
|
DALFOPRISTIN + QUINUPRISTIN 500 MG INJ
|
Facility
IP
|
$340.05
|
|
|
Service Code
|
HCPCS J2770
|
| Hospital Charge Code |
41643096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.02 |
| Max. Negotiated Rate |
$170.02 |
| Rate for Payer: Cash Price |
$493.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.02
|
|
|
DALFOPRISTIN + QUINUPRISTIN 500 MG INJ
|
Facility
OP
|
$340.05
|
|
|
Service Code
|
HCPCS J2770
|
| Hospital Charge Code |
41643096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.02 |
| Max. Negotiated Rate |
$518.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$187.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$493.97
|
| Rate for Payer: Aetna Government |
$493.97
|
| Rate for Payer: Cash Price |
$493.97
|
| Rate for Payer: Cash Price |
$493.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$493.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$170.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$493.97
|
| Rate for Payer: EmblemHealth Commercial |
$493.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$493.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$493.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$518.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$493.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$518.67
|
| Rate for Payer: Group Health Inc Commercial |
$493.97
|
| Rate for Payer: Group Health Inc Medicare |
$493.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$419.87
|
| Rate for Payer: Healthfirst QHP |
$493.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$493.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$395.18
|
| Rate for Payer: Wellcare Medicare |
$469.27
|
|
|
DALFOPRISTIN + QUINUPRISTIN 500 MG INJ
|
Facility
IP
|
$340.05
|
|
|
Service Code
|
HCPCS J2770
|
| Hospital Charge Code |
41653096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.02 |
| Max. Negotiated Rate |
$170.02 |
| Rate for Payer: Cash Price |
$493.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.02
|
|
|
DANAZOL 100 MG CAP
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41653958
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
DANAZOL 100 MG CAP
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41643958
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
DANAZOL 200 MG CAP
|
Facility
OP
|
$6.64
|
|
| Hospital Charge Code |
41643959
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.32
|
| Rate for Payer: Aetna Government |
$3.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.52
|
| Rate for Payer: Group Health Inc Commercial |
$3.32
|
| Rate for Payer: Group Health Inc Medicare |
$2.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.32
|
|
|
DANAZOL 200 MG CAP
|
Facility
OP
|
$6.64
|
|
| Hospital Charge Code |
41653959
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.32
|
| Rate for Payer: Aetna Government |
$3.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.52
|
| Rate for Payer: Group Health Inc Commercial |
$3.32
|
| Rate for Payer: Group Health Inc Medicare |
$2.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.32
|
|
|
DANTROLENE 100 MG CAP
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41650794
|
|
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
|
|
|
DANTROLENE 100 MG CAP
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41640794
|
|
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
|
|
|
DANTROLENE 20 MG INJ
|
Facility
OP
|
$130.00
|
|
| Hospital Charge Code |
41654793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.00
|
| Rate for Payer: Aetna Government |
$65.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.50
|
|
|
DANTROLENE 20 MG INJ
|
Facility
OP
|
$130.00
|
|
| Hospital Charge Code |
41644793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.00
|
| Rate for Payer: Aetna Government |
$65.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.50
|
|
|
DAPSONE 100 MG TAB
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41640357
|
|
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
|
|
|
DAPSONE 100 MG TAB
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41650357
|
|
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
|
|
|
DAPTOMYCIN 500 MG INJ
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
41653134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
DAPTOMYCIN 500 MG INJ
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
41653134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: SOMOS Essential |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DAPTOMYCIN 500 MG INJ
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
41643134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
DAPTOMYCIN 500 MG INJ
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
41643134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: SOMOS Essential |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DARATUMUMAB 100MG/5ML INJECTION
|
Facility
OP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41647833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$82.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.70
|
| Rate for Payer: Aetna Government |
$61.70
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.70
|
| Rate for Payer: EmblemHealth Commercial |
$61.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.79
|
| Rate for Payer: Group Health Inc Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Medicare |
$61.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.45
|
| Rate for Payer: Healthfirst QHP |
$61.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$49.36
|
| Rate for Payer: Wellcare Medicare |
$58.62
|
|
|
DARATUMUMAB 100MG/5ML INJECTION
|
Facility
OP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41657833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$82.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.70
|
| Rate for Payer: Aetna Government |
$61.70
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.70
|
| Rate for Payer: EmblemHealth Commercial |
$61.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.79
|
| Rate for Payer: Group Health Inc Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Medicare |
$61.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.45
|
| Rate for Payer: Healthfirst QHP |
$61.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$49.36
|
| Rate for Payer: Wellcare Medicare |
$58.62
|
|
|
DARATUMUMAB 100MG/5ML INJECTION
|
Facility
IP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41647833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$63.73 |
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
|
|
DARATUMUMAB 100MG/5ML INJECTION
|
Facility
IP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41657833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$63.73 |
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
|
|
DARATUMUMAB 400MG/20ML INJECTION
|
Facility
OP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41657832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$82.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.70
|
| Rate for Payer: Aetna Government |
$61.70
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.70
|
| Rate for Payer: EmblemHealth Commercial |
$61.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.79
|
| Rate for Payer: Group Health Inc Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Medicare |
$61.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.45
|
| Rate for Payer: Healthfirst QHP |
$61.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$49.36
|
| Rate for Payer: Wellcare Medicare |
$58.62
|
|
|
DARATUMUMAB 400MG/20ML INJECTION
|
Facility
IP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41647832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$63.73 |
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
|
