|
GEMCITABINE 1000 MG INJ
|
Facility
|
IP
|
$31.94
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
41641644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$15.97 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.97
|
|
|
GEMCITABINE 1000 MG INJ
|
Facility
|
OP
|
$31.94
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
41651644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.28
|
| Rate for Payer: Amida Care Medicaid |
$8.28
|
| Rate for Payer: Brighton Health Commercial |
$19.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$15.97
|
| Rate for Payer: Group Health Inc Medicare |
$11.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.28
|
| Rate for Payer: Healthfirst Essential Plan |
$18.63
|
| Rate for Payer: Healthfirst QHP |
$8.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.28
|
| Rate for Payer: SOMOS Essential |
$8.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$18.63
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$9.11
|
| Rate for Payer: United Healthcare Medicaid |
$8.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.28
|
|
|
GEMCITABINE 200 MG INJ
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
41651645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
GEMCITABINE 200 MG INJ
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
41651645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.28
|
| Rate for Payer: Amida Care Medicaid |
$8.28
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.28
|
| Rate for Payer: Healthfirst Essential Plan |
$18.63
|
| Rate for Payer: Healthfirst QHP |
$8.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.28
|
| Rate for Payer: SOMOS Essential |
$8.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$18.63
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$9.11
|
| Rate for Payer: United Healthcare Medicaid |
$8.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.28
|
|
|
GEMCITABINE 200 MG INJ
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
41641645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.28
|
| Rate for Payer: Amida Care Medicaid |
$8.28
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.28
|
| Rate for Payer: Healthfirst Essential Plan |
$18.63
|
| Rate for Payer: Healthfirst QHP |
$8.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.28
|
| Rate for Payer: SOMOS Essential |
$8.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$18.63
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$9.11
|
| Rate for Payer: United Healthcare Medicaid |
$8.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.28
|
|
|
GEMCITABINE 200 MG INJ
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
41641645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
GEMCITABINE HCL 1 GM/26.3ML IV SOLN [112787]
|
Facility
|
IP
|
$1.83
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
67457061730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.92
|
|
|
GEMCITABINE HCL 1 GM/26.3ML IV SOLN [112787]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
67457061730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.28
|
| Rate for Payer: Amida Care Medicaid |
$8.28
|
| Rate for Payer: Brighton Health Commercial |
$1.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.05
|
| Rate for Payer: EmblemHealth Commercial |
$0.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$0.92
|
| Rate for Payer: Group Health Inc Medicare |
$0.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.28
|
| Rate for Payer: Healthfirst Essential Plan |
$18.63
|
| Rate for Payer: Healthfirst QHP |
$8.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.28
|
| Rate for Payer: SOMOS Essential |
$8.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$18.63
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$9.11
|
| Rate for Payer: United Healthcare Medicaid |
$8.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.28
|
|
|
GEMCITABINE HCL 1 GM/26.3ML IV SOLN [112787]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
00409018101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.03
|
|
|
GEMCITABINE HCL 1 GM/26.3ML IV SOLN [112787]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
00409018101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.28
|
| Rate for Payer: Amida Care Medicaid |
$8.28
|
| Rate for Payer: Brighton Health Commercial |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.19
|
| Rate for Payer: EmblemHealth Commercial |
$1.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$1.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.28
|
| Rate for Payer: Healthfirst Essential Plan |
$18.63
|
| Rate for Payer: Healthfirst QHP |
$8.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.28
|
| Rate for Payer: SOMOS Essential |
$8.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$18.63
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$9.11
|
| Rate for Payer: United Healthcare Medicaid |
$8.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.28
|
|
|
GEMCITABINE HCL 200 MG/5.26ML IV SOLN [112786]
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
00409018301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.28
|
| Rate for Payer: Amida Care Medicaid |
$8.28
|
| Rate for Payer: Brighton Health Commercial |
$1.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| Rate for Payer: EmblemHealth Commercial |
$1.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$1.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.28
|
| Rate for Payer: Healthfirst Essential Plan |
$18.63
|
| Rate for Payer: Healthfirst QHP |
$8.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.28
|
| Rate for Payer: SOMOS Essential |
$8.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$18.63
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$9.11
|
| Rate for Payer: United Healthcare Medicaid |
$8.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.28
|
|
|
GEMCITABINE HCL 200 MG/5.26ML IV SOLN [112786]
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
00409018301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
|
|
GEMCITABINE HCL 2 GM/52.6ML IV SOLN [112788]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
00409018201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.28
|
| Rate for Payer: Amida Care Medicaid |
$8.28
|
| Rate for Payer: Brighton Health Commercial |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.19
|
| Rate for Payer: EmblemHealth Commercial |
$1.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$1.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.28
|
| Rate for Payer: Healthfirst Essential Plan |
$18.63
|
| Rate for Payer: Healthfirst QHP |
$8.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.28
|
| Rate for Payer: SOMOS Essential |
$8.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$18.63
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$9.11
|
| Rate for Payer: United Healthcare Medicaid |
$8.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.28
|
|
|
GEMCITABINE HCL 2 GM/52.6ML IV SOLN [112788]
|
Facility
|
IP
|
$1.83
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
67457061810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.92
|
|
|
GEMCITABINE HCL 2 GM/52.6ML IV SOLN [112788]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
67457061810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.28
|
| Rate for Payer: Amida Care Medicaid |
$8.28
|
| Rate for Payer: Brighton Health Commercial |
$1.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.05
|
| Rate for Payer: EmblemHealth Commercial |
$0.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$0.92
|
| Rate for Payer: Group Health Inc Medicare |
$0.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.28
|
| Rate for Payer: Healthfirst Essential Plan |
$18.63
|
| Rate for Payer: Healthfirst QHP |
$8.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.28
|
| Rate for Payer: SOMOS Essential |
$8.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$18.63
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$9.11
|
| Rate for Payer: United Healthcare Medicaid |
$8.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.28
|
|
|
GEMCITABINE HCL 2 GM/52.6ML IV SOLN [112788]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
00409018201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.03
|
|
|
GEMFIBROZIL 600 MG PO TABS [3378]
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
NDC 69097082103
|
| Hospital Charge Code |
69097082103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.22
|
| Rate for Payer: Aetna Government |
$1.22
|
| Rate for Payer: Brighton Health Commercial |
$1.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.58
|
|
|
GEMFIBROZIL 600 MG PO TABS [3378]
|
Facility
|
OP
|
$2.32
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
60687022411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.16
|
| Rate for Payer: Aetna Government |
$1.16
|
| Rate for Payer: Brighton Health Commercial |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.57
|
| Rate for Payer: Group Health Inc Commercial |
$1.16
|
| Rate for Payer: Group Health Inc Medicare |
$0.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.50
|
|
|
GEMFIBROZIL 600 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650688
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: 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: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
GEMFIBROZIL 600 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640688
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: 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: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
GENERAL ANESTHESIA EACH 15M
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS D9223
|
| Hospital Charge Code |
42303473
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$29,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$261.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.36
|
| Rate for Payer: Aetna Government |
$52.36
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$668.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$668.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$297.22
|
| Rate for Payer: Amida Care Medicaid |
$297.22
|
| Rate for Payer: Brighton Health Commercial |
$356.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$380.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$323.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$297.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$312.08
|
| Rate for Payer: Group Health Inc Commercial |
$237.50
|
| Rate for Payer: Group Health Inc Medicare |
$166.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.22
|
| Rate for Payer: Healthfirst Essential Plan |
$668.74
|
| Rate for Payer: Healthfirst QHP |
$297.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.22
|
| Rate for Payer: SOMOS Essential |
$668.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$668.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$326.94
|
| Rate for Payer: United Healthcare Medicaid |
$297.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$297.22
|
|
|
GENERAL ANESTHESIA EACH 15 MINS
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS D9223
|
| Hospital Charge Code |
42300753
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$29,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.36
|
| Rate for Payer: Aetna Government |
$52.36
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$668.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$668.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$297.22
|
| Rate for Payer: Amida Care Medicaid |
$297.22
|
| Rate for Payer: Brighton Health Commercial |
$142.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$297.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$312.08
|
| Rate for Payer: Group Health Inc Commercial |
$95.00
|
| Rate for Payer: Group Health Inc Medicare |
$66.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.22
|
| Rate for Payer: Healthfirst Essential Plan |
$668.74
|
| Rate for Payer: Healthfirst QHP |
$297.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.22
|
| Rate for Payer: SOMOS Essential |
$668.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$668.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$326.94
|
| Rate for Payer: United Healthcare Medicaid |
$297.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$297.22
|
|
|
GENERAL SCREW
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40207113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$60.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.50
|
| Rate for Payer: EmblemHealth Commercial |
$50.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.00
|
|
|
GENERAL SCREW
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40207113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
GENERATOR,NEUROSTIM, RECHG, SYS
|
Facility
|
OP
|
$36,000.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
40202500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,494.69 |
| Max. Negotiated Rate |
$37,800.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,800.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,494.69
|
| Rate for Payer: Aetna Government |
$2,494.69
|
| Rate for Payer: Brighton Health Commercial |
$21,600.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,700.00
|
| Rate for Payer: EmblemHealth Commercial |
$18,000.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$37,800.00
|
| Rate for Payer: Group Health Inc Commercial |
$18,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$12,600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,000.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,400.00
|
|
