|
BLEOMYCIN SULFATE 15 UNITS IJ SOLR
|
Facility
|
OP
|
$41.40
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
6332313610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.24
|
| Rate for Payer: Aetna Government |
$25.24
|
| Rate for Payer: Brighton Health Commercial |
$31.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.15
|
| Rate for Payer: EmblemHealth Commercial |
$20.70
|
| Rate for Payer: Group Health Inc Commercial |
$20.70
|
| Rate for Payer: Group Health Inc Medicare |
$14.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.91
|
|
|
BLOOD COUNT; RED BLOOD CELL (RBC), AUTOMATED
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
3058504102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
|
|
BLOOD COUNT; RED BLOOD CELL (RBC), AUTOMATED
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
3058504102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.11
|
| Rate for Payer: Brighton Health Commercial |
$5.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.02
|
| Rate for Payer: EmblemHealth Commercial |
$3.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.69
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.02
|
| Rate for Payer: Healthfirst Essential Plan |
$6.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.02
|
| Rate for Payer: Healthfirst QHP |
$3.02
|
| Rate for Payer: Humana Medicare |
$3.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.02
|
| Rate for Payer: United Healthcare Commercial |
$3.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.02
|
| Rate for Payer: Wellcare Medicare |
$2.72
|
|
|
BLOOD PROCESSING, STORAGE AND RELATED SERVICES
|
Facility
|
OP
|
$57.86
|
|
|
Service Code
|
EAPG 00499
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$57.86 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.86
|
|
|
BONE CONDUCTION HEARING DEVICE IMPLANTATION
|
Facility
|
OP
|
$4,318.48
|
|
|
Service Code
|
EAPG 03011
|
| Min. Negotiated Rate |
$4,318.48 |
| Max. Negotiated Rate |
$4,318.48 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,318.48
|
|
|
BONE DENSITY AND RELATED PROCEDURES
|
Facility
|
OP
|
$286.49
|
|
|
Service Code
|
EAPG 00291
|
| Min. Negotiated Rate |
$208.29 |
| Max. Negotiated Rate |
$286.49 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.29
|
| Rate for Payer: Healthfirst Commercial |
$286.49
|
|
|
BONE MARROW BIOPSIES
|
Facility
|
OP
|
$638.75
|
|
|
Service Code
|
EAPG 00124
|
| Min. Negotiated Rate |
$638.75 |
| Max. Negotiated Rate |
$638.75 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$638.75
|
|
|
Bone marrow transplant
|
Facility
|
IP
|
$213,921.00
|
|
|
Service Code
|
APR-DRG 0031
|
| Min. Negotiated Rate |
$66,019.63 |
| Max. Negotiated Rate |
$213,921.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$148,544.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148,544.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$66,019.63
|
| Rate for Payer: Amida Care Medicaid |
$66,019.63
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$148,544.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$66,019.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66,019.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79,223.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66,019.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66,019.63
|
| Rate for Payer: Healthfirst Commercial |
$213,921.00
|
| Rate for Payer: Healthfirst Essential Plan |
$148,544.17
|
| Rate for Payer: Healthfirst QHP |
$100,009.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66,019.63
|
| Rate for Payer: SOMOS Essential |
$148,544.17
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$148,544.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$148,544.17
|
| Rate for Payer: United Healthcare Medicaid |
$66,019.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$66,019.63
|
|
|
Bone marrow transplant
|
Facility
|
IP
|
$327,690.00
|
|
|
Service Code
|
APR-DRG 0033
|
| Min. Negotiated Rate |
$106,646.66 |
| Max. Negotiated Rate |
$327,690.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$239,954.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239,954.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$106,646.66
|
| Rate for Payer: Amida Care Medicaid |
$106,646.66
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$239,954.98
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$106,646.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106,646.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127,975.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106,646.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106,646.66
|
| Rate for Payer: Healthfirst Commercial |
$327,690.00
|
| Rate for Payer: Healthfirst Essential Plan |
$239,954.98
|
| Rate for Payer: Healthfirst QHP |
$203,120.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106,646.66
|
| Rate for Payer: SOMOS Essential |
$239,954.98
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$239,954.98
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$239,954.98
|
| Rate for Payer: United Healthcare Medicaid |
$106,646.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$106,646.66
|
|
|
Bone marrow transplant
|
Facility
|
IP
|
$243,114.00
|
|
|
Service Code
|
APR-DRG 0032
|
| Min. Negotiated Rate |
$74,891.52 |
| Max. Negotiated Rate |
$243,114.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$168,505.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$168,505.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$74,891.52
|
| Rate for Payer: Amida Care Medicaid |
$74,891.52
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$168,505.92
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$74,891.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74,891.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89,869.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74,891.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74,891.52
|
| Rate for Payer: Healthfirst Commercial |
$243,114.00
|
| Rate for Payer: Healthfirst Essential Plan |
$168,505.92
|
| Rate for Payer: Healthfirst QHP |
$127,198.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74,891.52
|
| Rate for Payer: SOMOS Essential |
$168,505.92
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$168,505.92
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$168,505.92
|
| Rate for Payer: United Healthcare Medicaid |
$74,891.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$74,891.52
|
|
|
Bone marrow transplant
|
Facility
|
IP
|
$659,196.00
|
|
|
Service Code
|
APR-DRG 0034
|
| Min. Negotiated Rate |
$189,403.10 |
| Max. Negotiated Rate |
$659,196.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$426,156.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$426,156.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$189,403.10
|
| Rate for Payer: Amida Care Medicaid |
$189,403.10
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$426,156.97
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$189,403.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$189,403.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$227,283.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189,403.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189,403.10
|
| Rate for Payer: Healthfirst Commercial |
$659,196.00
|
| Rate for Payer: Healthfirst Essential Plan |
$426,156.97
|
| Rate for Payer: Healthfirst QHP |
$394,531.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189,403.10
|
| Rate for Payer: SOMOS Essential |
$426,156.97
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$426,156.97
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$426,156.97
|
| Rate for Payer: United Healthcare Medicaid |
$189,403.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$189,403.10
|
|
|
BONE OR JOINT MANIPULATION UNDER ANESTHESIA
|
Facility
|
OP
|
$1,611.78
|
|
|
Service Code
|
EAPG 00044
|
| Min. Negotiated Rate |
$1,171.04 |
| Max. Negotiated Rate |
$1,611.78 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,171.04
|
| Rate for Payer: Healthfirst Commercial |
$1,611.78
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
5074248401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.00
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
4359842660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
5074248401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$198.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.16
|
| Rate for Payer: Aetna Government |
$45.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$270.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$288.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$244.80
|
| Rate for Payer: EmblemHealth Commercial |
$180.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$106.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$47.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$180.00
|
| Rate for Payer: Group Health Inc Medicare |
$126.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,722.00
|
| Rate for Payer: Healthfirst Essential Plan |
$106.25
|
| Rate for Payer: Healthfirst QHP |
$76.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$234.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.22
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
6302004901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.16
|
| Rate for Payer: Aetna Government |
$45.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: EmblemHealth Commercial |
$0.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$106.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$47.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| 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 |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,722.00
|
| Rate for Payer: Healthfirst Essential Plan |
$106.25
|
| Rate for Payer: Healthfirst QHP |
$76.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.22
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
4359842660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.16
|
| Rate for Payer: Aetna Government |
$45.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$225.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
| Rate for Payer: EmblemHealth Commercial |
$150.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$106.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$47.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$150.00
|
| Rate for Payer: Group Health Inc Medicare |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,722.00
|
| Rate for Payer: Healthfirst Essential Plan |
$106.25
|
| Rate for Payer: Healthfirst QHP |
$76.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.22
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
7086022510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.00
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
6302004901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
7128811810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.20
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2502124410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.16
|
| Rate for Payer: Aetna Government |
$45.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$63.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.12
|
| Rate for Payer: EmblemHealth Commercial |
$42.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$106.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$47.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$42.00
|
| Rate for Payer: Group Health Inc Medicare |
$29.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,722.00
|
| Rate for Payer: Healthfirst Essential Plan |
$106.25
|
| Rate for Payer: Healthfirst QHP |
$76.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.22
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2502124410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.00
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
0143909801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.16
|
| Rate for Payer: Aetna Government |
$45.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
| Rate for Payer: EmblemHealth Commercial |
$21.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$106.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$47.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$21.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,722.00
|
| Rate for Payer: Healthfirst Essential Plan |
$106.25
|
| Rate for Payer: Healthfirst QHP |
$76.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.22
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
0143909801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
7128811810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.16
|
| Rate for Payer: Aetna Government |
$45.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$37.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.27
|
| Rate for Payer: EmblemHealth Commercial |
$25.20
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$106.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$47.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$25.20
|
| Rate for Payer: Group Health Inc Medicare |
$17.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,722.00
|
| Rate for Payer: Healthfirst Essential Plan |
$106.25
|
| Rate for Payer: Healthfirst QHP |
$76.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.22
|
|
