|
ADMIN 2ND DOSE 6MONS-5YRS PFIZER
|
Facility
|
OP
|
$102.55
|
|
|
Service Code
|
HCPCS 0082A
|
| Hospital Charge Code |
30300262
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.28
|
| Rate for Payer: Aetna Government |
$51.28
|
| Rate for Payer: Brighton Health Commercial |
$76.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.73
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.28
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
ADMIN INFLUENZA VIRUS VACCINE
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
30300168
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.36
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Brighton Health Commercial |
$86.57
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Healthfirst Essential Plan |
$30.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$13.36
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$13.36
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$30.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$14.70
|
| Rate for Payer: United Healthcare Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
ADMIN INFLUENZA VIRUS VACCINE
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
30300168
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
ADMINISTRATIN SET,INTRAVENOUS
|
Facility
|
OP
|
$18.78
|
|
| Hospital Charge Code |
40200310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.39
|
| Rate for Payer: Aetna Government |
$9.39
|
| Rate for Payer: Brighton Health Commercial |
$14.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.77
|
| Rate for Payer: Group Health Inc Commercial |
$9.39
|
| Rate for Payer: Group Health Inc Medicare |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.39
|
|
|
ADMINISTRATION OF HEPATITIS B VAC
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
30304000
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
ADMINISTRATION OF HEPATITIS B VAC
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
30304000
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$38.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$38.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$38.45
|
| Rate for Payer: Brighton Health Commercial |
$86.57
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$54.93
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
ADMIN PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
30300177
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.36
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Brighton Health Commercial |
$86.57
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Healthfirst Essential Plan |
$30.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$13.36
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$13.36
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$30.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$14.70
|
| Rate for Payer: United Healthcare Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
ADMIN PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
30300177
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
ADMINSTRATION OF EVUSHELD
|
Facility
|
OP
|
$102.55
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
30300260
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.66
|
| Rate for Payer: Aetna Government |
$182.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.86
|
| Rate for Payer: Brighton Health Commercial |
$76.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.57
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.26
|
| Rate for Payer: Healthfirst QHP |
$182.66
|
| Rate for Payer: Humana Medicare |
$186.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.66
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$146.13
|
| Rate for Payer: Wellcare Medicare |
$173.53
|
|
|
ADMINSTRATION OF VACCINE
|
Facility
|
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
30305049
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$57.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$57.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$57.02
|
| Rate for Payer: Brighton Health Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.50
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
ADMINSTRATION OF VACCINE
|
Facility
|
IP
|
$183.15
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
30305049
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$81.46
|
|
|
ADMISSIONS KITS
|
Facility
|
OP
|
$12.05
|
|
| Hospital Charge Code |
40200333
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Brighton Health Commercial |
$9.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
ADM SARSCOV2 30MCG/0.3ML 3RD DOSE
|
Facility
|
OP
|
$120.55
|
|
|
Service Code
|
HCPCS 0003A
|
| Hospital Charge Code |
30302529
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Brighton Health Commercial |
$90.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.97
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.28
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
ADM SARSCOV2 VAC AD26 .5ML
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 0031A
|
| Hospital Charge Code |
30300266
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.60
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
ADM. SET,FOR BLOOD, Y-TYPE
|
Facility
|
OP
|
$14.53
|
|
| Hospital Charge Code |
40200330
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.26
|
| Rate for Payer: Aetna Government |
$7.26
|
| Rate for Payer: Brighton Health Commercial |
$10.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.88
|
| Rate for Payer: Group Health Inc Commercial |
$7.26
|
| Rate for Payer: Group Health Inc Medicare |
$5.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
|
|
ADM.SET,INTRAVENUS-SHT.NEEDLE
|
Facility
|
OP
|
$14.53
|
|
| Hospital Charge Code |
40200320
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.26
|
| Rate for Payer: Aetna Government |
$7.26
|
| Rate for Payer: Brighton Health Commercial |
$10.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.88
|
| Rate for Payer: Group Health Inc Commercial |
$7.26
|
| Rate for Payer: Group Health Inc Medicare |
$5.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
|
|
A&D Ointment
|
Facility
|
OP
|
$2.84
|
|
| Hospital Charge Code |
40200300
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.42
|
| Rate for Payer: Aetna Government |
$1.42
|
| Rate for Payer: Brighton Health Commercial |
$2.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.93
|
| Rate for Payer: Group Health Inc Commercial |
$1.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.42
|
|
|
ADO-TRASTUZUMAB 100MG/5ML -10MG
|
Facility
|
IP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41648445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$26.63 |
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
|
|
ADO-TRASTUZUMAB 100MG/5ML -10MG
|
Facility
|
OP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41658445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.37
|
| Rate for Payer: Aetna Government |
$38.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26.86
|
| Rate for Payer: Brighton Health Commercial |
$31.96
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.37
|
| Rate for Payer: EmblemHealth Commercial |
$38.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.29
|
| Rate for Payer: Group Health Inc Commercial |
$38.37
|
| Rate for Payer: Group Health Inc Medicare |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.61
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: Humana Medicare |
$39.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.74
|
| Rate for Payer: SOMOS Essential |
$40.74
|
| Rate for Payer: United Healthcare Commercial |
$36.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.69
|
| Rate for Payer: Wellcare Medicare |
$36.45
|
|
|
ADO-TRASTUZUMAB 100MG/5ML -10MG
|
Facility
|
OP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41648445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.37
|
| Rate for Payer: Aetna Government |
$38.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26.86
|
| Rate for Payer: Brighton Health Commercial |
$31.96
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.37
|
| Rate for Payer: EmblemHealth Commercial |
$38.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.29
|
| Rate for Payer: Group Health Inc Commercial |
$38.37
|
| Rate for Payer: Group Health Inc Medicare |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.61
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: Humana Medicare |
$39.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.74
|
| Rate for Payer: SOMOS Essential |
$40.74
|
| Rate for Payer: United Healthcare Commercial |
$36.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.69
|
| Rate for Payer: Wellcare Medicare |
$36.45
|
|
|
ADO-TRASTUZUMAB 100MG/5ML -10MG
|
Facility
|
IP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41658445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$26.63 |
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
|
|
ADO-TRASTUZUMAB 160MG/8ML - 10MG
|
Facility
|
OP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41648446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.37
|
| Rate for Payer: Aetna Government |
$38.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26.86
|
| Rate for Payer: Brighton Health Commercial |
$31.96
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.37
|
| Rate for Payer: EmblemHealth Commercial |
$38.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.29
|
| Rate for Payer: Group Health Inc Commercial |
$38.37
|
| Rate for Payer: Group Health Inc Medicare |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.61
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: Humana Medicare |
$39.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.74
|
| Rate for Payer: SOMOS Essential |
$40.74
|
| Rate for Payer: United Healthcare Commercial |
$36.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.69
|
| Rate for Payer: Wellcare Medicare |
$36.45
|
|
|
ADO-TRASTUZUMAB 160MG/8ML - 10MG
|
Facility
|
OP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41658446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.37
|
| Rate for Payer: Aetna Government |
$38.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26.86
|
| Rate for Payer: Brighton Health Commercial |
$31.96
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.37
|
| Rate for Payer: EmblemHealth Commercial |
$38.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.29
|
| Rate for Payer: Group Health Inc Commercial |
$38.37
|
| Rate for Payer: Group Health Inc Medicare |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.61
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: Humana Medicare |
$39.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.74
|
| Rate for Payer: SOMOS Essential |
$40.74
|
| Rate for Payer: United Healthcare Commercial |
$36.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.69
|
| Rate for Payer: Wellcare Medicare |
$36.45
|
|
|
ADO-TRASTUZUMAB 160MG/8ML - 10MG
|
Facility
|
IP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41648446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$26.63 |
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
|
|
ADO-TRASTUZUMAB 160MG/8ML - 10MG
|
Facility
|
IP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41658446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$26.63 |
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
|
