|
CYTOPATH SPUTUM, ETC
|
Facility
|
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
40635471
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.10
|
| Rate for Payer: Brighton Health Commercial |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.64
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$34.43
|
| Rate for Payer: Humana Medicare |
$35.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$30.99
|
|
|
CYTOPATH SPUTUM, ETC
|
Facility
|
IP
|
$69.63
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
40635470
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$34.43
|
|
|
CYTOPATH SPUTUM, ETC
|
Facility
|
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
40635470
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.10
|
| Rate for Payer: Brighton Health Commercial |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.64
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$34.43
|
| Rate for Payer: Humana Medicare |
$35.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$30.99
|
|
|
CYTOPLASMIC (C-ANCA)
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
HCPCS 86037
|
| Hospital Charge Code |
40729915
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.05
|
|
|
CYTOPLASMIC (C-ANCA)
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86037
|
| Hospital Charge Code |
40729915
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$24.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.44
|
| Rate for Payer: Brighton Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Humana Medicare |
$12.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$10.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: Wellcare Medicare |
$10.84
|
|
|
CYTP DX EVAL FNA 1ST EA SITE
|
Facility
|
IP
|
$434.63
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
40635427
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$197.52
|
|
|
CYTP DX EVAL FNA 1ST EA SITE
|
Facility
|
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
40635427
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$239.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$138.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$138.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$138.26
|
| Rate for Payer: Brighton Health Commercial |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Humana Medicare |
$201.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
CYTP FNA EVAL EACH ADDT'L
|
Facility
|
OP
|
$217.09
|
|
|
Service Code
|
HCPCS 88177
|
| Hospital Charge Code |
40635428
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$162.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.77
|
| Rate for Payer: Aetna Government |
$18.77
|
| Rate for Payer: Brighton Health Commercial |
$162.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.17
|
| Rate for Payer: Group Health Inc Commercial |
$108.54
|
| Rate for Payer: Group Health Inc Medicare |
$75.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.54
|
|
|
D001-IGE D PTERONYSSINUS
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729251
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
D001-IGE D PTERONYSSINUS
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729251
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.22
|
|
|
D002-IGE D FARINAE
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
D002-IGE D FARINAE
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729252
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.22
|
|
|
D071-IGE LEPIDOGLYPHUS
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729278
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
D071-IGE LEPIDOGLYPHUS
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729278
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.22
|
|
|
DABIGATRAN 150 MG CAP
|
Facility
|
OP
|
$5.97
|
|
| Hospital Charge Code |
41645594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.98
|
| Rate for Payer: Aetna Government |
$2.98
|
| Rate for Payer: Brighton Health Commercial |
$4.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.88
|
|
|
DABIGATRAN 150 MG CAP
|
Facility
|
OP
|
$5.97
|
|
| Hospital Charge Code |
41655594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.98
|
| Rate for Payer: Aetna Government |
$2.98
|
| Rate for Payer: Brighton Health Commercial |
$4.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.88
|
|
|
DABIGATRAN 75 MG CAP
|
Facility
|
OP
|
$5.63
|
|
| Hospital Charge Code |
41645607
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.82
|
| Rate for Payer: Aetna Government |
$2.82
|
| Rate for Payer: Brighton Health Commercial |
$4.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.83
|
| Rate for Payer: Group Health Inc Commercial |
$2.82
|
| Rate for Payer: Group Health Inc Medicare |
$1.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.66
|
|
|
DABIGATRAN 75 MG CAP
|
Facility
|
OP
|
$5.63
|
|
| Hospital Charge Code |
41655607
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.82
|
| Rate for Payer: Aetna Government |
$2.82
|
| Rate for Payer: Brighton Health Commercial |
$4.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.83
|
| Rate for Payer: Group Health Inc Commercial |
$2.82
|
| Rate for Payer: Group Health Inc Medicare |
$1.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.66
|
|
|
DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS [106491]
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 00597036082
|
| Hospital Charge Code |
00597036082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.98
|
| Rate for Payer: Aetna Government |
$1.98
|
| Rate for Payer: Brighton Health Commercial |
$2.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.98
|
| Rate for Payer: Group Health Inc Medicare |
$1.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.58
|
|
|
DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS [106490]
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 00597035556
|
| Hospital Charge Code |
00597035556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.98
|
| Rate for Payer: Aetna Government |
$1.98
|
| Rate for Payer: Brighton Health Commercial |
$2.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.98
|
| Rate for Payer: Group Health Inc Medicare |
$1.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.58
|
|
|
DACARBAZINE 100 MG IV SOLR [2090]
|
Facility
|
IP
|
$14.87
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
63323012710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.43
|
|
|
DACARBAZINE 100 MG IV SOLR [2090]
|
Facility
|
OP
|
$14.87
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
63323012710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.71
|
| Rate for Payer: Aetna Government |
$3.71
|
| Rate for Payer: Brighton Health Commercial |
$8.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.55
|
| Rate for Payer: EmblemHealth Commercial |
$7.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.61
|
| Rate for Payer: Group Health Inc Commercial |
$7.43
|
| Rate for Payer: Group Health Inc Medicare |
$5.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.66
|
|
|
DACARBAZINE 100 MJ INJ
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
41652884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.71
|
| Rate for Payer: Aetna Government |
$3.71
|
| Rate for Payer: Brighton Health Commercial |
$3.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.97
|
| Rate for Payer: Group Health Inc Commercial |
$2.58
|
| Rate for Payer: Group Health Inc Medicare |
$1.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.91
|
| Rate for Payer: SOMOS Essential |
$3.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.36
|
|
|
DACARBAZINE 100 MJ INJ
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
41652884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
|
|
DACARBAZINE 200 MG IV SOLR [2091]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
00143924510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.20
|
|
