|
DORZOLAMIDE 2% OPHTHALMIC SOLN
|
Facility
OP
|
$26.40
|
|
| Hospital Charge Code |
41654583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.20
|
| Rate for Payer: Aetna Government |
$13.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.95
|
| Rate for Payer: Group Health Inc Commercial |
$13.20
|
| Rate for Payer: Group Health Inc Medicare |
$9.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.16
|
|
|
DOUCHE SET
|
Facility
OP
|
$6.73
|
|
| Hospital Charge Code |
40201210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
|
|
DOWEL BONE LIFENET PCD
|
Facility
IP
|
$2,443.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,221.88 |
| Max. Negotiated Rate |
$1,221.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,221.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,221.88
|
|
|
DOWEL BONE LIFENET PCD
|
Facility
OP
|
$2,443.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,565.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,344.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,221.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,405.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,565.94
|
| Rate for Payer: Group Health Inc Commercial |
$1,221.88
|
| Rate for Payer: Group Health Inc Medicare |
$855.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,221.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,221.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,588.44
|
|
|
DOXAZOSIN 4 MG TAB
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41644095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DOXAZOSIN 4 MG TAB
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41654095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DOXEPIN 10 MG CAP
|
Facility
OP
|
$0.17
|
|
| Hospital Charge Code |
41641047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
DOXEPIN 10 MG CAP
|
Facility
OP
|
$0.17
|
|
| Hospital Charge Code |
41651047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
DOXEPIN 25 MG CAP
|
Facility
OP
|
$0.18
|
|
| Hospital Charge Code |
41651045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
DOXEPIN 25 MG CAP
|
Facility
OP
|
$0.18
|
|
| Hospital Charge Code |
41641045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
DOXEPIN 50 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41641730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DOXEPIN 50 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41651730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DOXEPIN 75 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41641731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DOXEPIN 75 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41651731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DOXERCALCIFEROL 2MCG/1ML INJ.
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
41657041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
DOXERCALCIFEROL 2MCG/1ML INJ.
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
41647041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
|
|
DOXERCALCIFEROL 2MCG/1ML INJ.
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
41647041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna Government |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.40
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.89
|
| Rate for Payer: SOMOS Essential |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
DOXERCALCIFEROL 2 MCG/ML INJ
|
Facility
IP
|
$5.84
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
41654664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.92
|
|
|
DOXERCALCIFEROL 2 MCG/ML INJ
|
Facility
IP
|
$5.84
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
41644664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.92
|
|
|
DOXERCALCIFEROL 2 MCG/ML INJ
|
Facility
OP
|
$5.84
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
41654664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna Government |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.92
|
| Rate for Payer: Group Health Inc Medicare |
$2.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.89
|
| Rate for Payer: SOMOS Essential |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.80
|
|
|
DOXERCALCIFEROL 2 MCG/ML INJ
|
Facility
OP
|
$5.84
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
41644664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna Government |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.92
|
| Rate for Payer: Group Health Inc Medicare |
$2.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.89
|
| Rate for Payer: SOMOS Essential |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.80
|
|
|
DOXORUBICIN 10 MG/5 ML INJ
|
Facility
OP
|
$8.94
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41643036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.14
|
| Rate for Payer: Group Health Inc Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.81
|
|
|
DOXORUBICIN 10 MG/5 ML INJ
|
Facility
IP
|
$8.94
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41643036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
|
|
DOXORUBICIN 10 MG/5 ML INJ
|
Facility
IP
|
$8.94
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41653036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
|
|
DOXORUBICIN 10 MG/5 ML INJ
|
Facility
OP
|
$8.94
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41653036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.14
|
| Rate for Payer: Group Health Inc Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.81
|
|
