|
CISATRACURIUM 200MG/NS 100ML INF
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
41657178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.00
|
| Rate for Payer: Aetna Government |
$225.00
|
| Rate for Payer: Brighton Health Commercial |
$337.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
|
CISATRACURIUM 2 MG/ML INJ 10 ML
|
Facility
|
OP
|
$28.73
|
|
| Hospital Charge Code |
41643350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$22.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.36
|
| Rate for Payer: Aetna Government |
$14.36
|
| Rate for Payer: Brighton Health Commercial |
$21.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.54
|
| Rate for Payer: Group Health Inc Commercial |
$14.36
|
| Rate for Payer: Group Health Inc Medicare |
$10.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.67
|
|
|
CISATRACURIUM 2 MG/ML INJ 10 ML
|
Facility
|
OP
|
$28.73
|
|
| Hospital Charge Code |
41653350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$22.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.36
|
| Rate for Payer: Aetna Government |
$14.36
|
| Rate for Payer: Brighton Health Commercial |
$21.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.54
|
| Rate for Payer: Group Health Inc Commercial |
$14.36
|
| Rate for Payer: Group Health Inc Medicare |
$10.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.67
|
|
|
CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN [119150]
|
Facility
|
OP
|
$2.76
|
|
|
Service Code
|
NDC 70069016110
|
| Hospital Charge Code |
70069016110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.38
|
| Rate for Payer: Aetna Government |
$1.38
|
| Rate for Payer: Brighton Health Commercial |
$1.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.59
|
| Rate for Payer: EmblemHealth Commercial |
$1.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.79
|
|
|
CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN [119150]
|
Facility
|
IP
|
$2.76
|
|
|
Service Code
|
NDC 70069016110
|
| Hospital Charge Code |
70069016110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.38
|
|
|
CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN [119149]
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
NDC 70069014110
|
| Hospital Charge Code |
70069014110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
|
|
CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN [119149]
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
NDC 70069014110
|
| Hospital Charge Code |
70069014110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$2.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.93
|
| Rate for Payer: EmblemHealth Commercial |
$1.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.53
|
| Rate for Payer: Group Health Inc Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.18
|
|
|
CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN [119149]
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 00409109812
|
| Hospital Charge Code |
00409109812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
|
|
CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN [119149]
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
NDC 00703203303
|
| Hospital Charge Code |
00703203303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$2.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.93
|
| Rate for Payer: EmblemHealth Commercial |
$1.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.53
|
| Rate for Payer: Group Health Inc Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.18
|
|
|
CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN [119149]
|
Facility
|
IP
|
$3.76
|
|
|
Service Code
|
NDC 00074437805
|
| Hospital Charge Code |
00074437805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.88
|
|
|
CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN [119149]
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 00409109802
|
| Hospital Charge Code |
00409109802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Brighton Health Commercial |
$2.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.95
|
| Rate for Payer: EmblemHealth Commercial |
$1.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.56
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.21
|
|
|
CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN [119149]
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
NDC 00703203303
|
| Hospital Charge Code |
00703203303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
|
|
CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN [119149]
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 00409109802
|
| Hospital Charge Code |
00409109802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
|
|
CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN [119149]
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 00409109812
|
| Hospital Charge Code |
00409109812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Brighton Health Commercial |
$2.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.95
|
| Rate for Payer: EmblemHealth Commercial |
$1.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.56
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.21
|
|
|
CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN [119149]
|
Facility
|
OP
|
$3.76
|
|
|
Service Code
|
NDC 00074437805
|
| Hospital Charge Code |
00074437805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.88
|
| Rate for Payer: Aetna Government |
$1.88
|
| Rate for Payer: Brighton Health Commercial |
$2.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.16
|
| Rate for Payer: EmblemHealth Commercial |
$1.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.95
|
| Rate for Payer: Group Health Inc Commercial |
$1.88
|
| Rate for Payer: Group Health Inc Medicare |
$1.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.45
|
|
|
CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN [131503]
|
Facility
|
OP
|
$16.39
|
|
|
Service Code
|
NDC 00409110301
|
| Hospital Charge Code |
00409110301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.20
|
| Rate for Payer: Aetna Government |
$8.20
|
| Rate for Payer: Brighton Health Commercial |
$9.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.43
|
| Rate for Payer: EmblemHealth Commercial |
$8.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.21
|
| Rate for Payer: Group Health Inc Commercial |
$8.20
|
| Rate for Payer: Group Health Inc Medicare |
$5.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.65
|
|
|
CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN [131503]
|
Facility
|
IP
|
$16.39
|
|
|
Service Code
|
NDC 00409110301
|
| Hospital Charge Code |
00409110301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$8.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.20
|
|
|
CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN [131503]
|
Facility
|
OP
|
$16.23
|
|
|
Service Code
|
NDC 70069015110
|
| Hospital Charge Code |
70069015110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.12
|
| Rate for Payer: Aetna Government |
$8.12
|
| Rate for Payer: Brighton Health Commercial |
$9.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.33
|
| Rate for Payer: EmblemHealth Commercial |
$8.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.04
|
| Rate for Payer: Group Health Inc Commercial |
$8.12
|
| Rate for Payer: Group Health Inc Medicare |
$5.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.55
|
|
|
CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN [131503]
|
Facility
|
IP
|
$16.23
|
|
|
Service Code
|
NDC 70069015110
|
| Hospital Charge Code |
70069015110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.12
|
|
|
CISPLATIN 100 MG/100ML IV SOLN [88377]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
00143950501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.39
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
CISPLATIN 100 MG/100ML IV SOLN [88377]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
00703574811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
|
|
CISPLATIN 100 MG/100ML IV SOLN [88377]
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
00143950501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
|
|
CISPLATIN 100 MG/100ML IV SOLN [88377]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
00703574811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.51
|
| 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
|
|
|
CISPLATIN 100 MG/100ML IV SOLN [88377]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
63323010365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Brighton Health Commercial |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: EmblemHealth Commercial |
$0.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.32
|
|
|
CISPLATIN 100 MG/100ML IV SOLN [88377]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
16729028838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Brighton Health Commercial |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: EmblemHealth Commercial |
$0.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.28
|
|
