|
DAPTOMYCIN 500 MG IV SOLR [36989]
|
Facility
|
OP
|
$23.04
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
70594003402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$24.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$13.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$11.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.19
|
| Rate for Payer: Group Health Inc Commercial |
$11.52
|
| Rate for Payer: Group Health Inc Medicare |
$8.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.98
|
|
|
DAPTOMYCIN 500 MG IV SOLR [36989]
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
70594003401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.00
|
|
|
DAPTOMYCIN 500 MG IV SOLR [36989]
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
00703012501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$75.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.45
|
| Rate for Payer: EmblemHealth Commercial |
$63.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.30
|
| Rate for Payer: Group Health Inc Commercial |
$63.00
|
| Rate for Payer: Group Health Inc Medicare |
$44.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.90
|
|
|
DAPTOMYCIN 500 MG IV SOLR [36989]
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
00703012501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.00
|
|
|
DAPTOMYCIN 500 MG IV SOLR [36989]
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
70594003401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$43.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.40
|
| Rate for Payer: EmblemHealth Commercial |
$36.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.60
|
| Rate for Payer: Group Health Inc Commercial |
$36.00
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.80
|
|
|
DAPTOMYCIN 500 MG IV SOLR [36989]
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
55150034401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.00
|
|
|
DAPTOMYCIN 500 MG IV SOLR [36989]
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
55150034401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$43.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.40
|
| Rate for Payer: EmblemHealth Commercial |
$36.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.60
|
| Rate for Payer: Group Health Inc Commercial |
$36.00
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.80
|
|
|
DARATUMUMAB 100MG/5ML INJECTION
|
Facility
|
IP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41657833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$63.73 |
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
|
|
DARATUMUMAB 100MG/5ML INJECTION
|
Facility
|
OP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41647833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.19 |
| Max. Negotiated Rate |
$82.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.70
|
| Rate for Payer: Aetna Government |
$61.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$43.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.19
|
| Rate for Payer: Brighton Health Commercial |
$76.48
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.70
|
| Rate for Payer: EmblemHealth Commercial |
$61.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.79
|
| Rate for Payer: Group Health Inc Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Medicare |
$61.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.45
|
| Rate for Payer: Healthfirst QHP |
$61.70
|
| Rate for Payer: Humana Medicare |
$62.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$58.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$49.36
|
| Rate for Payer: Wellcare Medicare |
$58.62
|
|
|
DARATUMUMAB 100MG/5ML INJECTION
|
Facility
|
IP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41647833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$63.73 |
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
|
|
DARATUMUMAB 100MG/5ML INJECTION
|
Facility
|
OP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41657833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.19 |
| Max. Negotiated Rate |
$82.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.70
|
| Rate for Payer: Aetna Government |
$61.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$43.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.19
|
| Rate for Payer: Brighton Health Commercial |
$76.48
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.70
|
| Rate for Payer: EmblemHealth Commercial |
$61.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.79
|
| Rate for Payer: Group Health Inc Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Medicare |
$61.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.45
|
| Rate for Payer: Healthfirst QHP |
$61.70
|
| Rate for Payer: Humana Medicare |
$62.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$58.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$49.36
|
| Rate for Payer: Wellcare Medicare |
$58.62
|
|
|
DARATUMUMAB 100 MG/5ML IV SOLN [131409]
|
Facility
|
OP
|
$170.68
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
57894050205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$110.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.70
|
| Rate for Payer: Aetna Government |
$61.70
|
| Rate for Payer: Brighton Health Commercial |
$102.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.70
|
| Rate for Payer: EmblemHealth Commercial |
$85.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.70
|
| Rate for Payer: Group Health Inc Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Medicare |
$61.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.45
|
| Rate for Payer: Healthfirst QHP |
$61.70
|
| Rate for Payer: Humana Medicare |
$62.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$49.36
|
|
|
DARATUMUMAB 100 MG/5ML IV SOLN [131409]
|
Facility
|
IP
|
$170.68
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
57894050205
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.34 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.34
|
|
|
DARATUMUMAB 400MG/20ML INJECTION
|
Facility
|
IP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41647832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$63.73 |
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
|
|
DARATUMUMAB 400MG/20ML INJECTION
|
Facility
|
OP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41657832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.19 |
| Max. Negotiated Rate |
$82.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.70
|
| Rate for Payer: Aetna Government |
$61.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$43.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.19
|
| Rate for Payer: Brighton Health Commercial |
$76.48
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.70
|
| Rate for Payer: EmblemHealth Commercial |
$61.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.79
|
| Rate for Payer: Group Health Inc Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Medicare |
$61.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.45
|
| Rate for Payer: Healthfirst QHP |
$61.70
|
| Rate for Payer: Humana Medicare |
$62.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$58.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$49.36
|
| Rate for Payer: Wellcare Medicare |
$58.62
|
|
|
DARATUMUMAB 400MG/20ML INJECTION
|
Facility
|
IP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41657832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$63.73 |
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
|
|
DARATUMUMAB 400MG/20ML INJECTION
|
Facility
|
OP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41647832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.19 |
| Max. Negotiated Rate |
$82.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.70
|
| Rate for Payer: Aetna Government |
$61.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$43.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.19
|
| Rate for Payer: Brighton Health Commercial |
$76.48
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.70
|
| Rate for Payer: EmblemHealth Commercial |
$61.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.79
|
| Rate for Payer: Group Health Inc Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Medicare |
$61.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.45
|
| Rate for Payer: Healthfirst QHP |
$61.70
|
| Rate for Payer: Humana Medicare |
$62.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$58.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$49.36
|
| Rate for Payer: Wellcare Medicare |
$58.62
|
|
|
DARATUMUMAB AND HYALURONIDASE
|
Facility
|
IP
|
$109.62
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
41650359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$54.81 |
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.81
|
|
|
DARATUMUMAB AND HYALURONIDASE
|
Facility
|
OP
|
$109.62
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
41640359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.05
|
| Rate for Payer: Aetna Government |
$49.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$34.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$34.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$34.34
|
| Rate for Payer: Brighton Health Commercial |
$65.77
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$49.05
|
| Rate for Payer: EmblemHealth Commercial |
$49.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.50
|
| Rate for Payer: Group Health Inc Commercial |
$49.05
|
| Rate for Payer: Group Health Inc Medicare |
$49.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.69
|
| Rate for Payer: Healthfirst QHP |
$49.05
|
| Rate for Payer: Humana Medicare |
$50.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.73
|
| Rate for Payer: SOMOS Essential |
$51.73
|
| Rate for Payer: United Healthcare Commercial |
$46.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$39.24
|
| Rate for Payer: Wellcare Medicare |
$46.60
|
|
|
DARATUMUMAB AND HYALURONIDASE
|
Facility
|
IP
|
$109.62
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
41640359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$54.81 |
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.81
|
|
|
DARATUMUMAB AND HYALURONIDASE
|
Facility
|
OP
|
$109.62
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
41650359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.05
|
| Rate for Payer: Aetna Government |
$49.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$34.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$34.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$34.34
|
| Rate for Payer: Brighton Health Commercial |
$65.77
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$49.05
|
| Rate for Payer: EmblemHealth Commercial |
$49.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.50
|
| Rate for Payer: Group Health Inc Commercial |
$49.05
|
| Rate for Payer: Group Health Inc Medicare |
$49.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.69
|
| Rate for Payer: Healthfirst QHP |
$49.05
|
| Rate for Payer: Humana Medicare |
$50.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.73
|
| Rate for Payer: SOMOS Essential |
$51.73
|
| Rate for Payer: United Healthcare Commercial |
$46.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$39.24
|
| Rate for Payer: Wellcare Medicare |
$46.60
|
|
|
DARATUMUMAB-HYALURONIDASE-FIHJ 1800-30000 MG-UT/15ML SC SOLN [173322]
|
Facility
|
OP
|
$775.45
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
57894050301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$620.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$426.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.05
|
| Rate for Payer: Aetna Government |
$49.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$34.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$34.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$34.34
|
| Rate for Payer: Brighton Health Commercial |
$581.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$620.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$527.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$49.05
|
| Rate for Payer: EmblemHealth Commercial |
$49.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.66
|
| Rate for Payer: Group Health Inc Commercial |
$49.05
|
| Rate for Payer: Group Health Inc Medicare |
$49.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$387.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.69
|
| Rate for Payer: Healthfirst QHP |
$49.05
|
| Rate for Payer: Humana Medicare |
$50.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$504.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$39.24
|
| Rate for Payer: Wellcare Medicare |
$46.60
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR ESRD
|
Facility
|
OP
|
$4.89
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41641842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.10
|
| Rate for Payer: Amida Care Medicaid |
$4.10
|
| Rate for Payer: Brighton Health Commercial |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.30
|
| Rate for Payer: Group Health Inc Commercial |
$2.93
|
| Rate for Payer: Group Health Inc Medicare |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.10
|
| Rate for Payer: Healthfirst Essential Plan |
$9.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$4.10
|
| Rate for Payer: Humana Medicare |
$2.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.10
|
| Rate for Payer: SOMOS Essential |
$4.10
|
| Rate for Payer: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$9.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$4.51
|
| Rate for Payer: United Healthcare Medicaid |
$4.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR ESRD
|
Facility
|
OP
|
$4.89
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41651842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.10
|
| Rate for Payer: Amida Care Medicaid |
$4.10
|
| Rate for Payer: Brighton Health Commercial |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.30
|
| Rate for Payer: Group Health Inc Commercial |
$2.93
|
| Rate for Payer: Group Health Inc Medicare |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.10
|
| Rate for Payer: Healthfirst Essential Plan |
$9.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$4.10
|
| Rate for Payer: Humana Medicare |
$2.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.10
|
| Rate for Payer: SOMOS Essential |
$4.10
|
| Rate for Payer: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$9.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$4.51
|
| Rate for Payer: United Healthcare Medicaid |
$4.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR ESRD
|
Facility
|
IP
|
$4.89
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41651842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
|
